Just one Dublin bed for drug-resistant TB patients

There is only one bed in Dublin for the treatment of multidrug-resistant TB, and this also has to be available for potential avian flu or Sars patients, a TB expert told the Oireachtas Health Committee yesterday.

Dr Tim McDonnell, consultant respiratory physician at St Vincent's hospital, said this was "a very serious lack" as patients with resistant TB needed particular isolation facilities.

He said multidrug-resistant TB accounted for less than 1 per cent of cases in this State, but the rate was much higher in countries such as Estonia, Lithuania and Latvia. Some 8 per cent of cases in the UK were now resistant to one of the two main drugs used to treat TB.

Dr McDonnell said multidrug- resistant TB was "especially feared" as 50 per cent of patients could die from it. Drug-resistant TB also needed prolonged treatment, up to 18 months in some cases.

He warned that the incidence of TB may rise with increased movement between countries and because many of our immigrants were coming from countries with a higher incidence than our own. The UK and other EU states had seen "a significant increase" in TB rates recently.

There was "a historical disorganisation" of the management of TB in the Republic. A national laboratory to identify TB specimens had been sanctioned for St James's Hospital but there was no funding to provide it.

Plans for a 15-bed TB unit at the hospital had been drawn up last July, but funding was still not available to run it.

Saying there were no cases of TB in large tracts of the US, Dr McDonnell said "it should be feasible to do a much better job" than is currently being done to eliminate TB on this small island.

He said there was also a grave shortage of respiratory physicians and public-health resources, such as specialised TB nurses.

He also questioned the administration of the BCG vaccine in this State. It protects babies against TB meningitis but many doctors believe it is not necessary and not all regions give the vaccine.

He said he, and many other doctors, did not believe it was a very effective vaccine as the best results found that the vaccine did not protect 20 per cent of people. Dr McDonnell also questioned recent reports about a cluster of TB cases in two pubs in north Dublin. He could find no data to support the report, and he was not aware of public-health doctors being involved in screening at pubs in north Dublin.

Meanwhile, Dr Joseph Keane, consultant respiratory physician at St James's Hospital, said there was a case to be made for screening immigrants shortly after they arrive in this State.

He pointed to the US approach where widespread testing was picking up latent TB before it appeared.

However, while immigrants were being blamed for spreading TB in this State, Dr McDonnell said relatively few of our patients with TB were foreign-born compared with other EU states.

"Most of the cases are in the indigenous population," he said.

This was a throwback to our past, and we had never managed to satisfactorily clear up the problem.

The number of TB cases has fallen from almost 7,000 in 1952 to 400 a year at present.

This decline had slowed down lately, both nationally and in the greater Dublin area.