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7. Re-emergent diseases

Matter for discussion submitted by the RCN Public Health Forum

That this meeting of RCN Congress discusses the re-emergence of diseases, such as tuberculosis, and the contribution nursing can make to reducing them

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Progress reports

Submitted by: Public Health Forum
Council lead and committee assigned: None
Committee decision: Existing work addresses this issue
Members involved: Members of the RCN Public Health Forum

Final summary update at May 2012

This discussion focused on the alarming rise in the re-emergence of diseases, in particular tuberculosis (TB). It was noted that London has the highest TB rate of any capital city in Western Europe.

This was a matter for discussion, and did not call for any specific action by the RCN. However, the organisation is already undertaking work in this area.

A key strand of RCN work is bringing TB nurses into the wider public health work streams and reinforcing their role within the frontline public health nursing workforce. The RCN also highlighted the importance of TB nurses in its response to the Government’s public health white paper Healthy lives, healthy people.

In addition, the RCN has recently released an RCN publication for TB case management with DH funding.

The RCN Public Health Forum also held a conference in February, open to the public health nursing workforce, which included a masterclass on TB nursing. Presented by an expert on the disease, the session looked at proactive treatment, especially within the London area.

Update at November 2011

The RCN has noted the concerning rise in TB cases as the increase in numbers of TB cases seen over the last 20 years continued in 2009, with a 4.2% rise.  This gives an overall rate of 15 cases per 100,000 population in the UK and a rate of 44.4 per 100,000 in London - the highest TB rate of any capital city in Western Europe.

A key strand of RCN work is drawing TB nurses into the wider public health work streams and reinforcing their role within the front line public health nursing workforce.

Public health has been rising within the political agenda with the publication of the Government’s Public Health White Paper Healthy lives, healthy people. The RCN has responded to this document.

The RCN has also submitted written evidence to the Health Select Committee Inquiry into Public Health.

In response to this political agenda, the RCN Public Health forum agreed two key large pieces of work at their annual strategy meeting. 

The first will be a conference to draw together the depth and breadth of the public health nursing workforce, as well as providing clinical updates to satisfy specialist nurses.  The conference will be held on 17 February 2012.

The second will be an RCN publication showcasing the public health nursing workforce to commissioners. 

Both of these pieces of work will have the outcome of highlighting the important work of TB nurses whilst drawing them into and encompassing their work as part of the wider workforce of public health.

Debate report

Malcolm Cocksedge, Senior TB Nurse Specialist and committee member of the RCN Public Health Forum led the discussion on the re-emergence of diseases, such as tuberculosis.  He said that TB infection has increased dramatically in recent years. There are now approximately 9,000 cases in the UK, of which half are in London. Malcolm spoke of the lack of public understanding on how TB is spreading, as they wrongly blame immigration rather than better transport links.

Malcolm said that nurses are crucial in the prevention, diagnosis and treatment of diseases but are not given enough education and guidance. He added that their skills are vital in developing successful strategies and a multi-disciplinary approach devoid of organisational and geographical boundaries. Education of the public is also vital to tackle misconceptions about the spread of diseases.

Kelvin Karim, South Yorkshire branch said, “We don’t have the resources to bring TB care and prevention services into the 21st Century”.

Sandra Grieve, Chair of the RCN Public Health Forum, also blamed travel for the spread of diseases, most importantly the re-emergence of measles. The EU is the most popular travel destination for UK travelers, and cases of measles are very high in some EU countries. 


The UK media has highlighted the unexpected rise in tuberculosis (TB) cases, and the re-emergence of conditions such as rickets which paediatricians have recently reported seeing for the first time in their medical careers.

In the developing world TB is a major killer, and in the European region alone the World Health Organization (WHO) estimates that TB causes 49 new cases and kills seven people every hour. WHO recommends that particular attention should be paid to vulnerable and poor communities and that to improve access to TB diagnosis and treatment the focus should be on developing collaboration between all health care sectors and the integration of TB control into primary health care services.

In 2006 a total of 8,497 cases of TB were reported in the UK – 40% of which occurred in London - and the steady growth in TB case numbers since the 1990s has resulted in action within all four UK countries. The RCN has been involved with many of these country specific TB initiatives.

In England the Chief Medical Officer published Getting ahead of the curve, stopping tuberculosis in England (2004), while NHS England produced Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high quality services in England (Department of Health, 2007a; Department of Health, 2007b). In response to the current Department of Health (England) consultation on proposals to change its current health arrangements the RCN has highlighted the need to protect public health funding and invest in public health teams, which should include public health specialist nurses.

Since 2005 there has been a continued increase in the number of TB cases in Scotland, and in 2009 the Scottish enhanced surveillance of mycobacterial infections scheme received 487 provisional notifications of TB – up 9.4 per cent on the previous year.

In Wales TB is a primary re-emerging illness. The Welsh Assembly Government provides advice on TB via the national public health service, and local health boards are funded and encouraged to arrange BCG vaccination services that ensure high uptakes in children from ethnic groups where TB rates are high. In May 2009 a cluster of new measles cases occurred in Wales following reluctance by parents to allow their children to have MMR vaccinations. A publicity campaign to highlight the benefits of the MMR vaccine resulted in an increase in uptake by December 2009.

The Northern Ireland Public Health Agency is very aware of the potential problem of re-emerging diseases and the issues presented by living in a global village. The agency engages in horizon scanning to prevent and prepare for any problems as they arise. There has been one case of multi-drug resistant TB in NI. Other priorities for the agency include a focus on maintaining the childhood immunisation programme (childhood immunisation rates are high in NI compared to elsewhere in the UK) and other programmes such as the seasonal flu vaccination programme.

The re-emergence of diseases and conditions such as TB and rickets demonstrates it should never be assumed that diseases are eradicated, and governments must not become complacent about public health or the need for disease prevention strategies.

Nurses are well placed to contribute to public health initiatives, including the management of TB. For example, one UK nurse runs a successful project with the International Council of Nurses (ICN) to train nurses to respond to the challenges of TB and multi-drug resistant TB.

References and further reading

Department of Health (2007a) PL/CMO/2007/7: TB:Toolkit for planning, commissioning  and delivering high-quality services in England, London: DH. Available at: www.dh.gov.uk (accessed 3/2/11) (Web).

Department of Health (2007b) PL/CNO/2007/5: TB:Toolkit for planning, commissioning  and delivering high-quality services in England, London: DH. Available at: www.dh.gov.uk (accessed 3/2/11) (Web).

Department of Health (2004) Stopping tuberculosis in England: an action plan from the Chief Medical Officer, London: DH. Available at: www.dh.gov.uk (accessed 3/2/11) (Web).

Health Protection Scotland (2010) Enhanced surveillance of mycobacterial infections (ESMI) in Scotland: 2010 tuberculosis annual report for Scotland, Glasgow: HPS. Available at: www.hps.scot.nhs.uk/resp/wrdetail.aspx?id=46572&wrtype=6 (accessed 3/2/11) (Web).

World Health Organization (no date) The stop TB strategy, Geneva: WHO. Available at: www.who.int/tb/strategy/en (accessed 3/2/11) (Web).