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Malta and tuberculosis

Tuberculosis has certainly not re-emerged in Malta - simply because TB had never quite left us in the first place. Unfortunately, doctors still continue to see about 10 to 20 new TB cases in Maltese-born patients every year.

Dr Anthony Lanfranco's contribution to the control of tuberculosis will never be forgotten. However tuberculosis has never been eradicated from Malta; by definition that would mean having less than one case per million of the population.

TB in Malta has undoubtedly been reduced to very low levels and we are considered as a low incidence country (less than 20 cases per 100,000 per year). Despite the recent increases in TB cases these last years, Malta is still considered as having one of the lowest incidences of this infection in Europe and in the world. All health care workers should be proud of this.

Dr Lanfranco was certainly someone to be admired, but I suspect that he would have wanted us to remember the dedicated work of so many other professionals working in the field including physicians, bronchoscopists, consultants, nurses, radiographers, physiotherapists, microbiologists, lab technicians, pharmacists, surgeons and other public health officials who risked their own health and safety to help others.

For the last 10 years in the West, increasing emphasis is placed on tracing latent TB infection (dormant TB) and treating it to prevent activation. The active disease state is not only very often fatal for the patient but poses a public health risk.

The discovery of increasing numbers of TB and multi-drug resistant TB (MDR-TB) in foreign-born individuals is very worrying. It is neither their fault nor ours. It is a problem that must be tackled with determination and without delay, or else we risk spread into the Maltese population. Then all the suffering, sacrifice, and work of the last 60 years would have been in vain. So far this has not been the case.

It is quite right to say that increasing incidence of TB and MDR-TB can be the result of a poorly managed and under-funded national TB programme. This situation has arisen, past and present, in various regions such as the US, Europe and Africa. MDR-TB also existed, in the past, in the Maltese, when TB was treated with single-drug regimes and before the advent of the multi-drug regimes we have today.

Nowadays, it is well accepted by the World Health Organisation, that there is no need to confine these patients to an isolation ward for six to 12 months just to observe them swallow their tablets. These patients can very often be managed at an out-patients clinic and compliance to treatment ensured by their own family or a visiting MMDNA nurse (to whom we should be grateful). This has been standard procedure for at least 20 years now and has worked very well.

If patients are unco-operative and refuse supervised drug treatment thus resulting in a grave risk to the community, the competent authorities should, only then, consider forceful confinement. Indeed there is a provision for this drastic public health measure in Maltese law.

Today the TB situation in Malta appears to be manageable, but unfortunately many strongly believe that the TB problem will continue to escalate and further co-ordinated measures will have to be taken quite soon.

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