Nora Owen
Ceist:4 Mrs. Owen asked the Minister for Health the number of cases of TB which have been diagnosed in 1990, 1991 and to date in 1992; and if he will make a statement on the purported increased incidence of this disease.
Ceisteanna—Questions. Oral Answers. - Tuberculosis Incidence Increase.
Pat Rabbitte
Ceist:37 Mr. Rabbitte asked the Minister for Health the steps, if any, which are being taken to identify the reasons for the resurgence in the level of tuberculosis, and particularly the reasons the incidence of the disease is twice the level found in Northern Ireland; and if he will make a statement on the matter.
I propose to take Questions Nos. 4 and 37 together.
There has been an increase in the incidence of tuberculosis throughout the world including western countries such as Ireland.
I have instructed the Chief Medical Officer of my Department to conduct a thorough review of the issue. He is, at present, consulting various experts in the field and will report to me at an early date.
Care should be taken when comparing the absolute prevalence of the disease in this country with that of other countries or indeed with Northern Ireland. There are diverging methods between countries of compiling statistical data on this disease. What is significant is that a number of countries are reporting an increase in the incidence of the disease.
The numbers of cases reported to my Department in 1990 was 624, while in 1991, 630 cases were reported.
I look forward to the challenge that my new portfolio offers here this afternoon for the first time on Priority Questions.
Is the Minister aware of the extreme concern that has been expressed in recent times at the increase in tuberculosis which the Minister will recall was tackled by the first interparliamentary Government in this country under Deputy Noel Browne? Is he aware that it has been referred to as the greatest killer on earth with one thousand million beings in two centuries dying from this disease? Arising from the statistics the Minister has given us, would he tell us how many deaths occurred in 1990 and 1991 and what are the trends for 1992 showing?
First, let me publicly congratulate Deputy Nora Owen. I look forward to having her bombard me with questions.
We have no figures on the deaths from TB, I must confess. I am very conscious of tuberculosis and the scourge it has been. I suffered in my own family and was a victim of it myself. I am very conscious of it and the problems that would be created by it.
The new cases of TB occurring each year fell from 1,933 in 1965 to 534 in 1988 but then it increased to 624 in 1990. This gives an overall incidence of it of 17 per 100,000 of which over 80 per cent or 14.6 per 100,000 is pulmonary tuberculosis. The incidence rate of pulmonary tuberculosis in other countries such as the United Kingdom, the Netherlands, Norway, Sweden and Denmark ranges between six and ten per 100,000 and Spain has a rate of 20 per 100,000. There are countries such as Turkey and other countries in eastern Europe which have much higher rates. The issues requiring attention in relation to tuberculosis are the role of BCG in the prevention and control of it — unfortunately there has been quite a lapse in the uptake by parents of immunisation of children with BCG; the refining of the system of reporting and the surveillance of TB under the infectious diseases regulations; and the determination of the most appropriate service structure to deal with TB cases as between hospital and primary care service. There is also the problem of contact tracing and the administration of prophylaxis and of course the emerging problem of HIV and Aids and its relationship to TB. There was a recently published survey in the Eastern Health Board showing that 7 per cent of patients reported as having tuberculosis in 1990 were known to be HIV positive.
I thank the Minister for that long reply. Is the Minister telling me that he does not know how many people have died from tuberculosis in the last few years in this country? I find that hard to understand. Perhaps if he has not got the information today he could undertake to let me have it. Is the Minister proposing, in running a campaign, to encourage an increase in BCG vaccinations lest this be found to be one of the reasons for the increased incidence of TB? Finally, can the Minister give this House any explanation for the increases since 1988? Would he perhaps agree with me that it has something to do with bad housing, lack of good housing for our people and also perhaps, as we see from the Land Registry office, some of the building materials and the type of building structures where people have to work?
We do not know, and indeed many countries do not know, why the disease suddenly increases. We have a higher standard of living now than we had in the forties and fifties. I have been seeking the chief medical officer's views on this and, in the case of the Land Registry, it occurred to me that there are old files down there with which people with tuberculosis have worked for many years. It is difficult to know the reason for the sudden increase in the last two years. I have asked them to look at this whole issue very urgently. I understand that there was a meeting between the Department of Health and the health boards' medical officers of health and a further meeting is to be held in two days time on it to make further progress towards developing a coherent national strategy to deal with that problem. I will be glad to let the Deputy have a report on it as soon as it becomes available.
Does the Minister know the number of deaths?
I do not, but as soon as I get the number I will let the Deputy know.