The number of TB cases in the Republic each year remains steady at, or just under, 400. Most will be diagnosed and receive initial treatment in an acute hospital, with follow-up by their GP and in the out-patient department for a further six months, writes Muiris Houston
However, a significant minority of those prone to TB require in-patient treatment for at least eight weeks in a specialist unit such as Peamount Hospital.
Because of personal and social factors, these patients cannot comply with complex multiple therapy and follow-up tests without hospital admission. Without such facilities, these people are at high risk of developing multi-drug-resistant TB (MDRTB), with the added danger of passing on this highly virulent form of the disease to others.
However, with the entry of the 10 accession states to the EU on May 1st, the risk to public health from TB in the Republic is set to increase. Latvia, Lithuania and Estonia have TB incidence rates up to eight times that of Ireland. They also have a higher percentage of cases of multi-drug-resistant TB, which takes longer to treat and requires much more expensive drugs to eradicate than ordinary TB.
A senior medical source told The Irish Times that the decision to phase out the TB unit will remove "an essential safety net and an essential national resource" in the fight against TB.
"It is the only place with a good record of treating those patients who cannot manage self-treatment," the source said, adding that without Peamount the danger of higher rates of multi-drug-resistant TB in the Republic was now "very real".
Yesterday the EU surveillance agency for infectious disease reported the first large outbreak of MDRTB in the Netherlands. It said that a TB patient from eastern Europe had infected six Dutch nationals and recommended that TB control in the Netherlands be strengthened.
According to the World Health Organisation (WHO), the prevalence of multi-drug-resistant TB is "exceptionally high" in the former countries of the Soviet Union, including Estonia, Latvia and Lithuania. Drug resistance in new patients is as high as 12 per cent in Estonia, it said. It also called for increased investment in TB prevention programmes.
The decision of the board of Peamount Hospital to terminate from next Monday the employment of Prof Luke Clancy, its medical director and a world expert on TB, was unexpected. But it is clear from the hospital's strategic plan, published in 2003, that it did not wish to pursue what it termed a "chest hospital option".
This would have involved Peamount providing a broad TB and non-TB respiratory service as part of a joint arrangement with St James's Hospital. Instead, it made clear its wish to develop other services, for the intellectually disabled, chronically sick young people and continuing care for older people.
In its five-year strategy the hospital states: "A transition plan for the chest hospital will be developed, outlining exactly what will happen to Peamount TB and non-TB respiratory services."
This was to have been completed by December 2003, but, according to a spokesman, "There are no dates at present. We are in the process of consulting with the ERHA, our funder, as to the time frame".
Peamount says it wishes to terminate Prof Clancy's appointment because the position of medical director "will be redundant", but it is unclear why it has made such a move in the absence of an agreed time frame for the transition of TB and other respiratory services.
While remaining staff will continue to provide the highest level of care, they will do so in the unique circumstance of having no consultant specialist to take medical responsibility for that care.