Cases linked to a tuberculosis (TB) outbreak linked to a pub in a Welsh village still occur more than a decade later. A recent report on the TB outbreak, which saw dozens of cases since 2010 in Lwinhand, described the initial response as “inadequate”.

The report, chaired by Professor Mike Morgan, former National Clinical Director of Respiratory Diseases for NHS England, identified four phases of the outbreak between 2010 and 2022. According to the report, the outbreak first occurred in Lwinhand when a 71-year-old patient contracted the disease after visiting a pub in the village.

The report, produced in conjunction with the Hywel Dda health council and the Public Health of Wales (PHW), said it was identified in 2010 and had been highly contagious for a long period of time due to delays in diagnosis.

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As a result of the initial “inadequate” response to the outbreak, infected people went undetected and developed active disease, transmitting the infection to others. In 2018, a woman died in an outbreak, but it wasn’t until 2019 that the outbreak was “formally discussed at council level” between Hywel Dda and PHW following media interest, a community screening program and a written complaint to the PHW.

The report also found that, at the start of the outbreak, there was no designated TB consultant or TB nurse to lead disease-specific services, and the outbreak control team was prematurely terminated and had to reopen three more times. more cases are reported, including a fatal case of the disease.

In 2019, dozens of people believed to have been exposed in Lwinhendi district were forced to attend tuberculosis screening sessions. Speaking to WalesOnline at the time, the woman, who declined to be identified, said she had a relative in the Llanelli area who had tuberculosis and said the screening program had been in place for a long time.

The report found that the initial focus of the outbreak was “very random” and public health officials did not believe that the spread of tuberculosis was “likely to become as severe as before”. It also identified shortcomings in contact tracing, stating: “Infected people were unrecognized and developed active disease, passing the infection on to others.”

Professor Morgan also found that understaffing in local offices contributed to the inadequate response. Reports noted that only in 2014, when Dr. Llywellyn Jones was appointed as the lead physician overseeing the outbreak response, “there has been a significant improvement in the care of TB patients and their contacts”.

However, Professor Morgan’s report warned that the initial outbreak “now continues to cause concern” and could be “a source of future outbreaks”. An estimated 31 cases of active TB and 300 cases of latent TB were associated with the first outbreak in Lwinhand in 2010.

Since then, in response, 663 personal contacts have been traced and a community-based screening program has been undertaken, testing 1,950 people and finding a “surprisingly” high rate of TB infection, particularly those who have had “historical” contact with the pub. The report added: “While we cannot be certain that the high level of TB infection in the community is wholly attributable to the outbreak, it does mean that there is a high risk of an outbreak in the community in the future.”

Tuberculosis cases with a known link to a local tavern in Lwinhand continued to be detected until July 2020 for active cases and until April 2022 for the last latent case, according to the report.

What is Tuberculosis?

Tuberculosis is a bacterial infection that spreads through inhaling droplets when an infected person coughs or sneezes.

The disease is usually found in the lungs, but it can also affect other parts of the body.

The most common symptom of tuberculosis is a persistent cough that lasts for more than three weeks and brings up blood, which can sometimes be smeared with blood.

Public Health Wales has listed the following main symptoms:

  • A cough that lasts three weeks or more and gets worse
  • Fever or high temperature
  • Profuse sweating at night.
  • unexplained weight loss
  • Fatigue
  • loss of appetite
  • coughing up blood

Professor Fu-Meng Khaw, National Director of Health Services and Screening and Medical Director of Public Health Wales, said: “Health Wales extends our deepest condolences to all those affected by the outbreak of tuberculosis (TB) in Wales. . community of Llwynhendy, Carmarthenshire since 2010.

“As an NHS organisation, we take our responsibility to protect the health of people in Wales very seriously, which is why this independent external review has been commissioned to ensure that we learn the lessons of this outbreak and take action to ensure that we do changes and improvements. . We fully accept the recommendations of this review.

“Although the analysis found that public health management improved significantly in the later stages of the outbreak, it is clear that the initial response was unsatisfactory and that our contact tracing and management of the outbreak team could have been better. We sincerely apologize to everyone who may have been affected.

“Managing such a complex TB outbreak is challenging due to the complex social networks and often long timeframes involved, but we want to assure the public that we have taken into account the lessons highlighted in the review and have made significant improvements to the way we address such issues. outbreaks.

“Public Health Wales and the Hywel Dda University Health Board would like to assure the public that lessons have been learned and that we have published a comprehensive action plan to implement the review recommendations. This includes a commitment to take steps to raise awareness among the public and health professionals to reduce the risk of future outbreaks; implement specific processes for TB control to ensure rapid identification of links between cases; and agreeing with the Welsh Government a TB strategy and delivery plan to reduce the incidence of TB in Wales.

“We also remind people that this outbreak is not over. We are calling on the 470 people who received a letter and were invited to take the test, but have not yet responded to the invitation, to volunteer.”

Professor Philip Kloer, Chief Medical Officer and Deputy CEO of the Hywel Dda University Health Board, said: “We are aware of the impact of this outbreak on the community of Llwynhendy and on behalf of the Hywel Dda University Health Board Dda I would like to express my condolences. to all who suffered

“The Hywel Dda University Board of Health fully accepts the recommendations of the review and is committed to implementing our action plan to develop our local TB service for both the current outbreak and any future outbreaks.

“I would like to thank Professor Mike Morgan and his team for their work on this report, which contains important, independent recommendations to ensure future TB outbreaks are mitigated.

“The health department has already invested and improved the TB service and this will be reviewed to meet the needs of the local population.

“This outbreak is not over and we reiterate our appeal to those who have been invited for screening but have not yet attended to do so as soon as possible and to encourage continued public awareness of TB and its symptoms.”

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