A NEW drive to tackle tuberculosis is being launched amid concern that around one in ten patients who catch it die from the disease.
Levels of the illness, often associated with slum-dwelling in the Victorian era, have dramatically reduced but it has never been wiped out completely.
More than 400 cases were recorded by doctors in Scotland in 2012 and 45 people died from TB the same year.
Now experts have agreed to try to stop the infection spreading on a number of fronts with the aim of meeting an international target to eradicate TB by 2050.
The plan includes offering a blood test to people moving to Scotland from countries where TB is more common to establish if they are carrying the bacteria, which can lie latent for decades without causing illness.
However, many of those who develop symptoms are men over the age of 50 who are suffering from addictions or homelessness, and this group will have to be tackled too. The latest figures show almost 44% of Scottish sufferers were born in the UK.
Dr Duncan McCormick, senior medical officer for the Scottish Government, said: "We did very well with TB. There was a decline from the 1850s right down to the 1980s. But then, five years ago, it began to creep up.
"That has begun to flatten out again, but if we start getting reassured with TB that it is all over, we will find it will come back again. If we want to eliminate it by 2050, we have to be watching it constantly."
Levels of TB in Scotland are relatively low compared to other parts of Europe, but Dr McCormick said a higher proportion of our cases are among local, often deprived people rather than those who have arrived from higher-risk areas such as parts of sub-Saharan Africa and South Asia.
The proportion of Scottish patients who stick to the treatment regime is also behind the European target, standing at 75 per cent rather than 85 per cent, and the death rate from TB in Scotland of 9.9 per cent is double the UK average.
Dr McCormick said: "We have more of our patients who are already sick, they maybe have heart disease, hepatitis B, liver disease and are malnourished. These people are much more difficult when it comes to completing treatment."
Scotland's National TB Network is now monitoring new approaches to tackling TB among this deprived group which are being tried in other countries.
These include taking X-ray machines to homeless shelters to screen people for the illness and training non-NHS professionals such as charity workers to help patients keep taking TB medication. To kill the bacteria patients have to take antibiotics for six or 12 months and there can be unpleasant side effects such as nausea, making follow-up care important.
Links are being developed with services and charities which work with the community affected.
The Scottish Government has allocated £20,000 for research which will in part be used to look at why patients delay seeking help with symptoms.
Mike Mandelbaum, chief executive of charity TB Alert, said: "The key to tackling TB is to treat it as early as possible, which helps prevent patients passing on the infection to others.
"TB is usually found among people who are not well connected to health services, such as homeless people or those who recently moved to the UK from countries with higher levels of TB.
"The best way to reach these people is to work closely with homeless shelters, voluntary organisations and local government departments who can bridge the gap between communities and health services."