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A RASH of deadly diseases that brought Victorian Britain to its knees are making a comeback in Wales.

Killer illnesses straight out of the pages of Charles Dickens like rickets, tuberculosis, scarlet fever, typhoid and whooping cough are all on the rise - and experts are putting it down to our modern lifestyles.

The rise of cheap package holidays to parts of the world where tuberculosis and typhoid are rife, combined with poor nutrition and outbreaks of flu, have paved the way for the return of some of history's most-feared diseases.

New figures from Public Health Wales (PHW) show cases of TB are at their highest level in more than a decade.

And measles cases more than quadrupled from 39 in 2008 to 158 in 2009.

Across Wales and England, scarlet fever cases rose by more than a thousand between 2008 and 2009, while cases of typhoid and whooping cough are at their worst levels in a decade, according to figures from the Health Protection Agency.

Dr Roland Salmon, head of the communicable disease surveillance centre for PHW, said the rise in cases of TB and typhoid could be linked to an increase in people travelling between countries, saying the majority of cases reported in Wales were picked up abroad and brought back to the country.

He said: "TB globally is an enormous resurgent phenomenon.

"The World Health Organisation (WHO) talk about nine or 10 million new cases in the world every year, while many millions more carry the virus in dormant form.

"There has been a modest rise in the UK and Wales since the 1990s, but I would stress it is still pretty rare."

He said outbreaks of infectious diseases, particularly recent outbreaks of TB in Swansea and the Rhondda, had reminded health officials to "be aware" of the problem.

"I would advise people that while cases of some of these diseases are rising, we are still talking about modest numbers," he added.

"I wouldn't underestimate the difficulties these kind of events can present, but TB at least remains a very rare disease and one you are not that likely to come across."

Meanwhile, Welsh health officials desperate to stop the spread of one crippling Victorian illness have set up a special project to teach parents about the importance of giving vitamins to children.

Rickets is caused by a lack of calcium and vitamin D - much of which comes from exposure to sunlight.

And it was the scourge of Victorian Britain, leaving thousands of children crippled for life.

Children living in city slums were most prone to the bonesoftening disease because thick smog stopped sunlight reaching their skin.

Experts say we need 15 minutes of exposure to sunlight during the summer - and more in the winter - to keep our vitamin D levels topped up.

Rickets was almost wiped out in the mid-20th century following public health campaigns that encouraged parents to give children cod liver oil, which is high in vitamin D, and other artificially fortified foods like margarine.

But these messages are now being forgotten and Welsh children are falling victim to the disease, which causes brittle bones and painful deformities like bowed legs.

Just last week, a report in the British Medical Journal blamed a recent rise in cases of the disease on children spending too much time indoors instead of playing outside.

Dietitian Sioned Quirke, who works in Rhondda Cynon Taf, said: "I find it absolutely amazing to think we have managed to get so far in the world of medicine that we almost wiped out a disease like rickets, only to find it return years later for completely different reasons. "It used to be known as something that happened in childhood because of malnutrition.

"In the past, malnutrition was perceived as happening when children didn't have enough to eat.

"Now it is happening for the opposite reason - because the quality, not the amount, of food given to children by their parents is so poor.

"We give advice every day to parents about this."

The problem is so bad, the Assembly Government has launched an 18-month pilot project aimed at increasing the uptake of vitamins in Wales' children.

The Deputy Chief Medical Officer for Wales, Dr Jane Wilkinson, said: "Health professionals have expressed concern over the increase in the number of cases of vitamin D deficiency in certain areas in Wales.

"In an effort to address this, we launched an 18-month pilot project in Cardiff in April 2010 to explore different options to increase the uptake of Healthy Start multivitamins to underfours and breastfeeding and pregnant women.

"Initial feedback is that this pilot has increased the take-up of vitamins," she added.

"When the pilot finishes, we will evaluate the project to determine how best to increase the take-up of these vitamins across Wales."

Dr Wilkinson said: "Most of our vitamin D comes from the effects of sunlight on our skin and regular short periods in the sun are enough for most people.

"Only a small proportion of vitamin D comes from food, even with a healthy balanced diet.

"Those most at risk of vitamin D deficiency are pregnant and breastfeeding women, young children under five, and people not exposed to much sun and who cover their skin for cultural reasons."

THE DISEASES MAKING A COMEBACK TUBERCULOSIS: Known as consumption or white death, TB was responsible for hundreds of thousands of deaths in Victorian Britain, especially in crowded cities, where the deadly airborne organism moved swiftly from one person to another.

It was not until 1946, and the development of an antibiotic that successfully treated TB, that cases in the UK began to drop dramatically from 117,000 per year in 1913 to around 5,000 in 1987 - although to this day TB-related deaths remain high in the world's developing countries.

However, the deadly infection is back on the rise in the UK as is the number of cases of drug-resistant TB.

In 2009 there were 9,000 cases of TB - the highest for nearly 30 years.

RICKETS: The bone disease was widespread in Victorian Britain where children living in smoggy cities did not get enough exposure to sunlight and suffered from malnutrition.

In the early 20th century, a link was found between rickets - which weakens bones and can cause deformity - and vitamin D deficiency, and doctors started using ultra-violet lights to treat their patients.

By 1940 the disease was all but eradicated in the UK because of the introduction of vitamin D-fortified foods like margarine.

But last week, two professors at the University of Newcastle warned modern lifestyles - in which children spend more time indoors and away from sunlight - have led to a rise in the disease.

MEASLES &MUMPS: Epidemics of the highly contagious measles virus were common and particularly lethal in Victorian Britain and throughout much of the 20th century.

Outbreaks in 1863 and 1874 proved especially deadly, and those victims who did not die were often left blind or deaf.

Measles remained a common virus until the 1960s, when a vaccine was developed, which eventually became the combined MMR (measles-mumps-rubella) jab.

In 1986, Cardiff-born writer Roald Dahl wrote an impassioned plea supporting the vaccine - his seven-year-old daughter Olivia had died of measles in 1962, before a vaccination was available.

The MMR jab lost favour in the 1990s after it was linked - through notorious research which has now been widely discredited - to autism, leading to a spike in cases of measles and mumps.

SCARLET FEVER: For a long time the highly contagious and deadly disease was thought to be a variation of measles.

In Victorian times, it claimed thousands of lives, especially among young children who were less likely to have developed immunity to the airborne infection.

It was not until the discovery of bacteria and, later, the invention of antibiotics like penicillin that an effective treatment was finally found.

Latest figures saw an increase in cases of the disease in Wales and England, which is typically at its highest levels following a busy flu season.

Fortunately, scarlet fever is now easily treatable with antibiotics and most children recover after four or five days.

TYPHOID: Typhoid is a serious and fatal bacterial infection passed from person to person through contaminated food and water.

In Victorian times the mortality rate from typhoid was huge, with outbreaks claiming thousands of lives. In 1880, the bacteria that causes typhoid was discovered and in 1890 an effective vaccine was developed.

But in the early 20th century the disease was still claiming hundreds of lives. In 1905, contamination of the water supply to Lincoln led to a typhoid epidemic which killed more than 60 people.

Rates dropped with the introduction of antibiotics, but typhoid still kills 600,000 people worldwide each year.

Experts have linked a recent increase in UK cases of typhoid to the popularity of package holidays to affected countries.


Dr Roland Salmon Life was tough in Dickens' day - as Oliver Twist knew only too well
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Publication:Wales On Sunday (Cardiff, Wales)
Geographic Code:4EUUK
Date:Jan 30, 2011
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