## Required Packages

library(tbinenglanddataclean)
## Registered S3 methods overwritten by 'ggplot2':
##   method         from
##   [.quosures     rlang
##   c.quosures     rlang
##   print.quosures rlang
library(kableExtra)
library(rlang)
library(ggplot2)

### TB Interventions

A timeline of interventions against TB. Antibiotics used to treat TB are commonly given together, with those with the fewest side effects given first. Second line antibiotics are then used if the initial treatment fails or tests show the strain is multiply drug resistant. BCG - Bacillus Calmette–Guérin; TB – Tuberculosis; MRSA - Methicillin-resistant Staphylococcus aureus; DOTS - Directly Observed Treatment Short-course
Year Intervention Type Line Detail
1921 BCG Vaccination The first use of the Bacillus Calmette–Guerin (BCG) vaccine in humans, it remains the only vaccine against Tuberculosis (TB). Efficacy has been shown to vary depending on latitude and there is only strong evidence of protection for 10-15 years after vaccination.
1944 Streptomycin Antibiotic Second The first antibiotic and the first bacterial agent against TB.
1944 4-Aminosalicylic acid Antibiotic Second The second antiobiotic to be developed. Due to lower potency than other antibiotics it is not considered a first line treatment.
1952 Isoniazid Antibiotic First Used against both active and latent TB, it may also be given as a prophylatic therapy.
1952 Cycloserine Antibiotic Second An antibiotic with severe side effects such as kidney failure and neurological conditions, which is therefore restricted for use against multiple drug resistant TB.
1952 Pyrazinamide Antibiotic First Discovered in 1936, it was first used against TB in 1952. Although showing no effect in-vitro it was shown to be effective in treating TB in mice. Used only for treating TB and never on its own.
1953 School age BCG Vaccination After a successful trial which showed high effectiveness for the vaccine, BCG was introduced in the UK for those at school leaving age as peak incidence was then in young, working adults.
1962 Ethambutol Antibiotic First Believed to work by interfering with TB bacteria’s metabolism. There are some concerns that it may not be safe to give during pregancy, as it may lead to vision loss in the baby.
1971 Rifampicin Antibiotic First Taken daily for at least a period of 6 months, if given alone resistance develops quickly. It may also be used in the treatment of MRSA amongst other diseases.
1995 DOTS Strategy Directly Observed Treatment, Short-Course (DOTS) is introdued by the World Health Organization as a control strategy for TB. The intermittent, supervised system aims to eliminate drug default.
2005 Neonatal high risk BCG Vaccination Due to a continued decline in TB incidence rates in the indigenous UK population, the BCG programme was refocused as risk-based. This meant vaccinating high risk neonates rather than those most likely to transmit TB.
2012 Bedaquiline Antibiotic Second The first new antiobiotic for use against TB in 40 years, reserved for use against multiple drug resistant TB. Approved via a fast track process, higher mortality in those that recieve the antibiotic has caused significant concern.