As admissions for scarlet fever, whooping cough, scurvy, and other “Dickensian Era” diseases rise, medical laboratories must continue to consider uncommon causes when performing tests and providing data to physicians developing treatment plans

Resurgence in once-rare diseases and conditions in both the United Kingdom and the United States highlight the importance of recognizing the unlikely and unexpected when ordering and performing medical laboratory testing.

While a large portion of tests performed at clinical laboratories and anatomic pathology groups result in relatively common outcomes and diagnoses, recent coverage by CNN reported on increases in instances of “diseases more commonly associated with the Victorian Era.” They include:

CNN’s coverage cites 2017-2018 data from the UK National Health Service (NHS) in which diagnoses of scarlet fever and whooping cough saw a 208% and 59% increase in hospital visits related to the diseases respectively, when compared against data gathered from 2010 to 2011.

The Independent added to the list of older diseases making a comeback. They include:

Though they also noted that tuberculosis admissions appeared to be trending downward, the UK’s Labour Party requested increased NHS funding to suppress the growth of these diseases and provide better healthcare access to impoverished individuals and rural areas.

US Homelessness Is One Cause of Disease Recurrence

The US is dealing with its own wave of once-rare diseases re-emerging, thanks in part to growing populations of homeless.

Measles outbreaks continue to make headlines. Washington State declared a state of emergency in January because of increased cases, noted NPR. According to Education Dive, 11 states confirmed more than 200 cases of measles in January/February of this year, despite public health officials declaring the disease eradicated in 2000.

And, The Atlantic reported on struggles California faces managing a range of “medieval diseases” making a comeback in the face of growing homelessness and decreased access to healthcare. They include:

“It’s a public-health disaster,” Jeffrey Duchin, MD, Professor, Medicine: Allergy and Infectious Diseases at the University of Washington told The Atlantic. Duchin is also Adjunct Professor of Epidemiology and a health officer for Seattle and King County, Wash. In an article posted on Public Health Insider, Duchin noted that public homelessness is a factor in the spread of disease. “People who lack permanent housing often also have limited access to medical care, so many people living homeless and with health problems have difficulty getting prompt treatment. Living conditions—like crowding and fewer opportunities for personal hygiene—can contribute to the spread of disease. If someone has an underlying medical condition, alcohol or drug use, or weakened immune system, they are even more susceptible.” (Photo copyright: King County, Wash.)

Medical Labs Key to Diagnosis and Monitoring as Pathogen Landscape Changes

Clinical pathologists and medical laboratories should consider causes outside the common scope of today’s modern pathogens and look to more historical origins when working with diagnosticians.

UK coverage largely blames a lack in NHS funding as reason for the increase in these “vintage” diseases. However, there also has been regular news coverage of the staffing shortages of physicians, nurses, and other medical specialist at the NHS. This is a factor that makes determining the causes of these disease outbreaks even harder for NHS physicians seeking to diagnose patients and manage the spread of these uncommon diseases.

Should this trend continue, clinical laboratories and microbiology laboratories in the US and UK, will serve critical roles in detecting and preventing the spread of these deadly bacteria and viruses. Until then, all medical laboratories worldwide should watch for unlikely and unexpected diseases in patients as these instances continue to occur.

—Jon Stone

Related Information:

“Dickensian Diseases” Making a Comeback in the UK

“Victorian-Era” Diseases on the Rise in the UK, but Why?

“Dickensian” Disease on the Rise in the UK: Is Australia at Risk?

Huge Increase in “Victorian Diseases” Including Rickets, Scurvy and Scarlet Fever, NHS Data Reveals

Washington State Officials Declare State of Emergency as Measles Outbreak Continues

206 Measles Outbreaks across 11 States Leave Schools Grappling with Effects

Medieval Diseases Are Infecting California’s Homeless Shortage of Histopathologists in the United Kingdom Now Contributing to Record-Long Cancer-Treatment Waiting Times in England