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TB rates in UK among highest in Western Europe

Last year 8,751 tuberculosis (TB) cases were reported in the UK, slightly lower than the 8,963 cases reported in 2011, Public Health England’s annual “TB in the UK: 2013 report” shows.

Rates of TB have stabilised at around 14 cases per 100,000 since the mid-2000s, following the increase in incidence seen in the previous two decades. However, despite considerable efforts to improve prevention, treatment and control, TB incidence in the UK remains high compared to most other Western European countries.

London retained the main burden of infection in 2012, with 3,426 cases accounting for almost 40 per cent of the UK total, followed by the West Midlands with 12 per cent.

Country of origin was recorded in 96 per cent of new TB cases. As in previous years, almost three quarters of cases were in people born in countries where TB is more common.  Of those born abroad, the majority of cases were from South Asia (60 per cent) and sub-Saharan Africa (22 per cent).

In the UK-born population, those most at risk remain individuals from ethnic minority groups, those with social risk factors such as a history of homelessness, imprisonment or problem use of drugs or alcohol, and the elderly.

Dr Lucy Thomas, head of TB Surveillance for PHE, said: “TB is a preventable and treatable condition, but, if left untreated, can be life threatening. Efforts to control the spread of this infection must remain a public health priority. Early diagnosis and appropriate treatment are key to reducing TB levels in the UK and local health service commissioners must prioritise the delivery of appropriate clinical and public health services for TB, especially in areas where TB rates are highest.

“To reduce the risk of active TB disease in people coming to the UK from high incidence countries, it is essential that new migrants have good access to screening and diagnostic services. Ensuring that NICE recommendations on screening for latent TB infection are implemented in a coordinated manner across the country is therefore very important.”

Drug resistance to TB treatment remains a problem, although the proportion of TB cases showing resistance to the first line antibiotic isoniazid decreased slightly to 6.8 per cent of cases in 2012.  The proportion of multi-drug resistant (MDR) TB cases remained stable at 1.6 per cent (81 cases).

Most MDR TB cases (89 per cent) occurred in those born outside the UK. Two cases of extensively drug resistant (XDR) TB were reported in 2012, compared with six in 2011, taking the total to 26 laboratory-confirmed XDR cases in the UK since 1995.

Dr Paul Cosford, Director for Health Protection and Medical Director at PHE, said: “TB remains a critical public health problem, particularly in parts of London and among people from vulnerable communities. Given current trends, within two years we are likely to have more new cases of TB each year in the UK than in the whole of the United States. We have therefore made TB one of the key priorities for PHE and are working with key partners to oversee the development of a stronger national approach to TB control. We will announce the details of this approach in the Autumn.

“This will have at its heart support to local clinical, preventive and social care services in the NHS, local government and wider health and social care system. We are determined to see a sustained reduction in TB, and will work tirelessly to support local partners in those areas where the burden is greatest.”
 

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