Tuberculosis in the UK: 2013 report

The latest UK annual TB report shows that rates of tuberculosis (TB) have stabilised in the UK over the past seven years, following the increase in the incidence from 1990 to 2005. However, despite considerable efforts to improve TB prevention, treatment and control, the incidence of TB in the UK remains high compared to most other Western European countries, with 8,751 cases reported in 2012, an incidence of 13.9 per 100,000 population. The majority of TB cases occurred in large urban centres, amongst young adults, those from countries with high TB burdens, and those with social risk factors for TB. As in previous years, London accounted for the highest proportion of cases in the UK (39%) followed by the West Midlands PHE Centre area (12%). Similarly to 2011, 73% of TB cases were born outside the UK and mainly originated from South Asia (60%) and sub-Saharan Africa (22%). The rate of TB among the non UK-born population was almost 20 times the rate in the UK-born, at 80 per 100,000 but has continued to decline over the last seven years. In the UK-born population, the incidence of TB has not declined in the past decade, with rates remaining stable at 4.1/100,000 per year. Within this population, those most at risk remain individuals from ethnic minority groups, those with social risk factors and the elderly. The proportion of TB cases with resistance to any first line drug (7.4 %) was slightly lower in 2012 than in 2011, while the proportion of multi-drug resistant (MDR) TB cases (1.6 %) remained stable. The majority of cases with MDR TB (89%) were born outside the UK. Although the total number of TB cases born in Eastern Europe remained low (69), a particularly high proportion of those that were culture confirmed (13/54, 24.1%) had MDR TB. Two cases of extensively drug resistant (XDR) TB were reported in 2012, compared with six in 2011. A total of 26 XDR cases have been reported by UK laboratories since 1995. The National Strain Typing Service has been in operation for more than three years. In 2012, 88% of culture confirmed cases from England, Wales and Northern Ireland had their strains typed at 23 loci or more. Between January 2010 and December 2012, 6,113 cases out of 11,745 cases with isolates typed were in in 1,401 molecular clusters and 5,632 cases had a unique strain type. Based on MIRU-VNTR strain typing, the maximum proportion of TB cases in the UK likely to be due to recent transmission was 40%. Non UK-born cases were more likely to have unique strain types than UK-born cases. Treatment outcome data was available for 97% of cases notified in 2011. The proportion of cases who had completed treatment by 12 months continued to improve gradually, accounting for 82.9% of cases notified in 2011. The highest level of treatment completion was in the Thames Valley PHEC area (89.7%, 260/290). Three other PHEC areas exceeded the Chief Medical Officer’s Action Plan goal of 85% treatment completion: London, South Midlands and Hertfordshire and Wessex. The most common reasons for not completing treatment were death (4.9%) and loss to follow-up (4.9%). The most common reason given for being lost to follow up was moving abroad (55.8%). The treatment completion rate at 24 months for MDR TB cases notified in 2009 was 74%, with zero deaths. While there have been notable achievements in strengthening TB services in some areas, the UK still lacks a nationally coordinated approach to TB and there is considerable variation in the delivery of some aspects of the service. To further strengthen TB prevention, treatment and control throughout the country a co-ordinated national TB strategy, involving NHS commissioners and providers, local government and PHE is required to support locally designed and implemented services, and monitor achievements against national standards. Annual report on Tuberculosis surveillance in the UK 2013 Slideset (PowerPoint Presentation, 2.3 MB) http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317139689631