The UK Health Security Agency (UKHSA), working with NHS
England (NHSE), has launched a 5-year action plan to drive down
tuberculosis (TB) cases in England.
The TB action plan for England, 2021 to
2026 will improve prevention, detection and control of
TB, enabling the UK to meet its
commitment to the World Health Organization (WHO) End TB Strategy and eliminate TB in England by 2035. Earlier detection
and treatment of TB increases
likelihood of recovery and reduces chances of onward spread of
disease.
Tuberculosis is a serious infectious disease, which can be
life-threatening without appropriate treatment; in 2019 4.1% of
cases had died by last recorded follow-up.
Across the country the story of TB prevention, detection and control has
been a success, with the incidence of TB falling significantly since 2011, when
it was among the highest in western Europe with a total of 8,963
cases recorded. However, in 2019 the rate of decline reversed,
with cases increasing by 2.4% (from 4,615 in 2018 to 4,725 in
2019). While recorded incidence of TB fell again in 2020 (to 4,138), the
coronavirus (COVID-19) pandemic has had an impact on diagnoses.
The significant impacts of the pandemic require renewed effort
and focus to ensure that England gets back on track to eliminate
TB. The joint UKHSA and NHSE TB action plan will build on the
improvements in the prevention, detection and control of
TB in England over the past 10
years, and focus on 5 key priority areas to provide partners with
the tools to reduce TB
incidence in all our communities.
The 5 priority areas are:
Recovery from COVID-19
It is expected that missed and delayed diagnoses, late
presentation of symptoms and delayed treatment will have
increased the pool of undetected and unreported TB in the community, potentially leading to
and increase in TB cases in the
short term.
Prevent TB
Prevent and protect susceptible people in England from acquiring
TBinfection and developing
active disease. This will include increasing latent tuberculosis
infection testing (where groups at risk of TB are screened to see if they are carrying
the bacteria without displaying symptoms) and offering the
BCG vaccine to all
those eligible within 4 weeks of birth.
Detect TB
Improve early detection of TB
by identifying, investigating and acting on the components that
contribute to patient delay.
Control TB disease
Prepare and respond to emerging threats from TB transmission clusters, outbreaks and
incidents and drug resistant TB. This will include the rollout of the
new National TB Surveillance
System and the routine provision of whole genome sequencing data
to TB services to allow them to
better understand how the infection is being transmitted in the
local community.
Workforce
Develop and maintain the healthcare workforce to ensure workforce
capacity to detect, case manage and control TB.
Dr Jenny Harries, Chief Executive, UK Health Security Agency
(UKHSA) said:
Tuberculosis affects some of the most vulnerable people in our
society and ensuring that everyone has access to a timely
diagnosis and effective treatment is critical.
The elimination of TB in our
communities is firmly within our grasp and this action plan
presents a solid plan to creating a healthier future. Working
with partners we will recover and build on learnings from the
pandemic, injecting renewed focus into TB elimination.
NHS England’s National Medical Director, Professor Stephen Powis,
said:
Thanks to the hard work of NHS staff, rates of TB are significantly lower in England
than they once were – but there is more work to be done to
eradicate this disease completely.
We know that there are groups who have disproportionately
higher risks of contracting TB, and this action plan sets out how
we’ll work with national and local partners to provide targeted
support to tackle those inequalities, prevent missed or delayed
diagnosis and keep people safe and well.
While the pandemic has likely led to a reduction in the detection
of TB, the action plan seeks to
build on lessons learned. This will include utilising the
expansion of the UK’s whole-genome sequencing (WGS) capabilities and increased
use of technology in healthcare.
Prior to COVID, WGS
was already in universal use for TB in England and was used to detect
clusters and outbreaks and support prevention of TBtransmission. The engagement between
local authority public health and health protection teams on
contact tracing during the pandemic will support future public
health interventions to prevent TB.
The action plan will also build on innovative approaches across
England to reach under-served populations, who are at greatest
risk of TB. This includes
schemes such as ‘Car in the Community’ in Lincolnshire, a team of
nurses, who deliver care and tailored support to vulnerable
groups direct from their car, to increase engagement and ease of
access to healthcare in rural settings.
As TB disproportionally impacts
on under-served populations such as those who have ever been
homeless, spent time in prison or misused drugs and other
substances, creative and collaborative approaches to not only
detect cases, but ensure treatment completion will be critical to
drive down cases in this country.
