TB rates in England remain
highest in areas of deprivation and in certain groups living in
large urban areas, including vulnerable migrants and people who
experience homelessness, contact with the criminal justice
system, mental health needs, and/or drug and alcohol misuse.
To mark World TB Day, the UK
Health Security Agency (UKHSA) has published its
annual TB report, with data up to end of 2021.
Despite an overall downward trend in the number and rate of
TB notifications in England
during the last 10 years, the rate of decline has slowed in the
last 4 years. Unless immediate action is taken, England will fall
short of achieving the World Health Organization (WHO)’s End
TB Strategy target of 90%
reduction in people with TB
from 2015 to 2035.
TB is the second leading
infectious killer globally, after coronavirus (COVID-19). The
WHO estimates that
globally 10.6 million people became ill in 2021, a 4.5% increase
from 2020.
In 2021, the incidence of TB
stood at 7.8 notifications per 100,000 people, compared to 8.4
notifications per 100,000 in 2019. Although this is a decline
since before the pandemic, in order to hit the WHO elimination target by
2035, we need to see a reduction in TB rates to 1.05 per 100,000. If we
continue at the current rate of decline, we will only hit 5.1 per
100,000 by 2035. Provisional data from 2022 indicates we remain
off trajectory.
TB notification rates in
England remain highest in large urban areas which are associated
with higher levels of deprivation, and in inclusion health groups
– a term used to describe people who are socially excluded and
typically experience multiple overlapping risk factors for poor
health, such as experiencing homelessness or contact with the
criminal justice system.
TB disproportionately impacts
certain people, in part, due to the barriers they may face in
accessing the interventions designed to identify clinical onset
of TB; access to diagnostic and
treatment services; ability to self-administer treatment and
attendance at follow-ups.
Dr Esther Robinson, Head of the TB Unit at UKHSA, said:
Tuberculosis remains a risk to some of the most vulnerable people
in our society and this data highlights that progress towards
elimination has stalled.
It is vital that we ensure that everyone has access to a timely
diagnosis and effective treatment. This will also help us to get
on course to eliminating TB in
our communities through strengthening the prevention, detection
and treatment of active TB in
higher risk groups.
Professor Sir Stephen Powis, NHS Medical Director, said:
Since the COVID-19 pandemic there has been a resurgence in
infectious diseases, like flu and norovirus, and the latest data
shows that rates of tuberculosis have also risen slightly,
although they are still lower than they were in 2019.
While the incidence of TB is
still considered low by WHO, the NHS, working with
UKHSA and other
partners, is committed to improving the prevention, detection and
control of TB across the
country, and anyone with symptoms of the disease should contact
their GP or use NHS 111 online to get the appropriate treatment
and advice.
Health Minister said:
It is vital that we act now to protect the progress that has been
made towards eliminating tuberculosis in England over the last
decade.
These figures highlight the importance of recognising symptoms
early – if you have a persistent cough that has lasted for
3 weeks alongside a fever, contact your GP as soon as possible.
TB is infectious and if not
treated can be potentially life threatening. We also know it
disproportionately impacts more vulnerable people so it’s
important to be vigilant and act so that anyone can access
treatment when they need it.
Anyone who has a persistent cough that lasts more than 3 weeks
along with a fever should contact their GP surgery.
Symptoms of
TB include:
- a persistent cough that lasts more than 3 weeks and usually
brings up phlegm, which may be bloody
- breathlessness that gradually gets worse
- lack of appetite and weight loss
- a high temperature
- night sweats
- extreme tiredness or fatigue
People born outside of the UK are disproportionately affected by
TB and account for the majority
of TB notifications in England
at 76.4% in 2021, with rates of TB in this group, at 37.6 per 100,000. This
is similar to rates in 2020 at 36.8 per 100,000.
Of people born in the UK, the highest notification rates were in
the black-other ethnic group – 19.5 per 100,000 compared with 1.4
per 100,000 for white ethnic group. For non-UK born individuals,
notification rates are highest in those who self-report as Indian
ethnic group (99.8 per 100,000) and lowest in the white ethnic
group (8.9 per 100,000).
Through the joint UKHSA and NHS England (NHSE)
TB action plan published in
2021, UKHSA is
working to improve the prevention, detection and control of
TB in England and to provide
partners with the tools to reduce TBincidence in all our communities.
