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Volume 5 No 49; 9 December 2011

Annual report on tuberculosis surveillance in the UK

The latest HPA annual report on tuberculosis surveillance shows a 4.9% decrease in the number of tuberculosis cases in the UK. Eight thousand, four hundred and eighty three new cases were reported in 2010 giving an overall rate of 13.6 per 100,000 population [1].

As in previous years, the majority of cases were concentrated in urban areas with London and the West Midlands accounting for 39% and 11% of cases in the UK, respectively. Sixty per cent of TB cases in the UK occurred in young adults aged 15-44 years. Over half (57 per cent) were male and 73% were born outside the UK and mainly originated from south Asia and sub-Saharan Africa. Only 23% of non-UK born cases were diagnosed within two years of entering the UK. Rates in the UK born population continued to remain stable at four per 100,000 population suggesting continued transmission of tuberculosis in the UK.

Analysis of treatment outcomes showed that 83.6% of all patients completed treatment - in London this was higher at 86.8%, exceeding the Chief Medical Officer's Action Plan goal of 85% [2]. Death was the most common reason for not completing treatment (5.5%); 4.2% failed to complete treatment because they were lost to follow up. Patients who had at least one social risk factor (homelessness, drug or alcohol misuse or imprisonment) were even less likely to complete treatment (77.1%) and 11.3% (6/53) of patients with multi-drug resistant tuberculosis were lost to follow up.

Although the observed decline in incidence of tuberculosis after nearly two decades of increasing rates is encouraging, trends need to be assessed over the next few years to determine whether this is a true reversal. The lack of a decline in tuberculosis in the UK-born population is explained by high rates of disease in the UK-born risk groups such as patients with relatives from, or connections to, high burden countries or those with social risk factors. Although progress has been made with regards to the proportions of patients completing treatment it is still worrying that 5% do not fully complete their treatment due to loss to follow up. Failure to adhere to or complete regimens can result in the development of drug resistance, which is more difficult and expensive to treat, as well as increasing the risk of onward transmission as patients may remain infectious.

It is essential that public health and NHS colleagues work in partnership across the UK to strengthen the control of tuberculosis in high risk groups and ensure treatment completion of all patients. The UK contribution to the global effort to control tuberculosis in high burden countries should continue.

References

1. HPA. Tuberculosis in the UK: 2011 report, December 2011. Downloadable from the HPA website: Home > Publications > Infectious diseases > Tuberculosis reports and leaflets.

2. Department of Health. Stopping tuberculosis in England: an action plan from the Chief Medical Officer (2004).

HPV immunisation programme: change of vaccine to Gardasil® from September 2012

The Department of Health's Director of Immunisation has written to health Trusts and other affected health professionals [1] providing details of arrangements for a change to the vaccine to be used in the human papillomavirus (HPV) vaccination programme with effect from the start of the next academic year.

The quadrivalent vaccine, Gardasil ®, supplied by Sanofi Pasteur MSD, will be the vaccine used from September 2012, replacing the bivalent vaccine, Cervarix ®. Cervarix will remain in use until that time for eligible girls who have yet to receive their first dose, and after that time to complete courses started with Cervarix.

The HPV programme was launched in September 2008 following a Joint Committee on Vaccination and Immunisation recommendation that the vaccine should be offered routinely to females aged 12 to 13 years. High uptake has been achieved, at around 80% in the routine programme [2], and 1.5 million young women and girls have been immunised, including girls up to 18 years of age offered vaccination by the catch-up programme.

The decision to change to a different vaccine followed a competitive tendering exercise informed by an updated cost effectiveness analysis of HPV vaccines [3]. A three-year contract has been awarded for the supply of Gardasil. The primary aim of the HPV vaccination programme is to prevent cervical cancer. Gardasil protects against two strains of HPV that cause over 70% of cervical cancer in England and a further two strains that cause the majority of genital warts. Warts are a common sexually transmitted infection in the UK and it is expected that a reduction in the number of diagnoses of genital warts will be seen following this change.

The HPV chapter of the Green Book will be updated in due course.

References

1. Department of Health (2011). HPV immunisation programme: change of supply to Gardasil® from September 2012. Letter from prof. David Salisbury, director of immunisation, 25 November 2011.

2. Department of Health/HPA (2011). Annual HPV vaccine coverage in England in 2009/2010. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_123795. See also: High vaccine coverage maintained in second year of HPV immunisation programme, HPR 5(4), 28 January 2011.

3. Jit et al. (2011). Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model BMJ. 2011; 343: d5775. Published online 2011 September 27. doi:10.1136/bmj.d5775 www.ncbi.nlm.nih.gov/pmc/articles/PMC3181234/?tool=pubmed.