Debora Pedrazzoli, Nicholas Fulton, Dr Laura Anderson, Dr Maeve Lalor, Professor Ibrahim Abubakar and Dr Dominik Zenner – Tuberculosis Section, Health Protection Services, HPA.
Publication date: 5 July 2012
The latest HPA’s annual TB report shows an increase in the number of tuberculosis (TB) cases compared to 2010, however TB cases overall have been stabilising since 2005 (1). 8,963 cases were reported in 2011, a rate of 14.4 cases per 100,000 population.
The majority of cases were notified from 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 region (11%). Similar to 2010, 74% of these were born outside the UK and mainly originated from South Asia and sub-Saharan Africa. Rates in the UK born population continued to remain stable at 4.1 per 100,000 population suggesting continued transmission of tuberculosis in the UK.
The number of drug resistant cases continues to rise with 431 cases (8.4%) resistant to any first line drug reported in 2011, up from 342 in 2010 – an increase of 26 per cent. The number and proportion of isoniazid resistant and multi drug resistant (MDR) cases increased in 2011 7.6% (388/5127) and 1.6% (81/5127), respectively. Over the last decade, the proportion of MDR cases has gradually but significantly increased from 0.9 in 2000 to 1.6% in 2011. The proportion of cases resistant to any first line drug was higher in those with a previous history of diagnosis of TB, compared to those without; and in non-UK born cases compared to UK born. This pattern is similar for MDR cases. Twenty four extensively drug resistant (XDR) cases have been reported since 1995, six of whom were reported in 2011.
Treatment outcome data was available for 97 per cent of cases (8,171 patients) in 2010. Eighty four percent of patients completed their treatment, up from 78% in 2001. Three regions exceeded the 85% Chief Medical Officer’s Action Plan goal for treatment completion this year (London, the North West and the South East of England) (2). Death was the most common reason for not completing treatment (5.3%) and 4.4% failed to complete treatment because they were lost to follow up, the majority of whom moved abroad. The treatment completion rate at 24 months for MDR TB cases notified in 2009 was also high at 80%.
The National Strain Typing Service began in England in January 2010. The proportion of culture confirmed cases with a completed strain type increased from 84.7% in 2010 to 94.1% (4974/5284) in 2011. Just over half the clusters (62/115) investigated remained active by December 2011. The majority of clusters (83.6%) were under the threshold for investigation and a higher proportion of these were in areas with a low burden of TB.
The stabilising trend of TB incidence rates in the UK is encouraging; however it should not lead to complacency. Whilst improving indicators such as treatment completion suggest that progress is being made in service provision, this has yet to translate into sustained reductions in rates of TB. Targeted efforts at both the service and population level are needed to achieve a sustained decrease in TB rates and to ensure that the threats of MDR and XDR are contained.
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Last reviewed: 9 July 2012