TB in the UK

Tuberculosis counts down in the UK but still remain highest in Western Europe

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) Although tuberculosis (TB) is a preventable and curable disease, it still causes death and illness, especially in developing countries. And even developed countries are not out of the danger zone, particularly as immigration and travel help spread the disease. 

According to a report released from Public Health England (PHE), a division of the United Kingdom (UK) government, rates of TB in the UK have stabilized over the past seven years, but still remain high compared to other countries in Western Europe.

The highest rates were seen in people who were not born in the UK, highlighting a potential need for screening of new migrants to identify TB and help control its spread.

"Cough into a tissue to help prevent the spread of germs."

According to the World Health Organization (WHO), over 95 percent of TB cases and deaths occur in developing countries. In 2011, there were an estimated 8.7 million TB illnesses and 1.4 million TB deaths across the globe. 

The disease, which is caused by a bacteria that usually affects the lungs, is spread through the air, like when an infected person coughs or sneezes.

The new PHE report showed a total of 8,751 TB cases in the UK during 2012. This amounts to a rate of 13.9 infections per 100,000 people.

By comparison, the latest TB report available from the US Centers for Disease Control and Prevention (CDC) showed 10,528 TB cases in the US during 2011, which amounts to a rate of 3.4 cases per 100,000 people.

The UK rates were relatively stable in recent years, dating back to 2005. In the two decades prior to 2005, rates had risen to much higher numbers, according to PHE. 

"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," PHE reported. 

London, with 39 percent of all the country's TB infections, was the city with the highest proportion of cases. 

"As in previous years, the majority of TB cases (73 percent) occurred among people born in high burden countries, and were concentrated in large urban centres," PHE noted. 

The rate of TB among the non-UK born population was nearly 20 times the rate among the UK-born population. However, the 2012 rate of TB cases among people not born in the UK was 80 cases per 100,000 people, which is down from the 2005 peak of 98 cases per 100,000 people. 

Most of the cases in people not born in the UK came from South Asia (60 percent) and sub-Saharan Africa (22 percent). Specifically, India, Pakistan and Somalia were the most common origin countries of non-UK born TB patients. 

In these cases of TB in patients born outside of the UK, almost half were diagnosed within five years of the patient entering the country. 

Not much change was seen in terms of drug resistance in the new report. "The proportion of TB cases with resistance to any first line drug (7.4 percent) was slightly lower in 2012 than in 2011; the proportion of multi-drug resistant (MDR) TB cases (1.6 percent) remained stable," PHE reported. 

Of the multi-drug resistant cases seen, 89 percent were in people born outside of the UK. 

The PHE report called for extra efforts to screen new migrants from countries with high TB rates for latent TB infection (LTBI) in an effort to help lower case numbers.

"About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease," explained WHO. 

Initial symptoms of active TB include cough, fever, night sweats and weight loss. Coughing up blood, chest pains and weakness may also occur. According to WHO, initial symptoms may be mild for months. 

"This can lead to delays in seeking care, and results in transmission of the bacteria to others," explained WHO. "People ill with TB can infect up to 10 to 15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die."

"To ensure that new migrants are identified for LTBI screening, and are rapidly diagnosed if they develop active disease, there must be no barriers to accessing primary health-care services," PHE stressed. 

No conflicts of interest were noted in the PHE report. 

Review Date: 
August 23, 2013
Last Updated:
January 2, 2014