Progress on eliminating tuberculosis in England has ‘stalled’

Tuberculosis (TB) rates in England remain highest in areas of deprivation and among certain vulnerable groups living in large urban areas, with progress towards eliminating the disease now largely “stalled”, the UK Health Security Agency (UKHSA) has warned.

To mark World TB Day, which took place last Friday (24 March), the UKHSA published its annual TB report, covering 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 had slowed in the last four years, it warned.

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, it added.

Key vulnerable groups included migrants and people who were experiencing homelessness, contact with the criminal justice system, mental health needs, and/or drug and alcohol misuse.

TB is estimated to be the second leading infectious killer globally, after 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, the UKHSA said.

“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,” it added.

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,” she added.

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), the UKHSA said.