Majority of London TB cases are in non-recent entrants to UK

Eight out of 10 Londoners with tuberculosis in 2012 were UK-born or had been living in the UK for at least 2 years prior to their diagnosis.

The data, published today (23 October 2013) in Public Health England’s 2012 TB Annual Review for London, show 3,426 people were diagnosed with the disease in the capital, accounting for around 40% of all cases nationally. This is more cases than were reported in Belgium, the Netherlands, Greece, Norway and Denmark combined.

While the rate in non-UK born Londoners is 10 times greater than among people born in the UK, only 14% of cases were recent entrants to the UK.

The review shows that 8% of TB cases were known to have a social risk factor including homelessness, drug or alcohol misuse, imprisonment or mental health issues. More than a quarter of these hard-to-reach people were reported to have multiple social risk factors. While this is a small percentage of the cases overall, hard-to-reach people were more likely to have drug resistant forms of TB (14%) than those without (8%). TB cases with social risk factors also have a greater public health impact as they are more likely to be infectious and less likely to complete TB treatment, which, while free, takes at least 6 months of medication.

Dr Yvonne Doyle, regional director for Public Health England in London, said:

It is very important to realise that the majority of TB cases in London are in people who have been living here for a number of years rather than recent entrants to the country. This tells us that reducing risk of TB transmission and screening for latent TB will be key to reducing TB levels in London and there is a need for focused commissioning of services in these areas. To reduce the risk of latent TB reactivating it is essential that people who have come to London from high incidence countries have good access to health services and are invited for screening.

We can be confident in our treatment services once people are diagnosed in London, as overall, 87% of TB cases completed treatment within 12 months, achieving the national and international target of 85% for the second year in a row, which is encouraging.

This latest review of TB data in London reinforces the importance of recently released NICE guidance on tackling TB among hard-to-reach groups through dedicated outreach services such as the Find & Treat mobile screening unit and other social care services who work with these groups.

Other key data within the Annual Review include:

• 11 of the 33 local authorities in London had rates of tuberculosis of 40 or higher per 100,000 population
• males accounted for 58% of cases overall
• in 2012, TB rates were highest (199 per 100,000 population) and continued to increase among the Indian population of London. These were followed by the Pakistani population at 149 per 100,000, which has also seen a slight increase since 2010. The rate among black Africans continued to decline in London, to 119 per 100,000 population in 2012.
• the TB rate in UK-born Londoners was twice the rate as the rest of the UK.
• 2012 saw an increase in children under 5 years diagnosed with TB at 10 per 100,000. These cases were almost all UK born and point to the need to reduce the risk of TB transmission in the capital.

Notes to editors:

1. Read the PHE Tuberculosis in London: Annual Review (2012 data).
2. View local authority profiles for London with key information on TB.
3. Read the national PHE Tuberculosis in the UK Report (2013).
4. TB is an infection caused by bacteria. It usually affects the lungs, but can affect other parts of the body. TB is transmitted when someone who has the infection coughs or sneezes, but it requires close prolonged contact in order to spread from person to person. More information about tuberculosis.
5. Latent TB is when a person has been infected with the TB bacteria but does not have any symptoms of the active disease. The disease however can reactivate at any time while the person is infected.
6. ECDC Director’s presentation on urban tuberculosis control in the European Union offers a useful comparison of London with other major European cities.
7. Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health.

Source: GOV.UK