2. Tuberculosis prevention, England, 2024

Question 1

Main points

Accepted Answer

In 2024:

the number of long-term visa applicants from high tuberculosis (TB) incidence countries screened before entry to the UK for pulmonary TB decreased from 1,206,358 in 2023 to 707,839 in 2024 , but the total number remains much higher than before the COVID-19 pandemic
the number of people diagnosed with pulmonary TB by the UK pre-entry screening programme was 388; the case detection rate in the programme is similar to 2019
the number of new entrant migrants eligible for the NHS England (NHSE) latent TB infection (LTBI) testing programme decreased in 2024 by 23% compared with 2023 (from 304,949 to 234,814 individuals)
the number of new entrant migrants tested for LTBI increased by 16.2% (from 34,858 in 2023 to 40,490 individuals in 2024)
the proportion of eligible new entrant migrants tested increased to 17.2% from 11.4% in 2023, with the proportion testing positive stable at 15.1% in 2024 compared with 15.3% in 2023
the proportion of people notified with pulmonary TB who had contact tracing information recorded was 81.8%, a 7.8% decrease compared with 2023
in 2024, screening of the contacts of people notified with active pulmonary TB resulted in the identification of 182 people with active TB disease and 1,276 people with LTBI

Supplementary tables

Data relating to this chapter can be found in the 25 supplementary data tables in the accompanying spreadsheet, Tuberculosis prevention, supplementary data, which is available to download.

UK pre-entry TB screening programme

In 2024, 82% of all people notified with TB in England were born outside the UK (see the Incidence and epidemiology chapter). The UK pre-entry TB screening programme is intended to reduce the importation of active pulmonary TB among applicants for long-term visas by screening migrants from high TB incidence countries (more than 40 per 100,000) for active pulmonary TB by symptoms review and chest X-ray (CXR) when applying for a long-term (more than 6 months) UK visa (UK tuberculosis technical instructions).

Screening numbers over time, by country and screening provider

The programme has operated in 102 countries since 2014 (see Supplementary Table 1 of the accompanying data set).

In 2024 there were 707,839 people screened, a decrease of 41.3% from 1,206,358 in 2023 (see Figure 1 and Supplementary Table 2). This is the first decrease since 2020, correlating with the reduction of migration because of policy changes in 2024 (see the Office for National Statistic report Long-term international migration, provisional). Screening is provided by either International Organization of Migration (IOM) or non-IOM clinics. Detailed analysis is reported for the provider types separately due to issues with data completion from non-IOM providers. Some countries have both types of providers (see Supplementary Table 1 of the accompanying data set for more details).

Figure 1. Number of people screened by screening provider, 2014 to 2024

Data used to create Figure 1 can be found in Supplementary Table 2 of the accompanying data set.

The largest number of people screened in 2024 were in India (161,540, 22.8%), followed by Pakistan (122,828, 17.4%) and China (115,471, 16.3%) (see Table 1 and Supplementary Table 3). In comparison to 2023, the number of people screened in countries shown in Table 1 all decreased, apart from Nepal which increased by 20.0% (30,176 compared to 25,146). The proportion of the total screened in Pakistan and China increased by 31.8% and 64.6% respectively, and the proportion screened in Nigeria decreased by 48.4% (see Supplementary Table 3).

Table 1. Number of reported screening episodes and people screened by country of screening in 2024.

Country of screening	Number of screening episodes	Number of people screened	Percentage of people screened by country
India	166,924	161,540	22.8
Pakistan	127,898	122,828	17.4
China	116,334	115,471	16.3
Nigeria	59,272	57,805	8.2
Bangladesh	34,204	32,432	4.6
Nepal	30,791	30,176	4.3
Ghana	24,488	23,695	3.3
Zimbabwe	20,546	19,687	2.8
Hong Kong	17,752	17,550	2.5
Sri Lanka	16,847	16,167	2.3
Philippines	14,074	13,684	1.9
South Africa	12,095	11,841	1.7
Kenya	11,034	10,730	1.5
Other	75,473	74,361	10.5
Total	727,732	707,839	100.0

Note to Table 1: the table is ordered by number of screens per country and limited to countries reporting more than 10,000 screening episodes. Some individuals were reported as having been screened more than once, accounting for the difference between the number of screening episodes and people screened. Some people were also screened in more than one country, so the total of people screened is less than the sum of people screened in each country. For a detailed breakdown of all countries by service provider see Supplementary Table 3 of the accompanying data set).

Age, sex and visa type of screening population

Age was known for 80.2% of screening episodes (583,658 of 727,732). The greatest proportion of screens in 2024 were among people aged 20 to 29 (50.5%; 294,706 of 583,658 episodes with known age) (see Appendix figure A1(A) and Supplementary Table 4 in the accompanying data set). The proportion of males and females screened in each age category was similar with an overall proportion of 53.2% males (246,289 of 466,630 where sex was known) (see Supplementary Table 5 of the accompanying data set for more details).

Student visas accounted for the largest proportion of screens with a known visa type (48.9%; 284,896 of 582,612) followed by work visas (26.0%; 151,714 of 583,612) and settlement and dependents visas (20.9%; 121,998 of 583,612). The proportions changed across age categories where student visas made up most of the total in the 20 to 29 age group (69.6%; 205,159 of 294,683).

See Appendix Figure A1(B) and Supplementary Table 6 of the accompanying data set for more details).

TB case detection rate by the programme

In 2024, 338 people were diagnosed with pulmonary TB by the programme, which is a decrease from 528 in 2023 (see Figure 2 and Supplementary Table 7 of the accompanying data set). The overall TB case detection rate was 47.8 per 100,000 (42.7 to 52.8); 103.2 (90.4 to 116.0) for IOM and 18.9 (15 to 22.9) for non-IOM. Despite a reduction in TB diagnoses in 2024, the overall TB case detection rate increased by 9.1% compared with the previous year, which was the lowest rate since 2018.

Figure 2. Number of people with confirmed TB (panel A) and TB case detection rate (panel B) by screening provider, 2018 to 2024

Note to Figure 2: data is presented from 2018 due to earlier data quality and a change in methodology affecting non-IOM clinics – for more information see the Methodology and data sources chapter of this report.

Data used to create Figure 2 can be found in Supplementary Table 7 of the accompanying data set.

TB detection rates were lower in non-IOM screening clinics; however, sputum test results were incomplete for 41.6% (2,358 out of 5,664) of sputum referrals, due to pending results, loss to follow-up, and unknown reason, and this is likely to result in an underestimate of the true rate of detection. Incomplete sputum results in IOM clinics for the same reason were noticeably lower at 13.1% (972 out of 7,110). In non-IOM data, applicants with an abnormal CXR but no sputum culture result who were recorded as ‘TB suspected’ were considered possible TB cases (see Methodology and data sources chapter of this report). If people with possible TB were included (Appendix Figure A2) the total number of people with active TB in 2023 was 1,075. This results in a TB case detection rate that is higher in non-IOM compared with IOM clinics and, therefore, is most likely an overestimate.

Data reflecting the diagnostic flow resulting in a person being diagnosed with culture-confirmed or clinically diagnosed TB reported by IOM clinics and non-IOM clinics is shown in Appendix Figures A3 and A4 and Supplementary Table 8 in the accompanying data set.

Demographics of individuals diagnosed with TB

In 2024, the highest case detection rate was from people screened in the Philippines (387.3 per 100,000, 95%CI: 283.2 to 491.4), followed by Nepal (248.5 per 100,000, 95%CI: 192.4 to 304.7), where the greatest number of people with confirmed TB were diagnosed. Both countries had most or all screens from IOM clinics (see more detail in Supplementary Table 3 in the accompanying data set).

Age, sex and visa type information of individuals diagnosed with TB in the programme was analysed over 3 years between 2022 and 2024. TB case detection rate was similar in males (51.8 per 100,000, 95%CI: 47.8 to 55.9) and females (48.0 per 100,000, 95% CI: 44.0 to 52.0). The TB case detection rate increased with age. It was 47.0 per 100,000 (95%CI: 43.0 to 51.1) in the largest age group of 20 to 29 years, significantly increasing in each subsequent age group, reaching 273.1 per 100,000 (95%CI: 175.5 to 370.7) in those aged 60 years or more (see Appendix Figure A5). Similarly, the case detection rate in people with student visas was significantly lower at 32.2 per 100,000 (95% CI: 28.8 to 35.6) than people with other visa categories (see Appendix Figure A6), likely due to their younger age (Appendix Figure A1B). See Supplementary Table 9 of the accompanying data set for more details.

Drug susceptibility in culture-confirmed TB

TB culture and drug susceptibility testing (DST) is a mandatory requirement under the UK tuberculosis technical instructions. Very limited conclusions can be drawn about drug resistance in the pre- entry screening cohort due to incomplete data returns. While culture confirmation is reported for 88.5% (299 out of 338) individuals with confirmed TB in 2024, this is mainly from IOM countries and excludes a number of high burden countries for multidrug-resistant (MDR) disease. Drug susceptibility is reported for 71.6% (214 out of 299) of culture-confirmed individuals (see Table 2 and Supplementary Table 10 in the accompanying data set).

Table 2. Drug resistance in people with culture-confirmed tuberculosis in both IOM and non-IOM clinics in 2024

Drug susceptibility category	Number of people with positive sputum culture	Percentage of total positive sputum cultures
Isoniazid mono-resistant	10	3.3
Mono-resistant other	2	0.7
Multidrug-resistant or rifampicin-resistant	9	3.0

Note to Table 2: drug sensitivity results were reported for 214 of 299 positive cultures in 2024; 193 were sensitive to all drugs tested.

Table 2 shows drug resistance in people with culture-confirmed tuberculosis in 2024 in both IOM and non-IOM clinics as defined under the 2021 World Health Organization (WHO) TB DST definitions. See Supplementary Table 10 for more details and a breakdown by screening provider and country.

Screening in the UK for Hong Kong British National (Overseas) visa applicants

There are a number of people who can undergo pre-entry screening from within the UK when applying for a Hong Kong British National Overseas (HK BN(O)) visa (see Background information for more details).

Between 2022 and 2024, 2,330 of HK BN(O) visa applicants were screened in the UK, 25 CXR results were suggestive of TB, and no applicants were diagnosed with active TB.

Table 3. Number of people screened in the UK for HK BN(O) visa applications

Screening year	Number of people screened	Number of CXRs suggestive of TB
2022	745	4
2023	701	8
2024	884	13

Note to Table 3: some people were screened in more than one year, so the total of people screened is less than the sum of people screened in each year.

LTBI testing and treatment programme for new entrants

The LTBI programme is commissioned by NHSE in integrated care boards (ICBs) with a higher burden of TB - 26 out of 42 ICBs in 2024. Individuals are eligible for testing in the programme if they migrated to England from a high TB incidence country (more than 150 per 100,000 population or any country in sub-Saharan Africa), have registered with a GP within 5 years of entering the UK and are 16 to 35 years of age (see National latent tuberculosis infection testing and treatment programme).

Proportion of eligible new entrant migrants tested

The numbers of people eligible for testing increased nearly three-fold between 2019 (80,665 individuals) and 2024 (234,814 individuals), The number eligible in 2024 was a decrease from 2023, when 304,949 were eligible (see Figure 3 and Supplementary Table 11 in the accompanying data set).

In 2024, 40,490 people were tested through the programme, representing 17.2% of the eligible population and an increase from 2023, when 34,858 people were tested. This is an increase in number compared with all years since 2019 and a higher proportion than every year in the period except 2019 (see Figure 3).

The percentage of people tested remains below the initial annual goal of the programme to test 25% of eligible new entrant migrants; however, it significantly exceeds the original commissioned number of 20,000 tests annually. The increased number was possible in 2024 because of additional non-recurrent funding being released by NHS England for the programme.

Figure 3. Number of eligible new entrant migrants and number tested by year with the proportion tested England from 2019 to 2024

Data used for Figure 3 can be found in Supplementary Table 11 and by UK Health Security Agency (UKHSA) region and ICB for each year in Supplementary Tables 12 and 13 of the accompanying data sets.

Numbers tested by UKHSA region from 2019 to 2024 are shown in appendix Figure A7. London, with the highest number of eligible migrants, has the most people tested in each year, however the proportion of eligible people tested is highest outside London. In 2024, Yorkshire and Humber UKHSA region tested the greatest proportion of eligible migrants (32%) (Supplementary Table 12 in the accompanying data set). Data by ICB is found in Supplementary Table 13 of the accompanying data set). As a low incidence area, the North East region of England does not have any ICBs commissioned to do programmatic testing.

Demographic characteristics (age, sex and country of birth) of eligible new entrant migrants who were tested through the programme were compared with those who were not tested for the period 2019 to 2024. The demographics of eligible individuals tested (age, sex and country of birth) were similar to those who were not tested (see Supplementary Table 14 of the accompanying data set).

In 2024 the greatest number of people eligible for the programme were born in or travelled from India (95,500). The highest proportion of eligible people tested were from Bangladesh (20.9%) and Afghanistan (20.1%).

Table 4 and Supplementary Table 15 of the accompanying data set describe numbers, numbers tested and test positivity for the country of birth or travel with the top 10 highest eligible new entrant migrants’ numbers and information for all countries, respectively.

Proportion of people testing positive

In 2024, 6,097 (15.1%) people tested positive for latent TB infection through the commissioned LTBI programme. Although the number testing positive has increased, as the number testing has also increased the proportion testing positive is slightly lower than the number and proportion in 2023 (5,324 or 15.3%) (p=0.42), see Figure 4.

Figure 4. The number of tests and number and proportion of positive tests in, England, 2019 to 2024

Data used for this figure can be found in Supplementary Table 16 of the accompanying data set.

The proportions of migrants testing positive in the programme varied widely by country of birth. The proportions may be unreliable where only small numbers of individuals have been tested. For countries with at least 100 individuals tested between 2019 and 2024, test positivity ranged from 6% in people from South Africa (6 of 100 individuals tested in 2021) to 41.6% in people from Kenya (84 of 202 individuals tested in 2023).

In 2024, people from Sudan, Eritrea, Zimbabwe and Nigeria had a LTBI positivity of 20% or higher (see Table 4). For other countries and years see Supplementary Table 15 in the accompanying data set.

Country of birth

In 2024 8 out of the top 10 countries for number of people eligible for LTBI testing were also in the top 10 in 2023. The 2 new countries in 2024 were Eritrea and Sudan, both of which had LTBI positivity of over 30%. Bangladesh was the only country in 2024 to have a positivity below 10%, as it did in 2023.

Table 4. LTBI testing rates and positivity for the top 10 countries by number of eligible new migrants, England, 2024

Country of birth	WHO rate per 100,000 population [note 1]	Number of eligible new entrant migrants	Number of eligible new entrant migrants tested	Percentage eligible new entrant migrants tested	Positive tests	Positivity (percentage)
India	195	95,500	13,739	14.4	2,235	16.3
Pakistan	277	43,007	5,549	12.9	681	12.3
Nigeria	219	18,742	2,615	14.0	522	20.0
Bangladesh	221	14,813	3,101	20.9	290	9.4
Nepal	229	9,747	953	9.8	183	19.2
Ghana	129	9,174	1,166	12.7	142	12.2
Afghanistan	180	7,156	1,435	20.1	236	16.4
Zimbabwe	211	3,801	333	8.8	72	21.6
Eritrea	65	3,458	529	15.3	183	34.6
Sudan	50	3,045	477	15.7	145	30.4

Note 1: WHO rate from 2023.

General note to Table 4: data about country of birth was missing for 8,069 (19.9%) individuals in 2024.

Data used for this table can be found in Supplementary Table 15 of the accompanying data set.

LTBI positivity by demographic characteristics

Test positivity increased with age and was higher in males (Figure 5). Since 2019 the positivity has reduced in the older age groups (see Supplementary Table 17 in the accompanying dataset).

Figure 5. LTBI positivity in different age groups by sex England 2024

Proportion of new entrant migrants diagnosed with LTBI who complete prophylactic treatment

In 2024, 715 (11.7%) of the 6,097 people who tested positive for LTBI were recorded as having completed treatment. This was significantly lower than in 2023 and 2022 at 20.4% (1,088 people) and 23.8% (594 people), respectively (p-value less than 0.001) (see Figure 6 and Supplementary Table 18 in the accompanying data set).

The lower proportion of treatment completion in 2024 may in part result from delays in updating treatment information. However, all years have large amounts of missing data on treatment uptake and completion (see Figure A8 and the Methodology section of this report) so these figures should be interpreted with caution. There is currently no additional payment to TB services for recording the treatment completion data.

Figure 6. Number of LTBI positive tests, number and proportion of people who complete prophylactic treatment, England, 2019 to 2024

Data used for this figure can be found in Supplementary Table 18 in the accompanying data set.

Figure A8 of the appendix and Supplementary Table 13 of the accompanying data set describe the number of tests done and positive by UKHSA region in 2024, and from 2019 to 2024, respectively.

London reported the highest number of positive tests (3,982) but its recorded treatment completion percentage was low (9.3% of 369 people) compared to the South West (43.1% of 369 people).

Three-year average active TB rate by ICB sub-locations with number of people eligible for the LTBI testing and treatment programme

The NHSE LTBI programme was originally commissioned in clinical commissioning groups (CCGs) with the highest rates of TB in 2015, when the programme started. The programme is now commissioned through ICBs. ICBs agree which sub-ICBs to include and engage in the programme (see Supplementary Table 19 in the accompanying data set for detailed information). There were 19 ICB sub-locations with rates of 10 per 100,000 population or higher. Three of the 19 ICB sub-locations were not actively testing new entrant migrants for LTBI in 2024. The size of the eligible population can also be viewed in Supplementary Table 19.

Contact tracing

Contact tracing remains a cornerstone of TB management and prevention by interrupting chains of transmission and reducing the overall burden of disease.

Contact tracing has 3 main objectives:

identification of individuals with undiagnosed active TB
testing to identify people with latent infection followed by chemoprophylaxis to prevent development of active disease
vaccination with BCG of those eligible

There is evidence that treating latent infection with chemoprophylaxis is safe and prevents progression to active disease, reducing morbidity and mortality for the individual and further spread of TB into the population.

Assessment and screening of close contacts should be undertaken in line with National Institute for Health and Care Excellence (NICE) guidance.

Contact tracing data is presented from England between 2018 and 2024. Data on contact tracing information in individuals with pulmonary TB was first reported in the TB prevention in England 2022 report. Individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.

Contact tracing information for people with active TB

In 2024, there were 2,980 people notified with pulmonary TB, who therefore required contact tracing according to NICE guidance. Of these, 81.9% (2,440 individuals) had contact tracing information recorded or had fewer than 65 contacts identified, a 7.8% decrease compared with 2023. The proportion of people with pulmonary TB for whom contact information was recorded for 2021 to 2024 for England and by UKHSA region are shown in Appendix Figure A9 and Supplementary Table 20 in the accompanying data set.

Figure 7 describes the number of contacts of people notified with pulmonary TB (index individuals) who had contacts assessed in England in 2024. Data between 2021 and 2024 is presented in Supplementary Table 21 in the accompanying data set. Where contact information was recorded, the median number of contacts identified per person notified with pulmonary TB was 3 (interquartile range or IQR: 1 to 5). The distribution of the total number of contacts identified per notification of infectious TB between 2021 and 2024 is presented in Appendix Figure A10.

The majority of individuals with pulmonary TB (69.1%; 1,686 of 2,440) for whom contact tracing information was recorded had fewer than 5 contacts identified.

Figure 7. Flow diagram of the number of contacts of people notified with pulmonary TB (index individuals) identified, traced and assessed, England 2024

Notes to Figure 7:

proportions for individuals with contact tracing information entered, missing contact tracing information and those with greater 65 contacts identified are derived from the total number of pulmonary notifications
proportions for individuals with 0, 1 to 4, and 5 or more contacts identified are derived from individuals with contact tracing information entered
proportions for individuals with information recorded for assessed contacts was derived from the number of individuals with 0, 1 to 4, and 5 or more contacts identified
proportions for individuals with 0, 1 to 4, and 5 or more contacts assessed are derived from the number of individuals with information recorded for assessed contacts

Figure 7: text description

This flowchart shows the number and proportion of individuals with contact information in England in 2024. It starts with 2,983 pulmonary cases, of which 540 (18.1%) are missing contact information. Of the 2,983 individuals, 3 (0.1%) individuals had more than 65 contacts identified.

A total of 9,676 contacts were identified for the 2,440 individuals that did have contact tracing information entered. This is a median of 3 identified for every individual notified with pulmonary TB.

Of the 2,440 individuals that did have contact tracing information entered, 326 (13.4%) had 0 contacts entered, and therefore no contacts were identified.

Of 2,440 individuals with contact tracing information entered, 1,360 individuals (55.7%) had 1 to 4 contacts identified. Of these 1,360 individuals, 271 (19.9%) had no information recorded for contacts, leaving 1,089 (80.1%) who did have information recorded for contacts and who were assessed with further screening. Of these 1,089, 108 (9.9%) had 0 contacts assessed, and 981 (90.1%) had 1 to 4 contacts assessed.

Of the 2,440 individuals that did have contact tracing information entered, 754 (30.9%) had 5 or more contacts identified. Of these 754 individuals, 90 (11.9%) had no information recorded for contacts, leaving 664 (88.1%) who did have information recorded for contacts and who were assessed with further screening. Of these 664, 22 (3.3%) had 0 contacts assessed, 96 (14.5%) had 1 to 4 contacts assessed, and 546 (82.2%) had 5 or more contacts assessed.

People notified with pulmonary TB (index individuals) who were identified, traced and assessed

Contact tracing information by demographic and social risk factors, and disease characteristics between 2021 and 2024 are presented in Supplementary Table 22 in the accompanying data set.

Contact tracing practices vary between services. Some services routinely carry out contact tracing on individuals with non-pulmonary disease based on local epidemiology, although this is not included in NICE guidance. Contact tracing information was recorded for 78.7% of people with non-pulmonary TB in 2024 (1,974 out of 2,507). Fewer contacts were recorded than for those with pulmonary disease with a total of 3,850 contacts (median of 1 contact; IQR: 0 to 3 close contacts).

Screening and treatment results in close contacts

Table 5 shows the numbers and proportion of adult and child contacts in 2023 and 2024 who were identified, screened, tested positive for LTBI, then started and completed treatment.

In 2024, a total of 9,676 contacts were identified from 2,980 people notified with pulmonary TB who had contact information recorded and who had fewer than 65 contacts recorded. Of those contacts, 72.1% were screened for active and latent TB while 18.3% tested positive for latent TB. A further 2.6% were reported to have active TB disease, compared with 2.8% in 2023 (see Table 5). This equates to 75 people with active TB and 523 with LTBI being identified for every 1,000 index individuals contact traced.

Table 5. Number of adult and child contacts of people notified with pulmonary TB (index individuals) screened and treated for active TB and latent TB infection, England, 2023 and 2024

Screening and treatment categories	All adult contacts in 2023	All child contacts in 2023	Total contacts in 2023	All adult contacts in 2024	All child contacts in 2024	Total contacts in 2024
Number of contacts identified	7,496	2,359	9,855	7,483	2,193	9,676
Number of contacts screened for active TB and latent TB (percentage)	5,783 (77.1%)	1,990 (84.4%)	7,773 (78.9%)	5,269 (70.4%)	1,711 (78%)	6,980 (72.1%)
Number of contacts with active TB (percentage)	144 (2.5%)	77 (3.9%)	221 (2.8%)	112 (2.1%)	70 (4.1%)	182 (2.6%)
Number of contacts with latent TB (percentage)	967 (16.7%)	459 (23.1%)	1,426 (18.3%)	916 (17.4%)	360 (21%)	1,276 (18.3%)
Number of contacts who started treatment for latent TB (percentage)	675 (69.8%)	407 (88.7%)	1,082 (75.9%)	642 (70.1%)	332 (92.2%)	974 (76.3%)
Number of contacts who completed treatment for latent TB (percentage)	537 (55.5%)	353 (76.9%)	890 (62.4%)	458 (50%)	250 (69.4%)	708 (55.5%)

Notes to Table 5:

the denominator for proportion of contacts screened for active TB and latent TB infection is number of contacts identified
the denominator for the proportion of contacts positive for active TB and LTBI is the number of contacts screened
the denominator for the proportion of contacts who started and completed treatment is the number of contacts positive for LTBI
individuals with greater than 65 contacts were excluded in the analysis

In 2024, children (aged 14 years or under) made up 22.7% of all contacts identified. Child contacts were more likely to be screened than adult contacts, and slightly more likely to have active (4.1% of child contacts, 2.1% of adults) and latent TB disease (21.0% versus 17.4%). This was similar to 2023 (see Table 5).

Just over three-quarters (76.3%) of all contacts with a positive LTBI test started treatment for latent TB and 55.5% were recorded as having completed treatment. This marks the lowest recorded percentage since reporting began (see Supplementary Table 23 in the accompanying data set from 2018).

Screening and treatment results varied by UKHSA region and are shown in Supplementary Table 24 in the accompanying data set, and proportions of treatment completion for LTBI by UKHSA region are shown in Appendix Figure A11 for 2021 to 2024.

Contacts of child index individuals compared with adult index individuals have generally had higher LTBI treatment completion rates, most notably in 2018 and 2019, but LTBI treatment completion percentages have decreased since 2018 in contacts of both adult and child index individuals, and are considerably lower in 2024 (see Figure 8 and Supplementary Table 25 in the accompanying data set). A similar trend was observed for contacts of index individuals by place of birth.

Figure 8. Latent TB infection (LTBI) treatment completion (proportion) in close contacts of adult or child index individuals (Panel A) and UK born or non-UK born index individuals (Panel B) with pulmonary TB, England, 2018 to 2024

Note to Figure 8: individuals with more than 65 contacts were excluded.

Data underlying this figure can be seen in Supplementary Table 25 of the accompanying data set.

BCG vaccination

The BCG vaccination programme is a risk-based programme recommended for individuals at higher risk of exposure to TB. This includes all infants (0 to 12 months) with a parent or grandparent born in a country where the annual incidence of TB is over 40 notifications per 100,000 population per year. In addition to this, all infants living in an area of the UK with an incidence above 40 per 100,000 population should be offered the BCG vaccine.

Eligible babies should be offered the BCG vaccine at 28 days or soon after. Detailed information on the BCG programme can be found in the Green Book. Evaluation studies have identified that BCG is most effective against the most severe forms of the disease, such as TB meningitis in children and less effective in preventing respiratory disease, which is the more common form in adults.

As part of the Cover of Vaccination Evaluated Rapidly (COVER) programme, BCG is included in the quarterly childhood vaccine coverage data extraction from local child health information systems (CHIS). This includes denominators of eligible children and therefore coverage for all local authorities of children at 3 months.

In Table 6 BCG vaccine coverage data is presented for England and by region from January to December 2024. For England, BCG coverage at 3 months of age for eligible children was 76.7%, varying from 41.9% in the North East to 86.3% in the West Midlands.

In Table 7 BCG vaccine coverage data is presented for local authorities with a 3-year TB incidence rate of greater than 20 per 100.000. The only local authorities with TB rates over 40 per 100,000 population were Newham and Leicester with BCG coverage of 86.0% and 87.0% compared with the highest coverage of 92.4% coverage in Wolverhampton and lowest of 71.0% in Redbridge.

Table 6. Annual BCG vaccine coverage of children up to 3 months old in England and in regions: January to December 2023

Area	Eligible population	Number of children vaccinated	Coverage (percentage)
England	183,322	140,695	76.7
London	58,029	44,502	76.7
West Midlands	24,845	21,435	86.3
North West	20,050	13,620	67.9
South East	24,131	19,612	81.3
East of England	17,587	14,331	81.5
East Midlands	12,271	9,393	76.5
Yorkshire and The Humber	15,056	12,069	80.2
South West	7,372	4,085	55.4
North East	3,981	1,670	41.9

Table 7. Annual BCG vaccine coverage of children up to 3 months old in English local authorities with a 3-year average TB rate of greater than 20 per 100.000: January to December 2024

Upper tier local authority	Three-year average (2022 to 2024) annual TB rate per 100,000	Number of eligible children	Number of children vaccinated	BCG coverage (per cent)
Tower Hamlets	20.2 (17.5, 23.2)	3,336	2,670	80.0
Barking and Dagenham	21.2 (17.9, 25)	2,631	1,882	71.5
Wolverhampton	22.3 (19.2, 25.7)	1,825	1,686	92.4
Luton	22.6 (19.2, 26.4)	3,557	3,000	84.3
Hillingdon	24.4 (21.4, 27.7)	2,533	2,132	84.2
Manchester	25.3 (23, 27.8)	3,799	2,909	76.6
Redbridge	29.9 (26.5, 33.6)	3,466	2,460	71.0
Hounslow	31.5 (27.9, 35.4)	2,395	1,982	82.8
Slough	32.8 (27.9, 38.3)	1,897	1,623	85.6
Ealing	33.6 (30.4, 37.2)	3,123	2,446	78.3
Harrow	35.0 (31, 39.4)	2,449	1,812	74.0
Brent	39.1 (35.4, 43.1)	3,058	2,386	78.0
Newham	41.4 (37.6, 45.3)	5,467	4,704	86.0
Leicester	42.1 (38.5, 46.1)	3,227	2,808	87.0

Appendix

Figure A1. Distribution of number of screening episodes by age and sex (panel A) and age and visa type (panel B), 2024

Data used to create Figure A1 can be found in Supplementary Tables 5 and 6 of the accompanying data set.

Figure A2. Number of people with confirmed and possible TB by screening provider, 2018 to 2023

Data underlying this figure can be seen in Supplementary Table 7 of the accompanying data set.

Figure A3. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for non-IOM screening providers in 2024

Note 1: other sputum referrals are sputum tests carried out in applicants that 1) did not have a CXR suggestive of TB, but TB was still suspected or 2) in applicants that did not have a CXR due to pregnancy.

Note 2: a clinically-confirmed case is one that does not have a sputum culture-positive test result but meets clinical criteria for diagnosis.

Data used to create Figure A3 can be found in Supplementary Table 8 in the accompanying data set.

Figure A3: text description

This flow chart shows the number of screening episodes in 2024 at non-IOM clinics. The steps in the process include the chest X-rays (CXRs), sputum tests, and the final number diagnosed with TB.

It starts with 477,199 screening episodes of which 440,008 had a CXR and 37,191 did not. Of the 37,191 episodes that did not have a CXR, 37,085 were a child, 36 were pregnant and 70 had an unknown reason.

Of the 440,008 screening episodes that had a CXR, 435,965 were not suggestive of TB and 4,043 were abnormal suggestive of TB. Of the 435,965 episodes not suggestive of TB, 428,420 were normal, 6,459 were abnormal without TB and 1,086 were an unknown result.

In addition to the 4,043 screening episodes that had a CXR suggestive of TB, a further 1,620 episodes were referred for sputum testing because TB was still suspected despite a negative CXR, or because the applicant did not have a CXR due to pregnancy. This brought the total number eligible for sputum testing to 5,663.

Of the 5,663 eligible for sputum testing, 4 were smear positive only, 3,227 were sputum negative, 186 were pending a result, 178 had an inconclusive result, 1,521 were lost to follow-up and 473 were not done for unknown reasons. The remaining 74 episodes were culture positive. An additional 15 episodes were diagnosed as clinically confirmed TB where one does not have a sputum culture positive result but meets the clinical criteria for diagnosis. This brought the total number of confirmed TB cases to 89, which represented 88 individual people with TB.

Figure A4. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for IOM screening providers in 2024

Note 1: other sputum referrals are sputum tests carried out in applicants that 1) did not have a CXR suggestive of TB, but TB was still suspected or 2) in applicants that did not have a CXR due to pregnancy.

Note 2: a clinically-confirmed case is one that does not have a sputum culture-positive test result but meets clinical criteria for diagnosis.

Data used to create Figure A4 can be found in Supplementary Table 8 in the accompanying data set.

Figure A4: text description

This flow chart shows the number of screening episodes in 2024 at IOM clinics. The steps in the process include the chest X-rays (CXRs), sputum tests, and the final number diagnosed with TB.

It starts with 250,533 screening episodes of which 215,916 had a CXR and 34,617 did not. Of the 34,617 episodes that did not have a CXR, 34,489 were a child, 99 were pregnant, 17 had another reason and 70 had an unknown reason.

Of the 215,916 screening episodes that had a CXR, 208,893 were not suggestive of TB and 7,023 were abnormal suggestive of TB. Of the 208,893 episodes not suggestive of TB, 194,384 were normal, 14,503 were abnormal without TB and 6 were an unknown result.

In addition to the 7,023 screening episodes that had a CXR suggestive of TB, a further 125 episodes were referred for sputum testing because TB was still suspected despite a negative CXR, or because the applicant did not have a CXR due to pregnancy. This brought the total number eligible for sputum testing to 7,148.

Of the 7,148 eligible for sputum testing, 12 were smear positive only, 5,938 were sputum negative, 17 were pending a result, none had an inconclusive result, 946 were lost to follow-up and 9 were not done for unknown reasons. The remaining 226 episodes were culture positive. An additional 25 episodes were diagnosed as clinically confirmed TB where one does not have a sputum culture positive result but meets the clinical criteria for diagnosis. This brought the total number of confirmed TB cases to 251, which represented 250 individual people with TB.

Figure A5. TB case detection rate by 10-year age group (2022 to 2024)

Data used to create Figure A5 can be found in Supplementary Table 9 in the accompanying data set.

Figure A6. TB case detection rate by visa type (2022 to 2024)

Data used to create Figure A6 can be found in Supplementary Table 9 in the accompanying data set.

Figure A7. The number of valid tests by UKHSA region in England from 2019 to 2024

Figure A7 and Supplementary Table 12 in the accompanying data set describe testing numbers by UKHSA region from 2019 to 2024. The South West was not entering negative tests prior to 2022 and so is under-reported before this time. In 2024 Yorkshire and Humber tested the highest proportion of its eligible migrant population (32.1%). The region that tested the smallest proportion of its eligible migrant population was the East of England (5.4%). Information by ICB level can be found in Supplementary Table 13 in the accompanying data set.

Figure A8. The number of positive tests and completed treatments with percent completion for each UKHSA region in England in 2024

Note to Figure A8: treatment completion as a percentage of those who tested positive is shown at the end of the completed treatment bar.

Data used in this figure can be found in Supplementary Table 12 of the accompanying data set.

In 2024, the UKHSA regions with over 25% completion of treatment were the South West (43.1%) and South East (28.3%), shown in Figure A8. Information by ICB level can be found in Supplementary Table 13 of the accompanying data set.

Contact tracing

Appendix Figure A9. Proportion of people notified with pulmonary TB with contact tracing information recorded by UKHSA region, England 2021 and 2024

Appendix Figure A10. Histogram of the number of contacts per notification of pulmonary TB, England 2021 to 2024

Appendix Figure A11. LTBI treatment completion in close contacts of people with pulmonary TB by UKHSA region, England 2021 to 2024

Background information

Pre-entry screening programme

The UK pre-entry screening programme replaced on-entry screening at UK airports in March 2014. It uses chest X-ray (CXR) based screening for active pulmonary TB carried out by appointed panel clinics, usually in the country of origin, with sputum cultures conducted for those with those with abnormal CXR considered to be consistent with TB.

Whilst pre-entry screening for active TB is a requirement when applying for a long-term visa prior to entry into the United Kingdom, there are a number of people who can apply for a Hong Kong British National Overseas (HK BN(O)) visa from within the UK without undergoing pre-entry screening. This is due to applicants initially being able to enter the UK on a short-term visa (less than 6 months). Individuals applying for a HK BN(O) visa that already reside in the UK and did not provide a TB test certificate when they last entered the UK must undergo TB screening at one of 8 clinics approved by the Home Office (see Tuberculosis testing in the UK for Hong Kong BN(O)).

NHSE new entrant migrant LTBI testing programme

The NHSE National LTBI testing, and treatment programme was introduced in 2015 as part of the Tuberculosis (TB): collaborative strategy for England (2015 to 2020). It is a key component of the TB Action Plan. The programme is commissioned and managed by NHSE with UKHSA responsible for the data collection database and the analysis and submission of this data to NHSE, used for payment per test to participating ICBs and monitoring and evaluation of the programme.

Some ICBs have local arrangements for LTBI testing and treatment outside of the nationally commissioned programme, for which no data is received by UKHSA and is not reported here.

Question 2

Supplementary tables

Accepted Answer

Data relating to this chapter can be found in the 25 supplementary data tables in the accompanying spreadsheet, Tuberculosis prevention, supplementary data, which is available to download.

Question 3

UK pre-entry TB screening programme

Accepted Answer

In 2024, 82% of all people notified with TB in England were born outside the UK (see the Incidence and epidemiology chapter). The UK pre-entry TB screening programme is intended to reduce the importation of active pulmonary TB among applicants for long-term visas by screening migrants from high TB incidence countries (more than 40 per 100,000) for active pulmonary TB by symptoms review and chest X-ray (CXR) when applying for a long-term (more than 6 months) UK visa (UK tuberculosis technical instructions).

Screening numbers over time, by country and screening provider

The programme has operated in 102 countries since 2014 (see Supplementary Table 1 of the accompanying data set).

In 2024 there were 707,839 people screened, a decrease of 41.3% from 1,206,358 in 2023 (see Figure 1 and Supplementary Table 2). This is the first decrease since 2020, correlating with the reduction of migration because of policy changes in 2024 (see the Office for National Statistic report Long-term international migration, provisional). Screening is provided by either International Organization of Migration (IOM) or non-IOM clinics. Detailed analysis is reported for the provider types separately due to issues with data completion from non-IOM providers. Some countries have both types of providers (see Supplementary Table 1 of the accompanying data set for more details).

Figure 1. Number of people screened by screening provider, 2014 to 2024

Data used to create Figure 1 can be found in Supplementary Table 2 of the accompanying data set.

The largest number of people screened in 2024 were in India (161,540, 22.8%), followed by Pakistan (122,828, 17.4%) and China (115,471, 16.3%) (see Table 1 and Supplementary Table 3). In comparison to 2023, the number of people screened in countries shown in Table 1 all decreased, apart from Nepal which increased by 20.0% (30,176 compared to 25,146). The proportion of the total screened in Pakistan and China increased by 31.8% and 64.6% respectively, and the proportion screened in Nigeria decreased by 48.4% (see Supplementary Table 3).

Table 1. Number of reported screening episodes and people screened by country of screening in 2024.

Country of screening	Number of screening episodes	Number of people screened	Percentage of people screened by country
India	166,924	161,540	22.8
Pakistan	127,898	122,828	17.4
China	116,334	115,471	16.3
Nigeria	59,272	57,805	8.2
Bangladesh	34,204	32,432	4.6
Nepal	30,791	30,176	4.3
Ghana	24,488	23,695	3.3
Zimbabwe	20,546	19,687	2.8
Hong Kong	17,752	17,550	2.5
Sri Lanka	16,847	16,167	2.3
Philippines	14,074	13,684	1.9
South Africa	12,095	11,841	1.7
Kenya	11,034	10,730	1.5
Other	75,473	74,361	10.5
Total	727,732	707,839	100.0

Note to Table 1: the table is ordered by number of screens per country and limited to countries reporting more than 10,000 screening episodes. Some individuals were reported as having been screened more than once, accounting for the difference between the number of screening episodes and people screened. Some people were also screened in more than one country, so the total of people screened is less than the sum of people screened in each country. For a detailed breakdown of all countries by service provider see Supplementary Table 3 of the accompanying data set).

Age, sex and visa type of screening population

Age was known for 80.2% of screening episodes (583,658 of 727,732). The greatest proportion of screens in 2024 were among people aged 20 to 29 (50.5%; 294,706 of 583,658 episodes with known age) (see Appendix figure A1(A) and Supplementary Table 4 in the accompanying data set). The proportion of males and females screened in each age category was similar with an overall proportion of 53.2% males (246,289 of 466,630 where sex was known) (see Supplementary Table 5 of the accompanying data set for more details).

Student visas accounted for the largest proportion of screens with a known visa type (48.9%; 284,896 of 582,612) followed by work visas (26.0%; 151,714 of 583,612) and settlement and dependents visas (20.9%; 121,998 of 583,612). The proportions changed across age categories where student visas made up most of the total in the 20 to 29 age group (69.6%; 205,159 of 294,683).

See Appendix Figure A1(B) and Supplementary Table 6 of the accompanying data set for more details).

TB case detection rate by the programme

In 2024, 338 people were diagnosed with pulmonary TB by the programme, which is a decrease from 528 in 2023 (see Figure 2 and Supplementary Table 7 of the accompanying data set). The overall TB case detection rate was 47.8 per 100,000 (42.7 to 52.8); 103.2 (90.4 to 116.0) for IOM and 18.9 (15 to 22.9) for non-IOM. Despite a reduction in TB diagnoses in 2024, the overall TB case detection rate increased by 9.1% compared with the previous year, which was the lowest rate since 2018.

Figure 2. Number of people with confirmed TB (panel A) and TB case detection rate (panel B) by screening provider, 2018 to 2024

Note to Figure 2: data is presented from 2018 due to earlier data quality and a change in methodology affecting non-IOM clinics – for more information see the Methodology and data sources chapter of this report.

Data used to create Figure 2 can be found in Supplementary Table 7 of the accompanying data set.

TB detection rates were lower in non-IOM screening clinics; however, sputum test results were incomplete for 41.6% (2,358 out of 5,664) of sputum referrals, due to pending results, loss to follow-up, and unknown reason, and this is likely to result in an underestimate of the true rate of detection. Incomplete sputum results in IOM clinics for the same reason were noticeably lower at 13.1% (972 out of 7,110). In non-IOM data, applicants with an abnormal CXR but no sputum culture result who were recorded as ‘TB suspected’ were considered possible TB cases (see Methodology and data sources chapter of this report). If people with possible TB were included (Appendix Figure A2) the total number of people with active TB in 2023 was 1,075. This results in a TB case detection rate that is higher in non-IOM compared with IOM clinics and, therefore, is most likely an overestimate.

Data reflecting the diagnostic flow resulting in a person being diagnosed with culture-confirmed or clinically diagnosed TB reported by IOM clinics and non-IOM clinics is shown in Appendix Figures A3 and A4 and Supplementary Table 8 in the accompanying data set.

Demographics of individuals diagnosed with TB

In 2024, the highest case detection rate was from people screened in the Philippines (387.3 per 100,000, 95%CI: 283.2 to 491.4), followed by Nepal (248.5 per 100,000, 95%CI: 192.4 to 304.7), where the greatest number of people with confirmed TB were diagnosed. Both countries had most or all screens from IOM clinics (see more detail in Supplementary Table 3 in the accompanying data set).

Age, sex and visa type information of individuals diagnosed with TB in the programme was analysed over 3 years between 2022 and 2024. TB case detection rate was similar in males (51.8 per 100,000, 95%CI: 47.8 to 55.9) and females (48.0 per 100,000, 95% CI: 44.0 to 52.0). The TB case detection rate increased with age. It was 47.0 per 100,000 (95%CI: 43.0 to 51.1) in the largest age group of 20 to 29 years, significantly increasing in each subsequent age group, reaching 273.1 per 100,000 (95%CI: 175.5 to 370.7) in those aged 60 years or more (see Appendix Figure A5). Similarly, the case detection rate in people with student visas was significantly lower at 32.2 per 100,000 (95% CI: 28.8 to 35.6) than people with other visa categories (see Appendix Figure A6), likely due to their younger age (Appendix Figure A1B). See Supplementary Table 9 of the accompanying data set for more details.

Drug susceptibility in culture-confirmed TB

TB culture and drug susceptibility testing (DST) is a mandatory requirement under the UK tuberculosis technical instructions. Very limited conclusions can be drawn about drug resistance in the pre- entry screening cohort due to incomplete data returns. While culture confirmation is reported for 88.5% (299 out of 338) individuals with confirmed TB in 2024, this is mainly from IOM countries and excludes a number of high burden countries for multidrug-resistant (MDR) disease. Drug susceptibility is reported for 71.6% (214 out of 299) of culture-confirmed individuals (see Table 2 and Supplementary Table 10 in the accompanying data set).

Table 2. Drug resistance in people with culture-confirmed tuberculosis in both IOM and non-IOM clinics in 2024

Drug susceptibility category	Number of people with positive sputum culture	Percentage of total positive sputum cultures
Isoniazid mono-resistant	10	3.3
Mono-resistant other	2	0.7
Multidrug-resistant or rifampicin-resistant	9	3.0

Note to Table 2: drug sensitivity results were reported for 214 of 299 positive cultures in 2024; 193 were sensitive to all drugs tested.

Table 2 shows drug resistance in people with culture-confirmed tuberculosis in 2024 in both IOM and non-IOM clinics as defined under the 2021 World Health Organization (WHO) TB DST definitions. See Supplementary Table 10 for more details and a breakdown by screening provider and country.

Screening in the UK for Hong Kong British National (Overseas) visa applicants

There are a number of people who can undergo pre-entry screening from within the UK when applying for a Hong Kong British National Overseas (HK BN(O)) visa (see Background information for more details).

Between 2022 and 2024, 2,330 of HK BN(O) visa applicants were screened in the UK, 25 CXR results were suggestive of TB, and no applicants were diagnosed with active TB.

Table 3. Number of people screened in the UK for HK BN(O) visa applications

Screening year	Number of people screened	Number of CXRs suggestive of TB
2022	745	4
2023	701	8
2024	884	13

Note to Table 3: some people were screened in more than one year, so the total of people screened is less than the sum of people screened in each year.

Question 4

LTBI testing and treatment programme for new entrants

Accepted Answer

The LTBI programme is commissioned by NHSE in integrated care boards (ICBs) with a higher burden of TB - 26 out of 42 ICBs in 2024. Individuals are eligible for testing in the programme if they migrated to England from a high TB incidence country (more than 150 per 100,000 population or any country in sub-Saharan Africa), have registered with a GP within 5 years of entering the UK and are 16 to 35 years of age (see National latent tuberculosis infection testing and treatment programme).

Proportion of eligible new entrant migrants tested

The numbers of people eligible for testing increased nearly three-fold between 2019 (80,665 individuals) and 2024 (234,814 individuals), The number eligible in 2024 was a decrease from 2023, when 304,949 were eligible (see Figure 3 and Supplementary Table 11 in the accompanying data set).

In 2024, 40,490 people were tested through the programme, representing 17.2% of the eligible population and an increase from 2023, when 34,858 people were tested. This is an increase in number compared with all years since 2019 and a higher proportion than every year in the period except 2019 (see Figure 3).

The percentage of people tested remains below the initial annual goal of the programme to test 25% of eligible new entrant migrants; however, it significantly exceeds the original commissioned number of 20,000 tests annually. The increased number was possible in 2024 because of additional non-recurrent funding being released by NHS England for the programme.

Figure 3. Number of eligible new entrant migrants and number tested by year with the proportion tested England from 2019 to 2024

Data used for Figure 3 can be found in Supplementary Table 11 and by UK Health Security Agency (UKHSA) region and ICB for each year in Supplementary Tables 12 and 13 of the accompanying data sets.

Numbers tested by UKHSA region from 2019 to 2024 are shown in appendix Figure A7. London, with the highest number of eligible migrants, has the most people tested in each year, however the proportion of eligible people tested is highest outside London. In 2024, Yorkshire and Humber UKHSA region tested the greatest proportion of eligible migrants (32%) (Supplementary Table 12 in the accompanying data set). Data by ICB is found in Supplementary Table 13 of the accompanying data set). As a low incidence area, the North East region of England does not have any ICBs commissioned to do programmatic testing.

Demographic characteristics (age, sex and country of birth) of eligible new entrant migrants who were tested through the programme were compared with those who were not tested for the period 2019 to 2024. The demographics of eligible individuals tested (age, sex and country of birth) were similar to those who were not tested (see Supplementary Table 14 of the accompanying data set).

In 2024 the greatest number of people eligible for the programme were born in or travelled from India (95,500). The highest proportion of eligible people tested were from Bangladesh (20.9%) and Afghanistan (20.1%).

Table 4 and Supplementary Table 15 of the accompanying data set describe numbers, numbers tested and test positivity for the country of birth or travel with the top 10 highest eligible new entrant migrants’ numbers and information for all countries, respectively.

Proportion of people testing positive

In 2024, 6,097 (15.1%) people tested positive for latent TB infection through the commissioned LTBI programme. Although the number testing positive has increased, as the number testing has also increased the proportion testing positive is slightly lower than the number and proportion in 2023 (5,324 or 15.3%) (p=0.42), see Figure 4.

Figure 4. The number of tests and number and proportion of positive tests in, England, 2019 to 2024

Data used for this figure can be found in Supplementary Table 16 of the accompanying data set.

The proportions of migrants testing positive in the programme varied widely by country of birth. The proportions may be unreliable where only small numbers of individuals have been tested. For countries with at least 100 individuals tested between 2019 and 2024, test positivity ranged from 6% in people from South Africa (6 of 100 individuals tested in 2021) to 41.6% in people from Kenya (84 of 202 individuals tested in 2023).

In 2024, people from Sudan, Eritrea, Zimbabwe and Nigeria had a LTBI positivity of 20% or higher (see Table 4). For other countries and years see Supplementary Table 15 in the accompanying data set.

Country of birth

In 2024 8 out of the top 10 countries for number of people eligible for LTBI testing were also in the top 10 in 2023. The 2 new countries in 2024 were Eritrea and Sudan, both of which had LTBI positivity of over 30%. Bangladesh was the only country in 2024 to have a positivity below 10%, as it did in 2023.

Table 4. LTBI testing rates and positivity for the top 10 countries by number of eligible new migrants, England, 2024

Country of birth	WHO rate per 100,000 population [note 1]	Number of eligible new entrant migrants	Number of eligible new entrant migrants tested	Percentage eligible new entrant migrants tested	Positive tests	Positivity (percentage)
India	195	95,500	13,739	14.4	2,235	16.3
Pakistan	277	43,007	5,549	12.9	681	12.3
Nigeria	219	18,742	2,615	14.0	522	20.0
Bangladesh	221	14,813	3,101	20.9	290	9.4
Nepal	229	9,747	953	9.8	183	19.2
Ghana	129	9,174	1,166	12.7	142	12.2
Afghanistan	180	7,156	1,435	20.1	236	16.4
Zimbabwe	211	3,801	333	8.8	72	21.6
Eritrea	65	3,458	529	15.3	183	34.6
Sudan	50	3,045	477	15.7	145	30.4

Note 1: WHO rate from 2023.

General note to Table 4: data about country of birth was missing for 8,069 (19.9%) individuals in 2024.

Data used for this table can be found in Supplementary Table 15 of the accompanying data set.

LTBI positivity by demographic characteristics

Test positivity increased with age and was higher in males (Figure 5). Since 2019 the positivity has reduced in the older age groups (see Supplementary Table 17 in the accompanying dataset).

Figure 5. LTBI positivity in different age groups by sex England 2024

Proportion of new entrant migrants diagnosed with LTBI who complete prophylactic treatment

In 2024, 715 (11.7%) of the 6,097 people who tested positive for LTBI were recorded as having completed treatment. This was significantly lower than in 2023 and 2022 at 20.4% (1,088 people) and 23.8% (594 people), respectively (p-value less than 0.001) (see Figure 6 and Supplementary Table 18 in the accompanying data set).

The lower proportion of treatment completion in 2024 may in part result from delays in updating treatment information. However, all years have large amounts of missing data on treatment uptake and completion (see Figure A8 and the Methodology section of this report) so these figures should be interpreted with caution. There is currently no additional payment to TB services for recording the treatment completion data.

Figure 6. Number of LTBI positive tests, number and proportion of people who complete prophylactic treatment, England, 2019 to 2024

Data used for this figure can be found in Supplementary Table 18 in the accompanying data set.

Figure A8 of the appendix and Supplementary Table 13 of the accompanying data set describe the number of tests done and positive by UKHSA region in 2024, and from 2019 to 2024, respectively.

London reported the highest number of positive tests (3,982) but its recorded treatment completion percentage was low (9.3% of 369 people) compared to the South West (43.1% of 369 people).

Three-year average active TB rate by ICB sub-locations with number of people eligible for the LTBI testing and treatment programme

The NHSE LTBI programme was originally commissioned in clinical commissioning groups (CCGs) with the highest rates of TB in 2015, when the programme started. The programme is now commissioned through ICBs. ICBs agree which sub-ICBs to include and engage in the programme (see Supplementary Table 19 in the accompanying data set for detailed information). There were 19 ICB sub-locations with rates of 10 per 100,000 population or higher. Three of the 19 ICB sub-locations were not actively testing new entrant migrants for LTBI in 2024. The size of the eligible population can also be viewed in Supplementary Table 19.

Question 5

Contact tracing

Accepted Answer

Contact tracing remains a cornerstone of TB management and prevention by interrupting chains of transmission and reducing the overall burden of disease.

Contact tracing has 3 main objectives:

identification of individuals with undiagnosed active TB
testing to identify people with latent infection followed by chemoprophylaxis to prevent development of active disease
vaccination with BCG of those eligible

There is evidence that treating latent infection with chemoprophylaxis is safe and prevents progression to active disease, reducing morbidity and mortality for the individual and further spread of TB into the population.

Assessment and screening of close contacts should be undertaken in line with National Institute for Health and Care Excellence (NICE) guidance.

Contact tracing data is presented from England between 2018 and 2024. Data on contact tracing information in individuals with pulmonary TB was first reported in the TB prevention in England 2022 report. Individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.

Contact tracing information for people with active TB

In 2024, there were 2,980 people notified with pulmonary TB, who therefore required contact tracing according to NICE guidance. Of these, 81.9% (2,440 individuals) had contact tracing information recorded or had fewer than 65 contacts identified, a 7.8% decrease compared with 2023. The proportion of people with pulmonary TB for whom contact information was recorded for 2021 to 2024 for England and by UKHSA region are shown in Appendix Figure A9 and Supplementary Table 20 in the accompanying data set.

Figure 7 describes the number of contacts of people notified with pulmonary TB (index individuals) who had contacts assessed in England in 2024. Data between 2021 and 2024 is presented in Supplementary Table 21 in the accompanying data set. Where contact information was recorded, the median number of contacts identified per person notified with pulmonary TB was 3 (interquartile range or IQR: 1 to 5). The distribution of the total number of contacts identified per notification of infectious TB between 2021 and 2024 is presented in Appendix Figure A10.

The majority of individuals with pulmonary TB (69.1%; 1,686 of 2,440) for whom contact tracing information was recorded had fewer than 5 contacts identified.

Figure 7. Flow diagram of the number of contacts of people notified with pulmonary TB (index individuals) identified, traced and assessed, England 2024

Notes to Figure 7:

proportions for individuals with contact tracing information entered, missing contact tracing information and those with greater 65 contacts identified are derived from the total number of pulmonary notifications
proportions for individuals with 0, 1 to 4, and 5 or more contacts identified are derived from individuals with contact tracing information entered
proportions for individuals with information recorded for assessed contacts was derived from the number of individuals with 0, 1 to 4, and 5 or more contacts identified
proportions for individuals with 0, 1 to 4, and 5 or more contacts assessed are derived from the number of individuals with information recorded for assessed contacts

Figure 7: text description

This flowchart shows the number and proportion of individuals with contact information in England in 2024. It starts with 2,983 pulmonary cases, of which 540 (18.1%) are missing contact information. Of the 2,983 individuals, 3 (0.1%) individuals had more than 65 contacts identified.

A total of 9,676 contacts were identified for the 2,440 individuals that did have contact tracing information entered. This is a median of 3 identified for every individual notified with pulmonary TB.

Of the 2,440 individuals that did have contact tracing information entered, 326 (13.4%) had 0 contacts entered, and therefore no contacts were identified.

Of 2,440 individuals with contact tracing information entered, 1,360 individuals (55.7%) had 1 to 4 contacts identified. Of these 1,360 individuals, 271 (19.9%) had no information recorded for contacts, leaving 1,089 (80.1%) who did have information recorded for contacts and who were assessed with further screening. Of these 1,089, 108 (9.9%) had 0 contacts assessed, and 981 (90.1%) had 1 to 4 contacts assessed.

Of the 2,440 individuals that did have contact tracing information entered, 754 (30.9%) had 5 or more contacts identified. Of these 754 individuals, 90 (11.9%) had no information recorded for contacts, leaving 664 (88.1%) who did have information recorded for contacts and who were assessed with further screening. Of these 664, 22 (3.3%) had 0 contacts assessed, 96 (14.5%) had 1 to 4 contacts assessed, and 546 (82.2%) had 5 or more contacts assessed.

People notified with pulmonary TB (index individuals) who were identified, traced and assessed

Contact tracing information by demographic and social risk factors, and disease characteristics between 2021 and 2024 are presented in Supplementary Table 22 in the accompanying data set.

Contact tracing practices vary between services. Some services routinely carry out contact tracing on individuals with non-pulmonary disease based on local epidemiology, although this is not included in NICE guidance. Contact tracing information was recorded for 78.7% of people with non-pulmonary TB in 2024 (1,974 out of 2,507). Fewer contacts were recorded than for those with pulmonary disease with a total of 3,850 contacts (median of 1 contact; IQR: 0 to 3 close contacts).

Screening and treatment results in close contacts

Table 5 shows the numbers and proportion of adult and child contacts in 2023 and 2024 who were identified, screened, tested positive for LTBI, then started and completed treatment.

In 2024, a total of 9,676 contacts were identified from 2,980 people notified with pulmonary TB who had contact information recorded and who had fewer than 65 contacts recorded. Of those contacts, 72.1% were screened for active and latent TB while 18.3% tested positive for latent TB. A further 2.6% were reported to have active TB disease, compared with 2.8% in 2023 (see Table 5). This equates to 75 people with active TB and 523 with LTBI being identified for every 1,000 index individuals contact traced.

Table 5. Number of adult and child contacts of people notified with pulmonary TB (index individuals) screened and treated for active TB and latent TB infection, England, 2023 and 2024

Screening and treatment categories	All adult contacts in 2023	All child contacts in 2023	Total contacts in 2023	All adult contacts in 2024	All child contacts in 2024	Total contacts in 2024
Number of contacts identified	7,496	2,359	9,855	7,483	2,193	9,676
Number of contacts screened for active TB and latent TB (percentage)	5,783 (77.1%)	1,990 (84.4%)	7,773 (78.9%)	5,269 (70.4%)	1,711 (78%)	6,980 (72.1%)
Number of contacts with active TB (percentage)	144 (2.5%)	77 (3.9%)	221 (2.8%)	112 (2.1%)	70 (4.1%)	182 (2.6%)
Number of contacts with latent TB (percentage)	967 (16.7%)	459 (23.1%)	1,426 (18.3%)	916 (17.4%)	360 (21%)	1,276 (18.3%)
Number of contacts who started treatment for latent TB (percentage)	675 (69.8%)	407 (88.7%)	1,082 (75.9%)	642 (70.1%)	332 (92.2%)	974 (76.3%)
Number of contacts who completed treatment for latent TB (percentage)	537 (55.5%)	353 (76.9%)	890 (62.4%)	458 (50%)	250 (69.4%)	708 (55.5%)

Notes to Table 5:

the denominator for proportion of contacts screened for active TB and latent TB infection is number of contacts identified
the denominator for the proportion of contacts positive for active TB and LTBI is the number of contacts screened
the denominator for the proportion of contacts who started and completed treatment is the number of contacts positive for LTBI
individuals with greater than 65 contacts were excluded in the analysis

In 2024, children (aged 14 years or under) made up 22.7% of all contacts identified. Child contacts were more likely to be screened than adult contacts, and slightly more likely to have active (4.1% of child contacts, 2.1% of adults) and latent TB disease (21.0% versus 17.4%). This was similar to 2023 (see Table 5).

Just over three-quarters (76.3%) of all contacts with a positive LTBI test started treatment for latent TB and 55.5% were recorded as having completed treatment. This marks the lowest recorded percentage since reporting began (see Supplementary Table 23 in the accompanying data set from 2018).

Screening and treatment results varied by UKHSA region and are shown in Supplementary Table 24 in the accompanying data set, and proportions of treatment completion for LTBI by UKHSA region are shown in Appendix Figure A11 for 2021 to 2024.

Contacts of child index individuals compared with adult index individuals have generally had higher LTBI treatment completion rates, most notably in 2018 and 2019, but LTBI treatment completion percentages have decreased since 2018 in contacts of both adult and child index individuals, and are considerably lower in 2024 (see Figure 8 and Supplementary Table 25 in the accompanying data set). A similar trend was observed for contacts of index individuals by place of birth.

Figure 8. Latent TB infection (LTBI) treatment completion (proportion) in close contacts of adult or child index individuals (Panel A) and UK born or non-UK born index individuals (Panel B) with pulmonary TB, England, 2018 to 2024

Note to Figure 8: individuals with more than 65 contacts were excluded.

Data underlying this figure can be seen in Supplementary Table 25 of the accompanying data set.

Question 6

BCG vaccination

Accepted Answer

The BCG vaccination programme is a risk-based programme recommended for individuals at higher risk of exposure to TB. This includes all infants (0 to 12 months) with a parent or grandparent born in a country where the annual incidence of TB is over 40 notifications per 100,000 population per year. In addition to this, all infants living in an area of the UK with an incidence above 40 per 100,000 population should be offered the BCG vaccine.

Eligible babies should be offered the BCG vaccine at 28 days or soon after. Detailed information on the BCG programme can be found in the Green Book. Evaluation studies have identified that BCG is most effective against the most severe forms of the disease, such as TB meningitis in children and less effective in preventing respiratory disease, which is the more common form in adults.

As part of the Cover of Vaccination Evaluated Rapidly (COVER) programme, BCG is included in the quarterly childhood vaccine coverage data extraction from local child health information systems (CHIS). This includes denominators of eligible children and therefore coverage for all local authorities of children at 3 months.

In Table 6 BCG vaccine coverage data is presented for England and by region from January to December 2024. For England, BCG coverage at 3 months of age for eligible children was 76.7%, varying from 41.9% in the North East to 86.3% in the West Midlands.

In Table 7 BCG vaccine coverage data is presented for local authorities with a 3-year TB incidence rate of greater than 20 per 100.000. The only local authorities with TB rates over 40 per 100,000 population were Newham and Leicester with BCG coverage of 86.0% and 87.0% compared with the highest coverage of 92.4% coverage in Wolverhampton and lowest of 71.0% in Redbridge.

Table 6. Annual BCG vaccine coverage of children up to 3 months old in England and in regions: January to December 2023

Area	Eligible population	Number of children vaccinated	Coverage (percentage)
England	183,322	140,695	76.7
London	58,029	44,502	76.7
West Midlands	24,845	21,435	86.3
North West	20,050	13,620	67.9
South East	24,131	19,612	81.3
East of England	17,587	14,331	81.5
East Midlands	12,271	9,393	76.5
Yorkshire and The Humber	15,056	12,069	80.2
South West	7,372	4,085	55.4
North East	3,981	1,670	41.9

Table 7. Annual BCG vaccine coverage of children up to 3 months old in English local authorities with a 3-year average TB rate of greater than 20 per 100.000: January to December 2024

Upper tier local authority	Three-year average (2022 to 2024) annual TB rate per 100,000	Number of eligible children	Number of children vaccinated	BCG coverage (per cent)
Tower Hamlets	20.2 (17.5, 23.2)	3,336	2,670	80.0
Barking and Dagenham	21.2 (17.9, 25)	2,631	1,882	71.5
Wolverhampton	22.3 (19.2, 25.7)	1,825	1,686	92.4
Luton	22.6 (19.2, 26.4)	3,557	3,000	84.3
Hillingdon	24.4 (21.4, 27.7)	2,533	2,132	84.2
Manchester	25.3 (23, 27.8)	3,799	2,909	76.6
Redbridge	29.9 (26.5, 33.6)	3,466	2,460	71.0
Hounslow	31.5 (27.9, 35.4)	2,395	1,982	82.8
Slough	32.8 (27.9, 38.3)	1,897	1,623	85.6
Ealing	33.6 (30.4, 37.2)	3,123	2,446	78.3
Harrow	35.0 (31, 39.4)	2,449	1,812	74.0
Brent	39.1 (35.4, 43.1)	3,058	2,386	78.0
Newham	41.4 (37.6, 45.3)	5,467	4,704	86.0
Leicester	42.1 (38.5, 46.1)	3,227	2,808	87.0

Question 7

Appendix

Accepted Answer

Figure A1. Distribution of number of screening episodes by age and sex (panel A) and age and visa type (panel B), 2024

Data used to create Figure A1 can be found in Supplementary Tables 5 and 6 of the accompanying data set.

Figure A2. Number of people with confirmed and possible TB by screening provider, 2018 to 2023

Data underlying this figure can be seen in Supplementary Table 7 of the accompanying data set.

Figure A3. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for non-IOM screening providers in 2024

Note 1: other sputum referrals are sputum tests carried out in applicants that 1) did not have a CXR suggestive of TB, but TB was still suspected or 2) in applicants that did not have a CXR due to pregnancy.

Note 2: a clinically-confirmed case is one that does not have a sputum culture-positive test result but meets clinical criteria for diagnosis.

Data used to create Figure A3 can be found in Supplementary Table 8 in the accompanying data set.

Figure A3: text description

This flow chart shows the number of screening episodes in 2024 at non-IOM clinics. The steps in the process include the chest X-rays (CXRs), sputum tests, and the final number diagnosed with TB.

It starts with 477,199 screening episodes of which 440,008 had a CXR and 37,191 did not. Of the 37,191 episodes that did not have a CXR, 37,085 were a child, 36 were pregnant and 70 had an unknown reason.

Of the 440,008 screening episodes that had a CXR, 435,965 were not suggestive of TB and 4,043 were abnormal suggestive of TB. Of the 435,965 episodes not suggestive of TB, 428,420 were normal, 6,459 were abnormal without TB and 1,086 were an unknown result.

In addition to the 4,043 screening episodes that had a CXR suggestive of TB, a further 1,620 episodes were referred for sputum testing because TB was still suspected despite a negative CXR, or because the applicant did not have a CXR due to pregnancy. This brought the total number eligible for sputum testing to 5,663.

Of the 5,663 eligible for sputum testing, 4 were smear positive only, 3,227 were sputum negative, 186 were pending a result, 178 had an inconclusive result, 1,521 were lost to follow-up and 473 were not done for unknown reasons. The remaining 74 episodes were culture positive. An additional 15 episodes were diagnosed as clinically confirmed TB where one does not have a sputum culture positive result but meets the clinical criteria for diagnosis. This brought the total number of confirmed TB cases to 89, which represented 88 individual people with TB.

Figure A4. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for IOM screening providers in 2024

Note 1: other sputum referrals are sputum tests carried out in applicants that 1) did not have a CXR suggestive of TB, but TB was still suspected or 2) in applicants that did not have a CXR due to pregnancy.

Note 2: a clinically-confirmed case is one that does not have a sputum culture-positive test result but meets clinical criteria for diagnosis.

Data used to create Figure A4 can be found in Supplementary Table 8 in the accompanying data set.

Figure A4: text description

This flow chart shows the number of screening episodes in 2024 at IOM clinics. The steps in the process include the chest X-rays (CXRs), sputum tests, and the final number diagnosed with TB.

It starts with 250,533 screening episodes of which 215,916 had a CXR and 34,617 did not. Of the 34,617 episodes that did not have a CXR, 34,489 were a child, 99 were pregnant, 17 had another reason and 70 had an unknown reason.

Of the 215,916 screening episodes that had a CXR, 208,893 were not suggestive of TB and 7,023 were abnormal suggestive of TB. Of the 208,893 episodes not suggestive of TB, 194,384 were normal, 14,503 were abnormal without TB and 6 were an unknown result.

In addition to the 7,023 screening episodes that had a CXR suggestive of TB, a further 125 episodes were referred for sputum testing because TB was still suspected despite a negative CXR, or because the applicant did not have a CXR due to pregnancy. This brought the total number eligible for sputum testing to 7,148.

Of the 7,148 eligible for sputum testing, 12 were smear positive only, 5,938 were sputum negative, 17 were pending a result, none had an inconclusive result, 946 were lost to follow-up and 9 were not done for unknown reasons. The remaining 226 episodes were culture positive. An additional 25 episodes were diagnosed as clinically confirmed TB where one does not have a sputum culture positive result but meets the clinical criteria for diagnosis. This brought the total number of confirmed TB cases to 251, which represented 250 individual people with TB.

Figure A5. TB case detection rate by 10-year age group (2022 to 2024)

Data used to create Figure A5 can be found in Supplementary Table 9 in the accompanying data set.

Figure A6. TB case detection rate by visa type (2022 to 2024)

Data used to create Figure A6 can be found in Supplementary Table 9 in the accompanying data set.

Figure A7. The number of valid tests by UKHSA region in England from 2019 to 2024

Figure A7 and Supplementary Table 12 in the accompanying data set describe testing numbers by UKHSA region from 2019 to 2024. The South West was not entering negative tests prior to 2022 and so is under-reported before this time. In 2024 Yorkshire and Humber tested the highest proportion of its eligible migrant population (32.1%). The region that tested the smallest proportion of its eligible migrant population was the East of England (5.4%). Information by ICB level can be found in Supplementary Table 13 in the accompanying data set.

Figure A8. The number of positive tests and completed treatments with percent completion for each UKHSA region in England in 2024

Note to Figure A8: treatment completion as a percentage of those who tested positive is shown at the end of the completed treatment bar.

Data used in this figure can be found in Supplementary Table 12 of the accompanying data set.

In 2024, the UKHSA regions with over 25% completion of treatment were the South West (43.1%) and South East (28.3%), shown in Figure A8. Information by ICB level can be found in Supplementary Table 13 of the accompanying data set.

Contact tracing

Appendix Figure A9. Proportion of people notified with pulmonary TB with contact tracing information recorded by UKHSA region, England 2021 and 2024

Appendix Figure A10. Histogram of the number of contacts per notification of pulmonary TB, England 2021 to 2024

Appendix Figure A11. LTBI treatment completion in close contacts of people with pulmonary TB by UKHSA region, England 2021 to 2024

Question 8

Background information

Accepted Answer

Pre-entry screening programme

The UK pre-entry screening programme replaced on-entry screening at UK airports in March 2014. It uses chest X-ray (CXR) based screening for active pulmonary TB carried out by appointed panel clinics, usually in the country of origin, with sputum cultures conducted for those with those with abnormal CXR considered to be consistent with TB.

Whilst pre-entry screening for active TB is a requirement when applying for a long-term visa prior to entry into the United Kingdom, there are a number of people who can apply for a Hong Kong British National Overseas (HK BN(O)) visa from within the UK without undergoing pre-entry screening. This is due to applicants initially being able to enter the UK on a short-term visa (less than 6 months). Individuals applying for a HK BN(O) visa that already reside in the UK and did not provide a TB test certificate when they last entered the UK must undergo TB screening at one of 8 clinics approved by the Home Office (see Tuberculosis testing in the UK for Hong Kong BN(O)).

NHSE new entrant migrant LTBI testing programme

The NHSE National LTBI testing, and treatment programme was introduced in 2015 as part of the Tuberculosis (TB): collaborative strategy for England (2015 to 2020). It is a key component of the TB Action Plan. The programme is commissioned and managed by NHSE with UKHSA responsible for the data collection database and the analysis and submission of this data to NHSE, used for payment per test to participating ICBs and monitoring and evaluation of the programme.

Some ICBs have local arrangements for LTBI testing and treatment outside of the nationally commissioned programme, for which no data is received by UKHSA and is not reported here.

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Applies to England

Main points

Supplementary tables

UK pre-entry TB screening programme

Screening numbers over time, by country and screening provider

Figure 1. Number of people screened by screening provider, 2014 to 2024

Table 1. Number of reported screening episodes and people screened by country of screening in 2024.

Age, sex and visa type of screening population

TB case detection rate by the programme

Figure 2. Number of people with confirmed TB (panel A) and TB case detection rate (panel B) by screening provider, 2018 to 2024

Demographics of individuals diagnosed with TB

Drug susceptibility in culture-confirmed TB

Table 2. Drug resistance in people with culture-confirmed tuberculosis in both IOM and non-IOM clinics in 2024

Screening in the UK for Hong Kong British National (Overseas) visa applicants

Table 3. Number of people screened in the UK for HK BN(O) visa applications

LTBI testing and treatment programme for new entrants

Proportion of eligible new entrant migrants tested

Figure 3. Number of eligible new entrant migrants and number tested by year with the proportion tested England from 2019 to 2024

Proportion of people testing positive

Figure 4. The number of tests and number and proportion of positive tests in, England, 2019 to 2024

Country of birth

Table 4. LTBI testing rates and positivity for the top 10 countries by number of eligible new migrants, England, 2024

LTBI positivity by demographic characteristics

Figure 5. LTBI positivity in different age groups by sex England 2024

Proportion of new entrant migrants diagnosed with LTBI who complete prophylactic treatment

Figure 6. Number of LTBI positive tests, number and proportion of people who complete prophylactic treatment, England, 2019 to 2024

Three-year average active TB rate by ICB sub-locations with number of people eligible for the LTBI testing and treatment programme

Contact tracing

Contact tracing information for people with active TB

Figure 7. Flow diagram of the number of contacts of people notified with pulmonary TB (index individuals) identified, traced and assessed, England 2024

Figure 7: text description

People notified with pulmonary TB (index individuals) who were identified, traced and assessed

Screening and treatment results in close contacts

Table 5. Number of adult and child contacts of people notified with pulmonary TB (index individuals) screened and treated for active TB and latent TB infection, England, 2023 and 2024

Figure 8. Latent TB infection (LTBI) treatment completion (proportion) in close contacts of adult or child index individuals (Panel A) and UK born or non-UK born index individuals (Panel B) with pulmonary TB, England, 2018 to 2024

BCG vaccination

Table 6. Annual BCG vaccine coverage of children up to 3 months old in England and in regions: January to December 2023

Table 7. Annual BCG vaccine coverage of children up to 3 months old in English local authorities with a 3-year average TB rate of greater than 20 per 100.000: January to December 2024

Appendix

Figure A1. Distribution of number of screening episodes by age and sex (panel A) and age and visa type (panel B), 2024

Figure A2. Number of people with confirmed and possible TB by screening provider, 2018 to 2023

Figure A3. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for non-IOM screening providers in 2024

Figure A3: text description

Figure A4. Flow diagram of the number of screening episodes, chest X-ray results, sputum test results and laboratory- and clinically-confirmed cases of TB for IOM screening providers in 2024

Figure A4: text description

Figure A5. TB case detection rate by 10-year age group (2022 to 2024)

Figure A6. TB case detection rate by visa type (2022 to 2024)

Figure A7. The number of valid tests by UKHSA region in England from 2019 to 2024

Figure A8. The number of positive tests and completed treatments with percent completion for each UKHSA region in England in 2024

Contact tracing

Appendix Figure A9. Proportion of people notified with pulmonary TB with contact tracing information recorded by UKHSA region, England 2021 and 2024

Appendix Figure A10. Histogram of the number of contacts per notification of pulmonary TB, England 2021 to 2024

Appendix Figure A11. LTBI treatment completion in close contacts of people with pulmonary TB by UKHSA region, England 2021 to 2024

Background information

Pre-entry screening programme

NHSE new entrant migrant LTBI testing programme

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