Research and analysis

Executive summary

Published 9 October 2025

Applies to England

Executive summary

Tuberculosis (TB) is caused by bacteria of the Mycobacterium tuberculosis complex. It is spread predominantly by the respiratory route, where bacteria are aerosolised by people with pulmonary disease and are inhaled by susceptible individuals.

In 2014 the World Health Organization (WHO) adopted the Global End TB Strategy, which aims to eliminate TB as a public health problem. In September 2023 the UK reconfirmed its commitment to the fight against TB at the United Nations high-level meeting on TB. The UK Health Security Agency (UKHSA) and National Health Service England (NHSE) joint TB Action Plan for England 2021 to 2026 outlines outcomes and indicators to achieve a 90% reduction in people with TB by 2035, aligned with the WHO elimination targets. In common with many other countries, the UK is not on track to reach these targets.

TB incidence and epidemiology in England

In 2024, the steep upward trajectory of TB notifications seen in 2023 continued, with an increase of 13.6% (10.6% in 2023). This is the second year in a row that the largest annual increase in the reporting period (1971 to 2025) has been recorded. A total of 5,490 people were notified with TB disease. The rate of notifications is now 9.4 per 100,000 population, just below the WHO threshold of 10 per 100,000 for a low incidence country. However, rates are still below the peak in this century (15.6 per 100,000 in 2011).

Provisional data for the first 2 quarters of 2025 suggests that the upward trajectory may be slowing, with a 3.9% increase seen in the first half of 2025 compared with the same period in 2024. It is likely that England will cross the low incidence threshold of 10 per 100,000 notifications per year in 2025.

TB rates remain highest in urban areas, with the increase in numbers (1,651 to 1,876 individuals; 13.6% increase) remaining highest in the UKHSA London region. Rates are also highest in London (20.6 per 100,000 population). However, percentage increases above those in London were seen in the West Midlands (22.7%), Yorkshire and the Humber (19.2%) and the South West (17.7%). Although the numbers and rates are lower outside London, big percentage increases put great pressure on services.

In 2024, the same 2 local authority districts as in 2023 had a 3-year average notification rate above 40 per 100,000. These were Leicester City (East Midlands) at 42.1 per 100,000 and Newham (London) at 41.4 per 100,000.

Individuals born outside of the UK continued to account for most TB notifications in England (81.9%). The rate of TB notifications in people born outside the UK has increased from 41.3 per 100,000 in 2023 to 46.9 per 100,000 in 2024. The numbers and proportions of people with TB born outside the UK who are diagnosed within 5 years of entering the UK have increased significantly since 2021. In 2024, 41.1% of people were diagnosed within 5 years of entry, nearly three-quarters of whom were actually within 3 years of entry (74.9%). In 2021 these proportions were 31.3% within 5 years of entry and over half within 3 years (64.2%). This likely reflects the increased migration from higher incidence countries and effects of global disruptions in TB care due to the COVID-19 pandemic. Rates in individuals born in the UK increased by 5%.

Tuberculosis continues to be strongly associated with inequalities. The rate of TB notifications in the 10% of individuals living in the most deprived areas of England has increased from 15.7 per 100,000 in 2019 to 17.5 per 100,000 in 2024. This is more than 5 times the rate in the 10% of the population living in the least deprived areas (3.3 per 100,000). The proportion of people with TB having one or more social risk factors reported (alcohol misuse, drug misuse, homelessness, imprisonment, mental health needs and asylum seeker status) was 15.3% in 2024, similar to previous years.

TB prevention

Prevention of importation of individuals with active pulmonary disease is through the pre-entry TB screening programme for those entering the UK on visas for at least 6 months’ stay from countries where TB incidence is more than 40 per 100,000 individuals. The number of people screened before entry to the UK decreased by 41.3% in 2024 (707,839 individuals) compared with 2023 (1,206,358 individuals). However, the numbers tested are still far higher than in any year prior to 2022. A total of 338 people were diagnosed with pulmonary TB in the pre-entry process, and detection rates have remained stable since 2019.

Active TB disease can also be prevented by identifying, testing and treating people with latent TB infection (LTBI) as a result of contact with a known infectious individual or because they have migrated from a high incidence country.

In 2024, of the 69,809 people who were identified as contacts of a person with active pulmonary TB disease and tested for active TB and LTBI, 2.6% had active disease and 18.3% were positive for LTBI. These proportions are similar to 2023.

The numbers of migrants eligible for the NHS England Latent TB Infection programme who were tested continued to rise in 2024, when 40,490 people (17.2% of eligible people) were tested, compared with 34, 680 people in 2023 (11.4%). These numbers are much higher than in any previous year. The increased number of tests was possible in 2024 because of additional non-recurrent funding being released by NHS England for the programme. The proportion with positive LTBI tests remained stable at 15.1%

TB detection

Timely and accurate detection and management of TB improves disease outcomes and reduces onward transmission. Diagnostic delays, time from symptom onset to diagnosis, have not improved in England in over 5 years. The median diagnostic delay for pulmonary TB was 72 days in 2024; this has been static since 2018.

Laboratory culture confirmation of TB disease provides information on drug resistance and likely transmission. In 2024, 62.4% of individuals with TB had their diagnosis confirmed on culture, similar to previous years. Antibiotic susceptibility results for first line anti-TB drugs were reported for 99.1% of people with a positive culture.

Numbers of rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in England remain low overall, but similar in 2024 to 2023, when increases were seen in the proportion of both culture-confirmed RR or MDR TB. These are now the highest since enhanced surveillance began (2.2%). We have continued with the reporting, started for the first time in 2023, of results of susceptibility testing for the new and repurposed anti-TB antibiotics. In 2024, we have added reporting of susceptibility tests for pretomanid, a critical component of the shorter, all-oral treatment regimen for MDR TB now commissioned by NHS England. Rates of resistance for all of these agents remain very low. However, it is widely recognised as essential to test and report for these drugs to support their use and avoid further resistance development.

Whole genome sequencing (WGS) on culture-confirmed specimens is used to identify genetically similar TB strains, suggestive of recent transmission. The proportion of individuals with a positive TB culture in England who were part of a genomic cluster has declined since 2019 and is now 29.7%. This likely reflects a combination of changes in transmission patterns because of more TB notifications resulting from importation of new strains from recent migrants and, possibly, better awareness regarding airborne transmission and how to limit this due to the COVID-19 pandemic. The presence of any social risk factor nearly doubled the likelihood of being in a cluster (relative risk 1.93).

TB control

The proportion of individuals who complete their treatment has not improved in the last decade and averaged 84.4% at 12 months in people expected to complete treatment within this period. Lower treatment completion rates have continued in those with social risk factors (78.0%).

However, treatment completion at 24 months for those being treated with a regimen for MDR or RR TB has improved from 78.8% in 2013 to 83.3% for people starting treatment in 2022 (the last year for which outcome data for this cohort is reported due to the expected duration of therapy). This is likely due to the availability of improved and short course drug regimens.

In 2024, for all people notified in 2023 in the non-MDR or RR TB cohort, 4.6% of people had died at their last reported treatment outcome. This is a decrease compared with the peak of 6.0% in 2021 for people notified in the peak pandemic year of 2020.

TB in children

Children are particularly vulnerable to TB, especially those aged under 5 years, who are at greatest risk of developing severe TB disease. Data continues to be reported for children aged 0 to 17 years. In 2024 numbers in children increased by 12.7% and the notification rate by 14.3% mirroring increases in observed for all age groups. The proportion of children with TB who were born in the UK (41.1%) is much higher than for adults (18.1%).

The proportion of children diagnosed with pulmonary disease (68.2%) was higher than for the entire cohort (54.3%). However, a greater proportion of children with pulmonary TB started treatment by 2 months of symptom onset (59.5%) compared with the overall population with TB (40.9%) and complete treatment by 12 months (91.8% in children compared with 84.4% in the entire cohort).