Research and analysis

Executive summary

Published 29 October 2026

Applies to England

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 people.

TB incidence and epidemiology in England

In 2025, the steep upward trajectory of TB notifications seen in 2023 and 2024 halted with a total of 5,449 people notified with TB disease compared with 5,485 in 2024. The TB notification rate in England in 2025 was 9.26 per 100,000 population compared with 9.36 per 100,000 in 2024. TB notification rates are lower in the devolved administrations of Scotland, Wales and Northern Ireland resulting in a TB notification rate for the UK of 8.58 per 100,000 in 2025 (no change from 2024).

Provisional data for the first 3 quarters of 2026 suggests a small decrease in TB notifications (8.2% decrease) compared with the same period in 2025. TB rates remain highest in urban areas, with TB notification rates highest in the UKHSA London region (20.2 per 100,000 population). TB notification rates in all regions were similar to 2024.

In 2025, 3 local authority districts had a 3-year average notification rate above 40 per 100,000. These were Leicester City (East Midlands) at 45.2 per 100,000, and 2 in London, Brent (42.8 per 100,000) and Newham (42.0 per 100,000).

People born outside of the UK continued to account for most TB notifications in England (82.3%). The rate of TB notifications in people born outside the UK was similar in 2025 (45.64 per 100,000) to 2024 but increased from 2022 (36.6 per 100,000). 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 but were similar in 2025 and 2024. In 2025, 40.8% of people were diagnosed less than 5 years after UK entry and 31.3% less than 3 years compared with 27.7% and 20.1% in 2021. A similar increase was observed when limited to people notified with potentially infectious pulmonary TB. This likely reflects the increased migration from higher incidence countries and effects of global disruptions in TB care due to the COVID-19 pandemic.

Tuberculosis continues to be strongly associated with inequalities and this disparity has further increased in 2025. The rate of TB notifications in the 10% of people living in the most deprived areas of England increased from 14.5 per 100,000 in 2019 to 19.4 per 100,000 in 2025, whilst the rate in the least deprived has remained similar at 2.9 in 2019 and 2.8 per 100,000 in 2025. Rates in the most deprived areas were 6.9 times higher than the least deprived areas in 2025, increased from 5 times higher in 2019. 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 16.7% in 2025, similar to previous years.

TB prevention

The pre-entry TB screening programme aims to identify people with active pulmonary TB before they enter the UK. Those entering the UK on visas for at least 6 months’ stay from countries where TB incidence is more than 40 per 100,000 are eligible. The number of people screened before entry to the UK decreased in 2025 (588,113 people) compared with 2024 (724,332 people), continuing the downward trajectory from the peak in 2023 (1,257,723 people). This correlates with the reduction of migration in this period. A total of 268 people were diagnosed with pulmonary TB in the pre-entry process, and detection rates have remained broadly stable since 2021.

Cases of active TB disease in the UK 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 where exposure to TB occurred.

In 2025, of the 6,337 people who were identified as close contacts of a person with active pulmonary TB disease and tested for active TB and LTBI, 2.1% had active disease and 17.7% were positive for LTBI. These proportions are similar to 2024.

The numbers of migrants eligible for the NHS England Latent TB Infection programme decreased in 2025 to 202,389. Of these, 26,770 were tested, which represents 13.2% of eligible people, increasing to 17.0% when including people tested whose eligibility could not be verified (usually based on country of birth data being absent). These proportions are unchanged from 2024. The proportion with positive LTBI tests was 15.4%.

Only 17.5% of people with LTBI were recorded as starting prophylactic treatment.90.3% of these people completed treatment. This resulted in overall treatment completion for people with LTBI of 15.8%, lower than previous years, but also influenced by substantial missing data as treatment initiation and completion are poorly recorded.

Of 137,728 people tested through the NHSE LTBI programme from 2016 to 2025, 602 were subsequently notified with active TB of whom 469 had tested positive for LTBI. Only 0.1% of people who tested positive for LTBI and were recorded as completing treatment were subsequently notified with active TB, compared with 2.6% who were LTBI positive but had no treatment recorded.

The neonatal Bacille Calmette-Guerin (BCG) immunisation programme is a risk-based programme recommended for people at higher risk of exposure to TB. BCG coverage at 3 months of age for eligible infants in England was 77.0% in 2025, similar to previous years.

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 74 days in 2025.

Laboratory culture confirmation of TB disease provides information on drug resistance and likely transmission. In 2025, 60.2% of people 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 people with rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in England remain low at 2.1% in 2025 (68 people), but the number who have pre-extensively drug- resistant (pre-XDR) TB has increased over time to 8 people in 2025 (11.8% of those with RR or MDR TB).

We have continued reporting, started in 2023, of susceptibility testing of the new and repurposed anti-TB antibiotics including pretomanid, a critical component of the shorter, all-oral treatment regimen for MDR TB first commissioned by NHS England in 2024. 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 monitor further resistance development.

Whole genome sequencing (WGS) on culture-confirmed specimens is used to identify genetically similar TB isolates, suggestive of recent transmission. The proportion of people with a positive TB culture in England who were part of a genomic cluster has declined since 2019 and is now 31.7%. This proportion is likely to increase for individuals notified in 2025 in future years’ annual reports as people who were infected by index individuals in 2025 develop disease and form genomic clusters. The presence of any social risk factor nearly doubled the likelihood of being in a cluster.

TB treatment and outcomes

The proportion of people who complete their treatment has not improved in the last decade. For people notified in 2024 and expected to complete treatment by 12 months, 84.8% had done so. Lower treatment completion rates have continued in those with social risk factors (78.3%).

However, treatment completion at 24 months for those being treated with a regimen for MDR or RR TB has improved from 50.7% in 2013 to 80.4% for people starting treatment in 2023 (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 2025, for all people notified in 2024 in the non-MDR or RR TB cohort, 212 people (3.9%) had died at their last reported outcome including 35 people who were only diagnosed after death (16.5% of deaths) and a further 9.4% who died without having started treatment. The proportion of people notified with TB who died has decreased compared with the peak of 6.7% for people notified in the 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 is reported for children aged 0 to 17 years. In 2025 numbers in children decreased by 18.8%, reversing the rises seen in 2023 and 2024. The proportion of children with TB who were born in the UK (41.6%) is much higher than for the overall population with TB (17.7%).

The proportion of children diagnosed with pulmonary disease (62.6%) 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 (56.1%) compared with the overall population with TB (40.9%) and completed treatment by 12 months (91.1% in children compared with 84.8% in the entire cohort).