North East: tuberculosis in 2023
Published 4 September 2025
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Incidence, treatment and prevention of tuberculosis in the North East using data up until the end of 2023.
Executive summary
National and regional
The North East remains a low area of tuberculosis (TB) incidence with consistently lower rates of TB than England overall. In 2023, 112 people resident in the North East were notified with TB to the UK Health Security Agency (UKHSA) National Tuberculosis Surveillance (NTBS) system. This equates to a notification rate of 4.1 per 100,000 compared with 8.4 per 100,000 population in England as shown in the Tuberculosis in England 2024 report.
In the North East, TB notifications generally decreased from 196 in 2007 to 77 in 2019, then remained relatively stable before increasing from 74 in 2022 to 112 in 2023, representing an increase in rate from 2.8 per 100,000 to 4.1 per 100,0000 population during this period. This increase is consistent with national trends. In England the rate of TB notifications increased from 7.7 per 100,000 population in 2022 to 8.4 per 100,000 population in 2023, following a general downward trend since 2011.
Local
In 2023, more than half of North East local authorities saw an increase in TB notifications. The largest increase rises were in Newcastle upon Tyne (34 compared with 23 in 2022), Stockton on Tees (15 compared with 7 in 2022), and Sunderland (15 compared with 5 in 2022). TB notifications rates were below the England average in all North East local authorities except Middlesbrough (8.5 per 100,000 population) and Newcastle upon (10.9 per 100,000 population).
Age and Sex
In 2023, the highest age specific rates of TB notifications in the North East were in males aged 20 to 29 years (13.6 per 100,000 males aged 20 to 29), and females aged 20 to 29 years (9.1 per 100,000 females aged 20 to 29). Using broader demographic age groups, the number of notifications of TB has increased in all age groups. Compared to 2022 the largest increase was in people in the 15 to 44 age group (up 55%, it was 68 in 2023 versus 44 in 2022).
Ethnic groups and country of birth
In 2023, 79% (85 of 112) of notifications for TB were in people born outside of the UK with a rate of 36.4 per 100,000 compared to 1.1 per 100,000 in those born in the UK, a rate of TB significantly higher than the rate among UK-born individuals. The number of people with TB born outside the UK has been increasing since 2021 following a decline to 2020. This largely reflects the higher incidence of TB in the cases’ respective countries of birth. In the North East, the rate of TB among UK-born individuals increased slightly in 2023 following a downward trend since 2015.
India continues to be the most common country of birth outside of the UK for people with TB (28%, of non-UK-born cases, 24 out of 85), followed by Nigeria, Sudan, Eritrea, Pakistan, and the Philippines.
Collectively, patients with a south-Asian ethnicity made up nearly a third (30%, 34 out of 112) of all North East cases, of whom the majority were of Indian ethnicity (76%, 26 out of 34).
People of Black ethnicity made up 27% (30 out of 112) of cases, of whom all were Black African. People of White ethnicity made up 22% of cases (25 out of 112), most of whom (88%, 22 out of 25) were UK-born. More than one third (37%; 29 out of 79) of TB notifications in people born outside the UK entered the UK less than 2 years prior to their diagnosis.
Clinical characteristics
Around half (54%; 61 of 112) of the notifications in 2023 were for pulmonary TB. Of these, 87% were confirmed by culture (53 out of 61), which is above the national target of 80%. 3% had been previously diagnosed with TB (3 out of 88).
People with pulmonary TB in the North East had a median delay from symptoms to starting treatment of 69 days, with 3 out of 5 experiencing a delay of more than 2 months.
Treatment outcomes
Treatment was completed within 12 months by 72% (48 out of 67) of people with fully sensitive TB (non-MDR or non-RR TB) whose expected treatment duration was less than 12 months, which is lower than completion rates than in the previous years. However, treatment outcome information was unknown for 21% of those notified in 2022.
Drug resistance
An increase in the proportion of TB notifications with resistance to a first line drug at diagnosis has been observed since 2020. TB antibiotic sensitivity was available for 79% of all cases in 2023 (88 out of 112) and 97% (88 out of 91) of those with culture-confirmed TB. Of these 20% were resistant to at least one first line drug (18 out of 91).
Underserved populations
There is a close association between TB, socio-economic disadvantage and other social risk factors including drug and alcohol misuse, homelessness, and a history of being in prison. In the North East, the rate of TB notifications increased in the more deprived areas and 21% of notifications (23 out of 110 cases) had one or more social risk factors recorded. This is above the national average of 17% of notifications with social risk factors recorded (811 out of 4715). The proportion of notifications with social risk factors reported in the North East has remained fairly consistent over the last 5 years.
Over half of the cases with at least one SRF were in the Black African ethnic group (57%). Most cases with at least one SRF were male (74%), and most (91%) were in the 15 to 44 years age group. Over half (57%) had pulmonary disease, and 87% were not born in the UK. In 2023 the most common risk factor reported in the North East was current asylum seeker status.
HIV
Information on HIV testing was available for 93% (104 out of 112). Of these, 99% (102 out of 104) were offered an HIV test. Overall, in the North East, 95% of all those offered an HIV test were tested.
Conclusion
The North East remains a low incidence region for TB notifications. However, the number of TB notifications increased in 2023 which is consistent with national trends. To achieve the World Health Organisation (WHO) End TB 2035 goal of a 90% reduction in new notifications by 2035, TB needs to remain a health priority across the health and social care system, with work to understand and address the reasons for the increase in incidence.
Although the incidence of TB in the North East is low, the higher frequency of social risk factors presents challenges. Levels of multi-drug resistance have increased, and issues remain with above average delays from symptom onset to treatment. Continued focus is needed by TB services and the wider health and care system to diagnose and support people successfully through treatment.
Data for all the graphs in this report can be found in the North East TB supplementary data 2023 spreadsheet
TB incidence and epidemiology
Overall numbers, rates and geographical distribution
In 2023, 112 people living in the North East were notified with TB, a rate of 4.1 per 100,000 population (Figure 1 and Figure 2). This represents an 51% increase in TB notifications compared with 2022 (74 notifications; rate of 2.1 per 100,000 population). Nationally, the number and rate of TB notifications declined between 2011 and 2022, with most of the reduction occurring between 2011 and 2018. Overall, the rate of TB notifications in the North East decreased between 2007 and 2019, with fluctuations in some years. The North East rate of TB notifications remained relatively stable between 2019 and 2020 with a decrease observed in 2021 and 2022 which may be due to factors arising from the COVID-19 pandemic, such as restrictions to travel and access to healthcare.
Figure 1. Number of TB notifications per year, North East, 2001 to 2023
The rate of TB notifications in the North East remains lower than the England average: 4.1 per 100,000 population compared to 8.4 per 100,000 population in England in 2023. The rate of TB notifications in England increased from 7.7 per 100,000 population in 2022 to 8.4 per 100,000 population in 2023 and a similar pattern was seen in the North East where the rate increased from 2.8 per 100,000 population in 2022 to 4.1 per 100,000 population in 2023 (Figure 2).
Figure 2. TB notification rates per 100,000 population per year, North East, 2001 to 2023 [note 1]
Note 1: error bars represent upper and lower 95% confidence intervals.
Figure 3 shows the observed North East TB notification rates compared with the rates required to achieve the WHO End TB goal. The rate observed in the North East has been lower than the required rate in all years since 2015 except 2018 and 2023.
Figure 3. Observed TB notification rate compared with required TB notification rates to meet the WHO End TB 2035 goal of 90% reduction in incidence by 2035, North East, 2015 to 2023 [note 2] [note 3]
Note 2: error bars represent upper and lower 95% confidence intervals.
Note 3: dashed line represents required TB notification rates to meet the WHO End TB 2035 goal of 90% reduction in incidence by 2035.
Geographical variation in the number and rate of TB notifications
The incidence of TB notifications is not evenly distributed among North East local authorities. In the North East, the highest rates of TB notifications in 2023 were observed in Newcastle upon Tyne (10.9 per 100,000 population) and Middlesbrough (8.5 per 100,000 population), and the lowest in County Durham, Darlington and Northumberland (Figure 4 and Figure 5). This trend has been consistent since 2001, although there is variation in some local authorities due to small numbers.
The rate of TB notifications was below the national average in all North East local authorities except Newcastle upon Tyne and Middlesbrough.
In 2023 the number and rate of TB notifications increased in 7 out of 12 North East local authorities, with the largest increase in numbers reported in Newcastle upon Tyne (34 versus 23 in 2022), Stockton on Tees (15 versus 7 in 2022), and Sunderland (15 versus 5 in 2022).
Figure 4. TB notification rate by upper tier local authority of residence, North East, 2001 to 2023 [note 4]
Note 4: grey lines represent the other upper tier local authorities in the region.
Figure 5. TB notification rate by upper tier local authority of residence, North East, 2023
Age and Sex
In 2023, 54% of the people notified with TB in the North East were males with a rate of 4.6 per 100,000 compared to 3.7 per 100,000 in females. This pattern is consistent with previous years. Among 10 year age groups the number and rates of notifications were highest for those age 20 to 29 for both males and females (Figure 6 and Figure 7).
Figure 6. Number of TB notifications by age and sex, North East, 2023
Figure 7. TB notification rate by age and sex, North East, 2023
Country of birth and time since entry
In the North East, people born outside of the UK accounted for 76% of notifications in 2023, (85 out of 112) (Figure 8), which was slightly lower than the proportion nationally (80%). The North East rate of TB notifications in people born outside the UK was 36.4 per 100,000 compared with 1.6 per 100,000 in the UK-born population.
In the North East, there has been a year on year increase in the number of TB notifications in people born outside the UK since 2021. This follows a decrease between 2013 and 2020.
In 2023, the North East TB notification rate in people born in the UK increased to 1.6 per 100,000 compared with 0.6 per 100,000 in 2022.
Figure 8. Number of TB notifications in non-UK-born and UK-born people by place of birth, North East, 2001 to 2023
The age distribution of people notified with TB in 2023 is shown in Figure 9 (all places of birth (UK and non-UK-born), non-UK-born, and UK-born). In 2023, among all places of birth the number of notifications of TB increased in all age groups, with the largest increase noted in the 15 to 44 age group.
The age distribution of TB notifications varied between people born in the UK and those born outside the UK (non-UK-born). People notified with TB in the non-UK-born population tended to be younger compared with the UK-born with most 65 years and over.
In 2023, the highest number of notifications in people born outside the UK was in those aged 15 to 44 years, accounting for 75% of the non-UK-born notifications, which is similar to previous years (Figure 9 non-UK-born). The number of notifications in people born outside the UK in this age group increased by 60% from 40 notifications in 2022 to 64 notifications in 2023. The number of notifications in people born outside the UK aged 45 to 64 increased by 45% from 11 notifications in 2022 to 16 notifications in 2023. Of the people notified who were born in the UK, the highest number of notifications was in those aged 65 years and older. The number of people notified in this age group increased from 5 in 2022 to 16 in 2023. The number of notifications in people born in the UK in the 0 to 14 years and 15 to 44 years age groups remained similar to 2022 (Figure 9 UK-born).
Figure 9. Number of TB notifications in non-UK-born and UK-born people by place of birth and age group, North East, 2001 to 2023
Figure 10 shows the proportion of individuals born outside the UK notified with TB, by time since entry to the UK, between 2001 to 2023.
In 2023, information about date of entry to the UK was available for 93% (79 out of 85) of those born abroad. Most (64%) of notifications for those born outside the UK were in people who entered the UK within the preceding 5 years; 37% entered the UK within the previous 2 years and 27% between 2 and 5 years prior to notification. Of the remainder, 11% of those born abroad were notified 6 to 10 years after entry and 25% were notified 11 years or more after entry, decreasing from 38% in 2022.
Figure 10. Proportion of TB notifications by time since entry for people born outside the UK, North East, 2001 to 2023
In 2023 the proportion of TB notifications occurring within 5 years of entry to the UK for all countries of birth outside the UK increased to 60% from 47% in 2022. Proportion in 2023 is similar to pre-pandemic levels seen in 2020 (Figure 11).
Figure 11. Proportion of TB notifications occurring within 5 years of entry to the UK for all countries of birth outside of the UK, North East, 2017 to 2023 [note 6] [note 7]
Note 6: error bars represent upper and lower 95% confidence intervals.
Note 7: within 5 years refers to a time since entry of less than 1 year to 5 years inclusive.
Table 1 shows the most common countries of birth for people notified with TB and time between entry to the UK and TB notification. Of those born outside the UK, information on country of birth was available for all the non-UK-born notifications. In 2023, the most common countries of birth for people born outside the UK were India (22.3%), and Nigeria (8%) followed by Sudan, Eritrea, Pakistan and Philippines. Those born in Eritrea had the shortest median time between entry to the UK and TB notification (1 year, IQR 1 to 6). The country with the longest median time between entry to the UK and notification was Pakistan (52 years, IQR 34 to 55.5 years).
In 2023, the most marked increases in number and proportion of TB notifications in people born outside the UK were in those born in India and Nigeria. Notifications decreased in those born in Pakistan and remained similar to 2022 for the remaining common countries of birth (Figure 12).
Table 1. Most common countries of birth for people with TB and time between entry to the UK and TB notification, North East, 2023 [note 8]
| Country of birth | Number of people notified with TB | Proportion of people notified with TB (%) | Median time since entry to UK in years | IQR of time since entry to UK in years |
|---|---|---|---|---|
| United Kingdom | 27 | 24.1 | Not applicable | Not applicable |
| India | 25 | 22.3 | 2.0 | 1.0 to 4.0 |
| Nigeria | 9 | 8.0 | 1.5 | 0.0 to 3.8 |
| Sudan | 8 | 7.1 | 4.0 | 0.8 to 5.0 |
| Eritrea | 5 | 4.5 | 1.0 | 1.0 to 6.0 |
| Pakistan | 5 | 4.5 | 52.0 | 34.0 to 55.5 |
| Philippines | 5 | 4.5 | 16.0 | 7.0 to 19.0 |
| Other | 28 | 25.0 | 4.5 | 1.0 to 17.0 |
| Total | 112 | 100.0 | Not applicable | Not applicable |
Note 8: other includes all countries with less than 5 people notified.
Figure 12. Numbers of TB notifications for the most common countries of birth for people with TB born outside the UK, North East, 2013 to 2023 [note 9]
Note 9: figure shows the top 6 countries in 2023.
Table 2. Characteristics of people with TB from the most common (non-UK) countries of birth, North East, 2023
| Country of birth | Number of people notified with TB | Mean age (years) | Proportion male (%) | Proportion pulmonary (includes laryngeal and miliary) (%) | Proportion with UK entry less than 2 years (%) | Proportion pulmonary of those in the UK less than 2 years (%) |
|---|---|---|---|---|---|---|
| India | 25 | 33.8 | 60.0 | 36.0 | 37.5 | 55.6 |
| Nigeria | 9 | 35.4 | 44.4 | 33.3 | 50.0 | 50.0 |
| Sudan | 8 | 25.0 | 100.0 | 37.5 | 37.5 | 33.3 |
| Eritrea | 5 | 31.2 | 20.0 | 20.0 | 60.0 | 33.3 |
| Pakistan | 5 | 51.4 | 80.0 | 40.0 | 0.0 | 0.0 |
| Philippines | 5 | 47.0 | 20.0 | 40.0 | 20.0 | 0.0 |
People with TB born in the Philippines were least likely to have entered the UK within 2 years before diagnosis (20%).
Those born in Sudan had the lowest median age of 25 years and the highest proportion of males (100%). Those born in Pakistan and Philippines had the highest proportion of pulmonary TB (40%). India had the highest proportion of recent entrants in the last 2 years (56%). Of those born in India and diagnosed with TB within 2 years since entry, 56% had pulmonary TB (Table 2).
Ethnicity
Figure 13 shows the number of North East TB notifications and TB notification rate for 8 different ethnic groupings, separated by place of birth (UK-born compared with non-UK-born) in 2023.
In 2023, ethnicity was known for all the people notified with TB. The most common ethnic groups among all people notified with TB in the North East were Black African (27%, 30 out of 112) followed by Indian (23%, 26 out of 112) and White (22%, 25 out of 112) ethnic groups.
Of the UK-born cases notified in 2023, the white ethnic group comprised the greatest proportion (85%, 22 out of 26). Among the non-UK-born 36% (31 out of 85) were in the South Asian ethnic group.
Figure 13. Number of TB notifications in ethnic groups by place of birth (UK and non-UK-born), North East, 2023 [note 10]
Note 10: figure ordered by total number of notifications within each ethnicity irrespective of place of birth.
From 2022 to 2023 the number of notifications in all places of birth increased among all ethnic groups. The largest increase in the number of notifications was observed in the Mixed or other ethnic group. Among the people notified in those born abroad, the number of reports increased in the South Asian, Black and Mixed or other ethnic groups, the number of notifications among the White ethic group remained stable. For the UK-born notifications the number increased among the White ethnic group, following a decline in previous years (Figure 14).
Figure 14. Number of TB notifications in ethnic groups by place of birth (UK and non-UK-born), North East, 2001 to 2023
Clinical characteristics
Site of disease
In 2023, 54.5% (61 out of 112) of people notified with TB had pulmonary disease (with or without extra-pulmonary sites) (Table 3), an increase from 47.3% in 2022 (Figure 15). Among the people notified with extra pulmonary TB the most common site of disease was ‘other extra pulmonary’, present in 34.8% (39 out of 112) of cases (Table 4).
Table 3. Number of pulmonary TB notifications by site of disease, North East, 2023 [note 11] [note 12]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All pulmonary | 61 | 54.5 |
| Pulmonary only | 41 | 36.6 |
| Miliary only | 4 | 3.6 |
| Laryngeal only | 0 | 0.0 |
Note 11: percentages may not add up to 100 as people with TB may have more than one site of disease.
Note 12: ‘pulmonary only’ includes people notified with only pulmonary TB and therefore have not also been notified with miliary, laryngeal or extra-pulmonary TB.
Table 4. Number of extra-pulmonary TB notifications by site of disease, North East, 2023 [note 13]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All extra-pulmonary | 71 | 63.4 |
| Other extra-pulmonary | 39 | 34.8 |
| Extra-thoracic lymph nodes | 25 | 22.3 |
| Intra-thoracic lymph nodes | 16 | 14.3 |
| Pleural | 7 | 6.2 |
| Bone - spine | 5 | 4.5 |
| Gastrointestinal | 5 | 4.5 |
| Bone - not spine | 4 | 3.6 |
| Cryptic disseminated | 4 | 3.6 |
| Genitourinary | 3 | 2.7 |
| Central nervous system | 3 | 2.7 |
Note 13: percentages may not add up to 100 as people with TB may have more than one site of disease.
Figure 15. Proportion of people notified with pulmonary TB, North East, 2013 to 2023 [note 14]
Note 14: error bars represent upper and lower 95% confidence intervals.
Comorbidities
Comorbidities with other infections or non-communicable diseases such as diabetes or chronic renal disease may affect TB susceptibility, treatment strategies and outcomes. In 2023, 20.5% (23 out of 112) of all people with TB were known to have at least one co-morbidity, compared to 21.6% (16 out of 74) in 2022. Diabetes was the most frequently reported co-morbidity at 12.6%, followed by immunosuppression 10.5% (Table 5). This was mirrored nationally.
In 2023 the proportion of people co-infected with hepatitis B was 2%; although the numbers are small this is an increase on the previous year where no cases were reported as having co-infection with either Hepatitis B or C.
Table 5. Number and proportion of people with TB with comorbidities, North East, 2023 [note 15]
| Comorbidity | Total with data reported | Number of people notified with TB with comorbidities | Proportion of people notified with TB with comorbidities (%) | Number of people notified with TB missing comorbidity data | Proportion of people notified with TB missing comorbidity data (%) |
|---|---|---|---|---|---|
| At least one of the named comorbidities | 112 | 23 | 20.5 | Not applicable | Not applicable |
| Chronic liver disease | 103 | 2 | 1.9 | 9 | 8 |
| Chronic renal disease | 101 | 2 | 2.0 | 11 | 9.8 |
| Diabetes | 103 | 13 | 12.6 | 9 | 8 |
| Hepatitis B | 98 | 2 | 2.0 | 14 | 12.5 |
| Hepatitis C | 98 | 0 | 0.0 | 14 | 12.5 |
| Immunosuppression | 105 | 11 | 10.5 | 7 | 6.2 |
Note 15: people with TB are reported as having at least one of the named comorbidities if any of the 6 comorbidities (chronic liver disease, chronic renal disease, diabetes, hepatitis B, hepatitis C or immunosuppression) had ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual comorbidities were a ‘no’ and may result in under-estimation.
HIV testing
Untreated HIV infection increases the risk of developing active TB disease and universal HIV testing is offered within TB management programmes. The proportion of people being offered HIV testing is recorded in NTBS although test results are not.
Information on HIV testing was available for 92.8% (104 out of 112) of North East cases reported in 2023. Of these, 99.3% (102 out of 104) were offered an HIV test.
The proportion of TB cases being offered an HIV test was comparable to 2022 and has increased over time (Figure 16).
Of the people that were offered a test: 95% (97 out of 102) received a test; 2% were offered but did not receive a test (2 out of 102) and for the remaining 3% (3 out of 102) HIV status was already known.
Figure 16. Proportion of people with TB offered an HIV test by year, North East, 2018 to 2023 [note 16] [note 17]
Note 16: dashed line indicates target of 100% of people offered HIV test.
Note 17: error bars represent upper and lower 95% confidence intervals.
Social risk factors
There is a close association between TB, socio-economic disadvantage and other social risk factors including drug and alcohol misuse, homelessness, and a history of being in prison. Data for important social risk factors (alcohol misuse, asylum seeker, drug misuse, homelessness, mental health needs and prison) is routinely collected as part of TB surveillance. The following analyses include people notified aged 15 years and older.
Of the 110 people notified with TB aged 15 years and older in 2023, 20.9% (23 out of 110) had at least one risk factor recorded (Table 6). This is an increase from 2022, where 16.4% (12 out of 73) of people notified had at least one social risk factor recorded (Figure 17 and Table 7)
The number of people notified with TB who are recorded as having more than one social risk factor at the time of notification decreased in 2023 to 5.8% (6 out of 104) compared to 7.5 (5 out of 67) in 2022.
In 2023 the most common risk factor reported in the North East was current asylum seeker status (14.0%, 15 out of 107) followed by homelessness (6.8%, 7 out of 103), and prison (4.9%, 5 out of 102) (Table 6).
Table 6. Number and proportion of people with TB aged 15 years or over with individual social risk factors, North East, 2023 [note 18]
| Social risk factor | Total with data reported | Number of people notified with TB with social risk factors | Proportion of people notified with TB with social risk factors (%) | Number of people notified with TB and missing social risk factor data | Proportion of people notified with TB and missing social risk factor data (%) |
|---|---|---|---|---|---|
| At least one named social risk factor | 110 | 23 | 20.9 | Not applicable | Not applicable |
| More than one social risk factor | 104 | 6 | 5.8 | 6 | 5.5 |
| Alcohol misuse (current) | 102 | 2 | 2.0 | 8 | 7.3 |
| Asylum seeker (current) | 107 | 15 | 14.0 | 3 | 2.7 |
| Drug misuse (current or previous) | 102 | 1 | 1.0 | 8 | 7.3 |
| Homelessness (current or previous) | 103 | 7 | 6.8 | 7 | 6.4 |
| Mental health needs (current) | 100 | 2 | 2.0 | 10 | 9.1 |
| Prison (current or previous) | 102 | 5 | 4.9 | 8 | 7.3 |
Note 18: people with TB are reported as having at least one of the named social risk factors if any of the 6 social risk factors (current alcohol misuse, current or a history of homelessness, drug misuse, imprisonment, current asylum seeker status and current mental health needs) had ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual social risk factors were a ‘no’ and may result in under-estimation.
Figure 17. Proportion of people with TB aged 15 years or over with at least one social risk factor (SRF), North East, 2018 to 2023 [note 19] [note 20]
Note 19: error bars represent upper and lower 95% confidence intervals.
Note 20: not all social risk factors were captured before 2021.
Table 7. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, North East, 2013 to 2023 [note 21]
| Year | Number of people notified with TB with any social risk factor | Proportion of people notified with TB with any social risk factor (%) | Total notifications |
|---|---|---|---|
| 2013 | 12 | 9.0 | 133 |
| 2014 | 14 | 8.9 | 157 |
| 2015 | 18 | 14.8 | 122 |
| 2016 | 22 | 19.1 | 115 |
| 2017 | 21 | 20.8 | 101 |
| 2018 | 20 | 17.2 | 116 |
| 2019 | 14 | 18.4 | 76 |
| 2020 | 14 | 17.7 | 79 |
| 2021 | 19 | 25.3 | 75 |
| 2022 | 12 | 16.4 | 73 |
| 2023 | 23 | 20.9 | 110 |
Note 21: not all social risk factors were captured before 2021 and that this table includes people with no information recorded in the denominator.
In 2023, males notified with TB were more likely to be reported as having a risk factor than females (Table 8). Presence of social risk factors also varied by age group. A social risk factor was more likely to be reported by those aged 15 to 44 years compared to those aged 45 to 64 years, and over 65. Those born outside the UK with TB were also more likely to report having a social risk factor.
For people notified with TB born outside the UK, experience of homelessness (8.8%) and seeking asylum (18.5%) were the most commonly reported social risk factors. This differed to UK-born where experience of drug misuse (4.3%) and mental health needs (4.5%) were most commonly reported.
Table 8. Number and proportion of people with TB aged 15 years or over with any social risk factor (SRF) by demographic characteristics, North East, 2023
| Demographic characteristics | Any social risk factor | Any social risk factor (proportion) |
|---|---|---|
| Female | 6 | 11.7 |
| Male | 17 | 28.8 |
| Aged 15 to 44 | 21 | 30.9 |
| Aged 45 to 64 | 2 | 7.7 |
| Aged 65 or older | 0 | 0.0 |
| Non-UK-born | 20 | 23.5 |
| UK-born | 3 | 11.1 |
Using the Index of Multiple Deprivation (IMD 2019) rank assigned to different areas of England in 2023, the incidence of TB was 9.3 per 100,000 in the 10% of the population living in the most deprived areas of the North East, compared to 2.4 per 100,000 in the 10% of the population living in the least deprived areas (Figure 17). 44% (49 out of 112) of people notified were living in the most socio-economically deprived decile compared with 3.6% (4 out of 112) of people notified living in the least socio-economically deprived decile. 29% (14 out of 49) of people notified in the most deprived decile also had at least one social risk factor.
Figure 18. TB notification rate by deprivation decile, North East, 2023 [note 22]
Note 22: error bars represent upper and lower 95% confidence intervals.
TB diagnosis, microbiology and drug resistance
Culture confirmation
In 2023, 86.8% (53 out of 61) of notifications for pulmonary TB were microbiologically confirmed by culture, compared with 82.9% (29 out of 35) in 2022 (Figure 19). The proportion of people notified with pulmonary disease confirmed by culture remains above the TB Action Plan for England target of 80%. The proportion of notifications confirmed by culture also varied by region; in 2023 the highest proportion of culture confirmation nationally was seen in the North East.
Figure 19. Proportion of people notified with pulmonary TB who were culture-confirmed, North East, 2017 to 2023 [note 23] [note 24]
Note 23: dashed line indicates target of 80% culture confirmation.
Note 24: error bars represent upper and lower 95% confidence.
Drug resistance
In 2023, information on first line drug sensitivity was available for 96.7% (88 out of 91) of those with culture-confirmed TB. This is a decrease from 2022 where drug sensitivity was available for all those with culture-confirmed TB (Figure 20). This is below the National Action Plan and WHO end TB target of 100%. Of those with antibiotic sensitivity results available in 2023 19.8% (18 out of 91) had TB that was resistant to a first line drug (Figure 21). The percentage of North East TB isolates with antibiotic resistance has been increasing gradually since 2020.
Between 2018 and 2023, 3.8% of North East cases (16 out of 411) were resistant to isoniazid without Multi Drug Resistant (MDR) TB and 1.7% (7 out of 411) had multi-drug resistant or rifampicin-resistant TB (rifampicin-resistant MDR). Cases of extensively drug-resistant TB (XDR-TB) are rare in England and the North East. There were no cases of extensively drug-resistant TB (XDR-TB) notified between 2018 to 2023 in the North East.
Figure 20. Proportion of people culture-confirmed with TB with first line drug results, North East, 2017 to 2023 [note 25]
Note 25: error bars represent upper and lower 95% confidence intervals.
Figure 21. Proportion of people notified with culture-confirmed TB with initial resistance to any first line drug, North East, 2017 to 2023 [note 25, above]
Clustering
Whole genome sequencing is undertaken at UKHSA Mycobacterium Reference Service laboratories and provides information about mycobacterium species, drug resistance and the similarity between different TB isolates. This information about relatedness of isolates can help to understand potential links between cases. In England, individuals with a positive TB culture are grouped into genomic clusters if they have at least one other individual within 12 single nucleotide polymorphisms (SNPs). This information is used to support contact tracing and public health action. More information is found in the WGS handbook. UKHSA North East HPT and the Field Service systematically collect and review TB relatedness information to better understand TB transmission in the North East and identify where public health action may be applied to interrupt this.
In 2023, 25.3% of people notified with TB in 2023 with a positive TB culture were part of a WGS TB cluster, a decrease from 46.3% in 2020 (Table 9).
Table 9. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, North East, 2020 to 2023 [note 26] [note 27]
| Year | Total TB notifications | Number of notifications cultured | Proportion of notifications cultured | Number of culture-confirmed notifications identified in a cluster with more than one person | Proportion of culture-confirmed notifications identified in a cluster with more than one person (%) | 95% confidence interval |
|---|---|---|---|---|---|---|
| 2020 | 85 | 67 | 78.8 | 31 | 46.3 | 34.9 to 58.1 |
| 2021 | 81 | 56 | 69.1 | 14 | 25.0 | 15.5 to 37.7 |
| 2022 | 74 | 56 | 75.7 | 16 | 28.6 | 18.4 to 41.5 |
| 2023 | 112 | 91 | 81.2 | 23 | 25.3 | 17.5 to 35.1 |
| Total | 352 | 270 | 76.7 | 84 | 31.1 | 25.9 to 36.9 |
Note 26: a WGS cluster is defined as 2 or more individuals that have isolates with a less than 12 SNP difference.
Note 27: WGS cluster reporting has changed over time. These changes are likely to have affected the most recent year’s data.
TB in children: incidence, and epidemiology
In 2023, there were 2 notifications of TB in children under the age of 15 years old, resident in the North East (Figure 22). The number and rate of TB notifications in children in the North East remains very low (0.2 per 100,000 of the population, Figure 23).
Figure 22. Number of TB notifications in children aged under 15 years, North East, 2001 to 2023
Figure 23. TB notification rate in children aged under 15 years, North East, 2001 to 2023 [note 28]
Note 28: error bars represent upper and lower 95% confidence intervals.
TB treatment
Enhanced case management
The 2022 joint case management tool provides standardised recommendations for TB management, including enhanced case management (ECM) for people with clinical or social complexities. Where there are social risk factors (SRFs), MDR or RR TB, the case may be deemed ECM level 3 and require DOT or VOT, following National Institute of Health and Care Excellence (NICE) guidelines.
The ECM levels are:
- ECM level 1: people with clinical or social issues which impact on treatment, for example, children with TB, or those taking antiretrovirals
- ECM level 2: people with complex clinical or social issues which impact on treatment, for example, complex side effects or single drug resistance, which may necessitate weekly visits
- ECM level 3: people with very complex clinical and or social issues which impact on treatment, for example, SRFs or MDR or RR TB which necessitates DOT or VOT
Table 10 shows levels of ECM by year. In 2023, 26 people notified with TB (23.2%, 26 out of 112) were assessed as needing some level of ECM compared to 42.8% of people notified nationally. The proportion of people notified with TB in the North East who needed some level of ECM increased from 2022 (20.3%, 15 out of 74).
Table 10. Number of people with TB receiving enhanced case management, North East, 2021 to 2023 [note 29]
| Year | Total TB notifications | Any ECM (number) | Any ECM (proportion) | Level 1 (number) | Level 1 (proportion) | Level 2 (number) | Level 2 (proportion) | Level 3 (number) | Level 3 (proportion) | Unknown level (number) | Unknown level (proportion) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021 | 81 | 15 | 18.5 | 2 | 2.5 | 1 | 1.2 | 11 | 13.6 | 1 | 1.2 |
| 2022 | 74 | 15 | 20.3 | 9 | 12.2 | 2 | 2.7 | 4 | 5.4 | 0 | 0.0 |
| 2023 | 112 | 26 | 23.2 | 8 | 7.1 | 7 | 6.2 | 10 | 8.9 | 1 | 0.9 |
Note 29: total TB notifications includes all people notified with TB regardless of whether they are receiving ECM or not, or if this information is missing.
Treatment delay
Treatment delay is defined as the period from the start of symptoms (as reported by the patient) and the start of TB treatment.
Information on delay was available for 95% (43 out of 61) of all people with pulmonary TB. The remaining people were either asymptomatic at diagnosis, did not have a date of onset recorded, did not have a start of treatment recorded or were diagnosed post-mortem.
Figure 24 presents data on the proportion of people notified with pulmonary TB with delay from symptom onset to treatment start over 2 months. In 2023, 62.8% (27 out of 43) of people notified had a treatment delay over 2 months. This trend has been increasing since 2021 where 52.6% of people notified with pulmonary TB had a treatment delay of over 2 months. The average proportion of people with pulmonary TB with a treatment delay of more than 4 months is available by upper tier local authority in supplementary tables of the Tuberculosis in England 2024 report.
Figure 24. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, North East, 2018 to 2023 [note 30] [note 31]
Note 30: error bars represent upper and lower 95% confidence intervals.
Note 31: delay to treatment is defined by when treatment was started from symptom onset.
Figure 25 presents data on the proportion of people notified with extra-pulmonary TB with delay from symptom onset to treatment start over 2 months. In 2023, 67.4% (31 out of 46) of people notified had a treatment delay over 2 months. This trend has increased from 2022 where 51.8% of people notified with extra-pulmonary TB had a treatment delay of over 2 months.
Figure 25. Proportion of people notified with extra-pulmonary TB with a treatment delay over 2 months, North East, 2018 to 2023 [note 32] [note 33]
Note 32: error bars represent upper and lower 95% confidence intervals.
Note 33: delay to treatment is defined by when treatment was started from symptom onset.
Table 11 shows the number and proportion of people with pulmonary TB with a treatment delay. In 2023, of those 27.9% (12 out of 43) had a delay of between 2 and 4 months from symptom onset and the remaining 34.9% (15 out of 43) had a delay from symptom onset to treatment start of more than 4 months
In 2023 the median period between diagnosis and starting treatment was 69 days (IQR 44.5 to 169). Treatment delay among people notified with pulmonary TB has declined between 2022 and 2023 as shown in Figure 26. This indicates an improvement in the time from symptom onset to treatment start, but the majority of people were not treated within the TB Action Plan for England target time of 56 days (Figure 26).
Table 11. Number and proportion of people notified with pulmonary TB with a treatment delay, time between symptom onset and treatment start, North East, 2018 to 2023 [note 34]
| Year | 2 to 4 months delay (number) | 2 to 4 months delay (proportion) | Over 4 months delay (number) | Over 4 months delay (proportion) | Total | Missing (number) | Missing (proportion) | Total eligible |
|---|---|---|---|---|---|---|---|---|
| 2018 | 23 | 34.8 | 17 | 25.8 | 66 | 2 | 2.9 | 68 |
| 2019 | 8 | 24.2 | 14 | 42.4 | 33 | 1 | 2.9 | 34 |
| 2020 | 20 | 39.2 | 12 | 23.5 | 51 | 1 | 1.9 | 52 |
| 2021 | 12 | 30.8 | 8 | 20.5 | 39 | 8 | 17.0 | 47 |
| 2022 | 10 | 34.5 | 6 | 20.7 | 29 | 4 | 12.1 | 33 |
| 2023 | 12 | 27.9 | 15 | 34.9 | 43 | 13 | 23.2 | 56 |
Note 34: all people included in this table are people with pulmonary TB who did not have a postmortem diagnosis, and it was known that they had started treatment. People included within the ‘Total’ includes these individuals and where the time from symptom onset to treatment start was also known. ‘Total eligible’ includes people in ‘Total’ plus those people where the time from symptom onset to treatment start was unknown or missing. Percentages for ‘2 to 4 month delay’ and ‘over 4 months’ delay were calculated using the ‘Total’ figure. The percentage for ‘Missing’ uses ‘Total eligible’. ‘2 to 4 month delay’ includes people with a delay of 61 to 121 days inclusive. An ‘over 4 month delay’ includes people with a delay between 122 and 730 days inclusive.
Figure 26. Median treatment delays among people notified with pulmonary TB, North East, 2018 to 2023 [note 35] [note 36] [note 37] [note 38]
Note 35: dashed line represents the target treatment delay of 56 days by 2027.
Note 36: ends of the whiskers represent the theoretical lower and upper limits for detecting outliers (lower or upper quartile negative or positive 1.5 times the interquartile range). Outliers falling outside of these limits have been removed.
Note 37: delay to treatment is defined by when treatment was started from symptom onset.
Note 38: all people included in this figure are people with pulmonary TB who did not have a postmortem diagnosis, and it was known that they had started treatment. It excludes individuals with a delay over 730 days.
In 2023, 54.9% (28 out of 51) of pulmonary TB cases were notified within 3 days of diagnosis. This was an increase from 2022 (Table 12).
Table 12. Proportion of people notified with pulmonary TB within 3 days of diagnosis by year, North East, 2018 to 2023 [note 39]
| Year | Number of people notified | Proportion of people notified (%) | Total |
|---|---|---|---|
| 2018 | 23 | 43.4 | 53 |
| 2019 | 14 | 50.0 | 28 |
| 2020 | 27 | 51.9 | 52 |
| 2021 | 20 | 46.5 | 43 |
| 2022 | 11 | 45.8 | 24 |
| 2023 | 28 | 54.9 | 51 |
Note 39: includes people with pulmonary TB who were not diagnosed at postmortem, and where report delay was known and between 0 and 90 days (inclusive).
In 2023 37.2% (16 out of 43) of people with pulmonary disease started treatment within 2 months, a decrease from the previous year (44.8%, 13 out of 29) (Table 13).
Table 13. Time between symptom onset and treatment start in people with pulmonary TB, North East, 2015 to 2023 [note 40]
| Year | 0 to 2 months (number) | 0 to 2 months (proportion) | 2 to 4 months (number) | 2 to 4 months (proportion) | More than 4 months (number) | More than 4 months (proportion) | Total | Median time in days | IQR of time in days |
|---|---|---|---|---|---|---|---|---|---|
| 2015 | 39 | 65.0 | 11 | 18.3 | 10 | 16.7 | 60 | 49.0 | 25.2 to 76.5 |
| 2016 | 24 | 40.7 | 21 | 35.6 | 14 | 23.7 | 59 | 73.0 | 35.5 to 119.5 |
| 2017 | 23 | 44.2 | 17 | 32.7 | 12 | 23.1 | 52 | 63.0 | 40.5 to 107.8 |
| 2018 | 26 | 39.4 | 23 | 34.8 | 17 | 25.8 | 66 | 76.5 | 39.5 to 121.0 |
| 2019 | 11 | 33.3 | 8 | 24.2 | 14 | 42.4 | 33 | 99.0 | 42.0 to 192.0 |
| 2020 | 19 | 37.3 | 20 | 39.2 | 12 | 23.5 | 51 | 80.0 | 47.0 to 116.0 |
| 2021 | 19 | 48.7 | 12 | 30.8 | 8 | 20.5 | 39 | 61.0 | 34.0 to 93.0 |
| 2022 | 13 | 44.8 | 10 | 34.5 | 6 | 20.7 | 29 | 71.0 | 38.0 to 113.0 |
| 2023 | 16 | 37.2 | 12 | 27.9 | 15 | 34.9 | 43 | 69.0 | 44.5 to 139.0 |
Note 40: this table includes people with pulmonary TB where they did not have a postmortem diagnosis, they had started treatment, and the start of treatment date was known. Total includes all these people including where the time between symptom onset and treatment start was missing or not known.
TB treatment outcomes
Treatment outcomes in the non-MDR or non-RR TB cohort (without CNS disease)
People with TB sites of disease that do not include the central nervous system (CNS), spinal, miliary or cryptic disseminated disease are usually expected to complete treatment within 12 months. 71.6% of people (48 out of 67) diagnosed in 2022 with rifampicin-sensitive TB and an expected treatment duration of less than 12 months completed treatment within 12 months). A further 4 people completed treatment by the time their last treatment outcome was recorded. The next most common treatment outcome was death, among 3% (2 out of 67) people with TB. 1.5% (1 out of 67) were lost to follow up, 1.5% (1 out of 67) were still on treatment and 1.5% (1 out of 67) had treatment stopped. Overall treatment completion increased to 77.6% (52 out of 67) for last recorded treatment outcome (Table 14).
Table 14. Treatment outcome at 12 months and last recorded outcome for people notified in 2022 with non-MDR or non-RR TB with expected treatment duration less than 12 months, North East, 2022 [note 41] [note 42]
| Outcome | TB treatment outcome at 12 months (number) | TB treatment outcome at 12 months (proportion) | Last recorded treatment outcome (number) | Last recorded treatment outcome (proportion) |
|---|---|---|---|---|
| Treatment completed | 48 | 71.6 | 52 | 77.6 |
| Died | 2 | 3.0 | 2 | 3.0 |
| Lost to follow up | 1 | 1.5 | 1 | 1.5 |
| Still on treatment | 1 | 1.5 | 0 | 0.0 |
| Treatment stopped | 1 | 1.5 | 1 | 1.5 |
| Not evaluated | 14 | 20.9 | 11 | 16.4 |
| Total | 67 | 100.0 | 67 | 100.0 |
Note 41: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not still on treatment nor died.
Note 42: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.
In 2023, the 12-month TB treatment completion in people notified in 2022 treated for non-MDR or non-RR TB and expected to complete within 12 months with one or more social risk factors was 83.3% an increase from the previous year where 72.2% had one or more social risk factors (Figure 27).
Figure 27. Proportion of people treated for non-MDR or non-RR TB without central nervous system (CNS) disease and with one or more social risk factors who completed treatment within 12 months, North East, 2018 to 2022 [note 43]
Note 43: error bars represent upper and lower 95% confidence intervals.
In 2023, the 12-month TB treatment completion in people notified in 2022 treated for non-MDR or non-RR TB and expected to complete within 12 months was below the Action Plan for England target of 90%. Following an increase towards the target in 2019, a decreasing trend in the proportion of treatment completion at 12 months from 2019 to 2022 can be seen in Figure 28.
Figure 28. Proportion of people with non-severe TB treated for non-MDR or non-RR TB who completed treatment within 12 months compared with the target of 90%, North East, 2018 to 2022 [note 44] [note 45]
Note 44: dashed line indicates treatment target of 90%.
Note 45: error bars represent upper and lower 95% confidence intervals.
Treatment outcomes of people who did not complete treatment within this period are shown in Figure 29. The proportion of those who died within 12 months (measured from start of treatment, diagnosis or notification was 3%, which was lower than the previous high of 15% in those notified in 2020. The proportion of persons lost to follow-up decreased from 2022 (1.5% in 2022 compared to 4.3% in 2021). No further deaths were recorded in the last recorded outcome.
Figure 29. Outcomes of people evaluated who did not complete treatment by 12 months for people with non-MDR or non-RR TB and expected treatment duration of less than 12 months, North East, 2013 to 2022
Treatment outcome for the non-MDR or non-RR or MDR-TB with expected treatment duration of within 12 months are shown in Table 16, by 12 months since start of treatment: 71.6% (48 out of 67) had completed treatment, a decrease from 2021, where 73.6% (53 out of 72) had completed treatment. Of those not completing treatment in 2022, 3.0% (2 out of 67) had died, 1.5% (1 out of 67) were lost to follow up, 1.5% (1 out of 67) were still on treatment and 1.5% (1 out of 67) had treatment stopped (Table 15).
Table 15. TB outcome at 12 months for people with non-RR or MDR-TB with expected treatment duration of within 12 months, North East, 2013 to 2022 [note 46]
| Year | Treatment completed (number) | Treatment completed with any social risk factor (number) | Died (number) | Lost to follow up (number) | Still on treatment (number) | Treatment stopped (number) | Not evaluated (number) | Total (number) |
|---|---|---|---|---|---|---|---|---|
| 2013 | 100 | 7 | 6 | 6 | 5 | 1 | 3 | 121 |
| 2014 | 112 | 7 | 6 | 7 | 6 | 3 | 1 | 135 |
| 2015 | 92 | 13 | 8 | 2 | 8 | 2 | 0 | 112 |
| 2016 | 91 | 16 | 5 | 2 | 4 | 2 | 1 | 105 |
| 2017 | 78 | 13 | 4 | 6 | 3 | 3 | 2 | 96 |
| 2018 | 86 | 10 | 8 | 2 | 9 | 3 | 2 | 110 |
| 2019 | 58 | 9 | 1 | 2 | 3 | 1 | 1 | 66 |
| 2020 | 55 | 9 | 11 | 2 | 0 | 1 | 4 | 73 |
| 2021 | 53 | 13 | 6 | 3 | 0 | 0 | 10 | 72 |
| 2022 | 48 | 10 | 2 | 1 | 1 | 1 | 14 | 67 |
Note 46: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 12 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB.
Table 16. Proportions of TB outcomes at 12 months for people with non-RR or MDR-TB with expected treatment duration of less than 12 months, North East, 2013 to 2022 [note 47]
| Year | Treatment completed (proportion) | Treatment completed with any social risk factor (proportion) | Died (proportion) | Lost to follow up (proportion) | Still on treatment (proportion) | Treatment stopped (proportion) | Not evaluated (proportion) |
|---|---|---|---|---|---|---|---|
| 2013 | 82.6 | 5.8 | 5.0 | 5.0 | 4.1 | 0.8 | 2.5 |
| 2014 | 83.0 | 5.2 | 4.4 | 5.2 | 4.4 | 2.2 | 0.7 |
| 2015 | 82.1 | 11.6 | 7.1 | 1.8 | 7.1 | 1.8 | 0.0 |
| 2016 | 86.7 | 15.2 | 4.8 | 1.9 | 3.8 | 1.9 | 1.0 |
| 2017 | 81.2 | 13.5 | 4.2 | 6.2 | 3.1 | 3.1 | 2.1 |
| 2018 | 78.2 | 9.1 | 7.3 | 1.8 | 8.2 | 2.7 | 1.8 |
| 2019 | 87.9 | 13.6 | 1.5 | 3.0 | 4.5 | 1.5 | 1.5 |
| 2020 | 75.3 | 12.3 | 15.1 | 2.7 | 0.0 | 1.4 | 5.5 |
| 2021 | 73.6 | 18.1 | 8.3 | 4.2 | 0.0 | 0.0 | 13.9 |
| 2022 | 71.6 | 14.9 | 3.0 | 1.5 | 1.5 | 1.5 | 20.9 |
Note 47: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 12 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB.
TB prevention
In 2023, 61 of the 112 people notified had pulmonary disease and therefore required contact tracing according to NICE guidance. Of these, 80.3 (49 out of 61) had contact tracing information recorded: a reduction of 6.3% from 2022.
Table 17 describes the number of contacts of people notified with pulmonary TB (index individuals) who had contacts assessed in England in 2023. Where contact information was recorded, the median number of contacts identified per person notified with pulmonary TB was 3 (IQR: 1 to 6).
Females were more likely to have 5 or more contacts identified and screened (26.1% for females versus 11.5% for males).
UK-born people with TB were more likely to have 5 or more contacts identified (33%) than non-UK-born (9.7%).
People with TB and at least 1 social risk factor were more likely to have 5 or more contacts identified and screened (25%) than people with TB and no social risk factors (17.1%).
The median number of contacts identified was higher than the median for all people with pulmonary TB for females, UK-born and people with at least one social risk factor (Table 17).
Table 17. Contact tracing information for people with pulmonary TB by demographic and disease characteristics, North East, 2023 [note 48]
| Category | Total | Contact information entered (number) | Contact information entered (proportion) | 5 or more contacts identified and screened (number) | 5 or more contacts identified and screened (proportion) | Median contacts identified and screened (median) | IQR of contacts identified and screened |
|---|---|---|---|---|---|---|---|
| All people with pulmonary TB | 61 | 49 | 80.3 | 9 | 14.8 | 3 | 1.0 to 6.0 |
| Female | 25 | 23 | 92.0 | 6 | 24.0 | 4 | 3.0 to 6.0 |
| Male | 36 | 26 | 72.2 | 3 | 8.3 | 2 | 0.2 to 3.5 |
| Adults | 59 | 47 | 79.7 | 9 | 15.3 | 3 | 1.2 to 6.0 |
| Children (15 years or less) | 2 | 2 | 100.0 | 0 | 0.0 | 1 | 1.0 to 1.0 |
| Non-UK-born | 39 | 31 | 79.5 | 3 | 7.7 | 2 | 1.0 to 4.0 |
| UK-born | 22 | 18 | 81.8 | 6 | 27.3 | 6 | 2.0 to 7.5 |
| No social risk factor | 47 | 41 | 87.2 | 7 | 14.9 | 2 | 1.0 to 6.0 |
| At least 1 social risk factor | 14 | 8 | 57.1 | 2 | 14.3 | 4 | 2.5 to 7.0 |
| Non-MDR or RR TB | 58 | 47 | 81.0 | 9 | 15.5 | 3 | 1.2 to 6.0 |
| MDR or RR TB | 3 | 2 | 66.7 | 0 | 0.0 | 1 | 1.0 to 1.0 |
Note 48: routine contact tracing information is collected from close contacts only. Individuals identified as part of an incident are collected separately and not included in this table.
Figure 30 shows the proportion of those notified in 2023 with 5 or more contacts identified and screened has increased from 11.4% (4 out of 31) in 2022 to 14.8% in 2023 (9 out of 52).
Figure 30. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, North East, 2018 to 2023 [note 49] [note 50]
Note 49: error bars represent upper and lower 95% confidence intervals.
Note 50: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
Table 18 shows the numbers and proportion of adult and child contacts of people notified with pulmonary TB in 2023 who were identified, screened, tested positive for LTBI, then started and completed treatment.
In 2023, a total of 303 contacts were identified from 61 people notified with pulmonary TB who had contact information recorded. Of those contacts, 34% were screened for active and latent TB; 28.2% tested positive for latent TB. A further 1.9% were reported to have active TB disease, compared with no cases in 2022.
In 2023, children (aged 14 years or under) made up 33.8% of all contacts identified. The proportion of contacts screened among adults and children were similar (34 versus 33.8%). Children were slightly more likely to have active (1.5% of child contacts, 1.2% of adults) and latent TB disease (59.1% versus 19.8%). Over three-quarters (75.9%) of contacts with a positive LTBI test started treatment for latent TB, compared to 72.7% in 2022 and 31% were recorded as having completed treatment, higher than in 2022 where 18.2% were recorded as completing treatment.
Table 18. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), North East, 2023
| Treatment and screening categories | All adult contacts (number) | All adult contacts (proportion) | All child contacts (number) | All child contacts (proportion) | Total contacts (number) | Total contacts (proportion) |
|---|---|---|---|---|---|---|
| Number of contacts identified | 238 | Not applicable | 65 | Not applicable | 303 | Not applicable |
| Number of contacts screened for active TB and latent TB | 81 | 34 | 22 | 33.8 | 103 | 34 |
| Number of contacts with active TB | 1 | 1.2 | 1 | 4.5 | 2 | 1.9 |
| Number of contacts with latent TB | 16 | 19.8 | 13 | 59.1 | 29 | 28.2 |
| Number of contacts who started treatment for latent TB | 9 | 56.2 | 13 | 100 | 22 | 75.9 |
| Number of contacts who completed treatment for latent tuberculosis | 4 | 25 | 5 | 38.5 | 9 | 31 |
Figure 31. LTBI treatment completion in close contacts of adult or child and UK-born or non-UK-born index individuals, North East, 2023 [note 51]
LTBI treatment completion among the contacts of adult index cases (32.1%) was higher than child index individuals; and LTBI treatment completion was higher among the contacts of non-UK-born index individuals (64.3%) compared to non-UK-born index individuals (64.3%) (Figure 31).
BCG immunisation
BCG immunisation is recommended for people at higher risk of exposure to TB, particularly to protect against serious forms of disease in infants. Those eligible are:
- all infants (up to 12 months) with a parent or grandparent born in a country where incidence of TB is over 40 cases per 100,000 population per year
- all infants living in an area of the UK with an incidence above 40 per 100,000 population – no North East local authorities meet this criteria
The timing of the neonatal BCG immunisation was changed to a 28-day immunisation programme in September 2021. This change was prompted by the addition of screening for severe combined immunodeficiency (SCID) to the routine newborn screening test at 5 days of age.
Coverage data for BCG is available from the Cover of vaccination evaluated rapidly (COVER) programme Coverage Statistics 2022 to 2023 - NHS England Digital. Coverage is assessed at 3 months, with overall coverage for North East 54.8% of the eligible population in 2022 to 2023. Coverage varied by local authority, from 17.9% in Middlesbrough to 89% in Sunderland.
Of people notified with TB in 2023, 53% (59 out of 112) of cases were known to have received the BCG vaccination. The proportion receiving BCG vaccination was greater in non-UK-born than those born in the UK (51 out of 85, 60% versus 8 out of 27, 30%).
Discussion
The North East remains the region with the lowest incidence of TB in England. The incidence of TB in the North East generally decreased from 2007 to 2019, remaining relatively stable before increasing in 2023. A decrease was seen in 2021 and 2022 which may be due to factors arising from the COVID-19 pandemic, such as restrictions to travel and access to healthcare.
The 51% increase in TB incidence in the North East from 2022 to 2023 reflects national trends and is concerning. It means that the North East has not met the year-on-year decrease required to remain on track to meet the WHO End TB 2035 goal of a 90% reduction in incidence.
TB is not distributed evenly across the North East and a small number of local authorities bear a substantial burden of disease, with rates above the national average. Being a low incidence region, North East TB nursing services which undertake contact tracing and case management are small teams. Consequently, whilst increases in incidence across the North East may be small in absolute numbers, this nevertheless has a substantial impact for TB nursing teams.
The rate of TB notifications remains highest among men, young adults aged 15 to 44, and those born outside the UK. Since 2020, there has been a marked increase in the number of notifications in people aged 15 to 44 who were born outside the UK, after a sustained decline in this group from 2012 to 2020. Meanwhile, numbers have remained stable among those aged under 15 or over 44 years who were born abroad. Another notable change has been the increase in TB notifications in people who are recent entrants to the UK, following a significant decrease in this group since 2015 (and the introduction of pre-entry and post-entry screening for migrants from certain high incidence countries). Despite these changes, more than a quarter of TB notifications in those born abroad were in people who entered the UK more than 10 years previously.
India was the most common country of birth for those born outside of the UK, accounting for over a fifth people notified with TB in the North East. Of those notified with TB who were born outside the UK, the largest increase was seen in people born in India. In 2023, 37.5% of the people with TB who were born in India, had entered the UK less than 2 years before their TB diagnosis (of whom 55.6% had pulmonary TB).
Although numbers overall remain small, in 2023 we observed a decrease in the number of children aged under 15 years with TB, particularly among those born in the UK.
TB is associated with socio-economic disadvantage and in the North East, higher rates are seen in people living in the most deprived areas. People with TB frequently have complex medical and social needs. Just over a fifth of people with TB in the North East in 2023 had at least one of the reported key comorbidities (with diabetes most common, experienced by 12.6% of those with TB in the North East). Just over a fifth of people notified with TB had at least one social risk factor, with asylum seeker current the most reported, although multiple issues were common. This was reflected in the use of enhanced case management by TB services, with over a fifth of all people with TB requiring enhanced support, and of those nearly a third needing the highest level of support to complete their treatment. This is notable because, although a low incidence region, the complexity of case management places additional demands on North East TB nursing teams and others involved in supporting cases through diagnosis and treatment.
Over one-third of patients with pulmonary TB experienced a delay of over 4 months between onset of symptoms and treatment start date. Reduction in delay could improve potential transmission of TB.
Overall treatment completion rates have reduced in recent years, with just 71.6% of those notified in 2022 completing treatment within 12 months (excluding those who would be expected to be on treatment for longer). Lower levels of loss to follow up are encouraging, but increased numbers still on treatment among those with expected regimens of less than 12 months may need further investigation, although this is usually associated with disease severity.
The proportion of people with pulmonary TB confirmed by culture is above the 80% target. The slight increase in resistance to first line drugs supports the need to obtain culture confirmation where possible and requires careful monitoring in the future.
Effective contact tracing and screening is important reducing transmission and overall incidence by identifying those at highest risk of exposure, finding people with disease earlier and treating latent infection. Close contacts with recent exposure remain at elevated risk of developing TB. Whilst information about contacts was reported for most people notified with TB, the majority had fewer than 5 contacts identified and screened for TB. The proportion of people with 5 or more contacts identified and screened has been increasing since 2021. Where screened, over a quarter of contacts had latent TB and 1.9% had active disease.
As noted, the increase in TB notifications in the North East is concerning. Diagnosing TB, identifying contacts and supporting cases through treatment in a low incidence area case presents specific challenges and addressing the increase in incidence requires collaboration and continued focus from partners across the whole of the North East health and social care system. Further work to understand reasons behind the changing incidence will help identify solutions, but work must also continue to find, treat, and prevent cases of TB occurring in the known higher risk communities in North East. A continued emphasis on early diagnosis and support through treatment remains a priority for the North East, and in particular focused work to reduce the inequalities associated with TB.
Recommendations
This report describes the latest epidemiology of TB in the North East, including those populations at increased risk of disease. This evidence can support services implement the basic elements of TB control, namely:
- prompt identification of active cases of disease
- supporting patients to successfully complete treatment
- preventing new cases of disease occurring, through effective case management and robust contact tracing
The information will also be useful to target resources effectively.
Important recommendations for the NHS and UKHSA derived from the data presented in this report include:
- ensuring that accurate and complete information is reported by TB services on the UKHSA National TB Surveillance system in a timely manner
- continuing to offer and encourage HIV testing for all those diagnosed with TB and ensuring, where possible, that tests are done, in line with national guidance
- increasing the proportion of pulmonary TB cases with a sputum smear result to better inform local infection control and prevention activity
- reporting treatment outcome for all patients, and reviewing reasons why completion is low in some areas
In addition, all named organisations should have due regard for the actions assigned to them in the national Tuberculosis Action Plan for 2021 to 2026, which include strengthening detection of TB in higher risk groups and those with social risk factors.
The recommendations below link to the 5 priority areas in TB action plan Tuberculosis (TB): action plan for England, 2021 to 2026:
1. Recovery from COVID-19
UKHSA North East teams should continue to monitor TB notifications: reports will be shared with partners quarterly (for timely information) and more in-depth analysis annually, to be reviewed at the network meeting across the North East.
2. Prevent TB
The increase in TB among recently arrived migrants suggests there may be opportunities to improve identification of people with TB in this group.
North East TB service providers should continue to work with local authorities, ICBs and others to identify opportunities to offer appropriate screening for high risk groups (including people experiencing homelessness, those in contact with the criminal justice system, people seeking asylum, and those starting biological therapies).
Contact tracing data should continue to be collected and reported on NTBS.
3. Detect TB
Partners should maintain oversight of delays to treatment and associated reasons.
Surveillance reports should continue to include information about delays to treatment and describe trends over time.
TB services should continue to improve culture confirmation rates for all people with TB (to remain above 80% for pulmonary), and ensure PCR use for all people with suspected pulmonary or infectious TB.
4. Control TB disease
Partners should continue to:
- work to improve current TB completion rates, aiming for target of 90% treatment completion rates for TB drug-sensitive cases by 2026
- ensure effective management of cases of multi-drug resistant (MDR-TB) in association with the British Thoracic Society (BTS) MDR-TB Clinical Advice Service (CAS)
In the North East, the MDR TB review should continue to review all MDR cases and provide learning and educational opportunities to TB services.
5. Workforce
North East TB services should continue to make use of the various TB fora including the TB nurses’ network for shared learning and development, as well as multidisciplinary peer support and strengthening relationships across disciplines.
The recent Getting it Right First Time (GIRFT) Review of Tuberculosis National Report is timely. It highlights challenges in TB control and the importance of maintaining focus on TB services. Given the increase in incidence of TB described during 2025, North East stakeholders in TB control should continue to work collaboratively over the coming year. This is to ensure that services are equipped to meet needs of local communities and able to address the priority areas described above. These stakeholders include the North East and North Cumbria integrated care board (ICB), UKHSA North East and TB services.
Appendix
Data sources
This report is based on TB case notifications made to NTBS for North East residents to the end of 2023 (calendar year). This information is updated annually to take into account denotifications (where the patient was found not to have TB), late notifications and other updates. The data presented in this report supersedes data in previous reports. NTBS replaced the previous TB surveillance system Enhanced TB Surveillance (ETS) system in 2021. NTBS records all TB notifications in the UK and will be the data source used in future reports. Diagnostic laboratories serving acute hospitals are the first place in which TB infection-related samples are received and processed within the pathway of clinical diagnosis and management of suspected TB cases. Results for microscopy, PCR, histology and culture are collected in NTBS. Appropriate referral of clinical specimens to the Mycobacterium Reference Laboratories is an important part of the routine work of the diagnostic laboratories in the investigation and management of TB cases.
Methods
Full details of the data sources and methodologies used in this report are available in the Tuberculosis in England 2024 report.
Acknowledgements
We are grateful to all those who contribute information on people with tuberculosis in the North East, including nurses, physicians, microbiologists, scientists, outreach and social care and administrative staff. We also acknowledge colleagues at the UKHSA National Mycobacterium Reference Service for information on culture confirmation and drug susceptibility testing. Further thanks are due to the UKHSA National TB Unit for providing the cleaned matched dataset, North East Health Protection Team and the Field Service team for their work supporting TB surveillance.