Yorkshire and the Humber: tuberculosis in 2023
Published 4 September 2025
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Incidence, treatment and prevention of tuberculosis (TB) in Yorkshire and the Humber using data up until the end of 2023.
Executive summary
There were 357 notifications of TB in Yorkshire and the Humber in 2023, an incidence rate of 6.4 notifications per 100,000 population, which is an increase compared to 2022. This increase in notifications followed a steady decline in TB notifications since 2009. Yorkshire and the Humber had a lower rate of TB than the England average of 8.4 per 100,000 population in 2023; the only local authorities with a higher rate than this were Bradford (16.4 per 100,000) and Kirklees (8.8 per 100,000).
The TB notification rate was highest in the male 20 to 29 year age group (54 notifications, 15 per 100,000 population) and lowest in the 0 to 9 year age groups (0.3 and 0.9 per 100,000 population among females and males, respectively). The majority of people notified with TB in Yorkshire and the Humber in 2023 were born outside the UK (74%), the most common countries of birth reported were Pakistan, India, Nigeria, Zimbabwe, and Romania. The number of people notified with TB in Yorkshire and the Humber who were born outside the UK increased in 2023, particularly among people who had entered the UK less than 2 years before diagnosis.
Of the people notified with TB in 2023, 63% had pulmonary disease of which 71% were confirmed by culture, compared with 61% culture confirmation in England as reported in the Tuberculosis in England 2024 report. 29% of people with pulmonary TB experienced a delay of more than 4 months between symptom onset and start of treatment, with a median time of 76 days.
Among people notified in 2023, 16% reported at least one social risk factor, and 8% reported more than one. The most common social risk factors reported were being a current asylum seeker (overall and among males), and among females was drug and alcohol misuse. Three-quarters of people notified with TB in Yorkshire and the Humber in 2023 were resident in the 3 most deprived deciles (76%), and the TB notification rate was highest in the most deprived decile (13.2 per 100,000 population). Approximately, one quarter (24%) of people notified with TB in 2023 received enhanced case management.
Excluding people with rifampicin-resistant, central nervous system (CNS), spinal, cryptic or miliary TB, 83% of people with TB notified in 2022 completed treatment at 12 months, and 5% died before completing treatment.
In conclusion, after years of a decreasing rate of TB in Yorkshire and the Humber, there was an increase in 2023. Recommendations from this report include continued efforts to strengthen contact tracing, reduce delays in diagnosis, improve the proportion of cases with culture-confirmed disease, and improve treatment completion rates.
Data for all the graphs in this report can be found in the Yorkshire & Humber TB supplementary data 2023 spreadsheet
TB incidence and epidemiology
Overall numbers, rates, and geographical distribution
In 2023, 357 people in Yorkshire and the Humber were diagnosed with TB within the region, a rate of 6.4 per 100,000 population (95% confidence interval (CI) 5.7 to 7.1). Compared to 2022, this is an increase in both the number of notifications and the rate (307 notifications, 5.5 per 100,000 population), and is similar to pre-pandemic 2019 levels (354 notifications) (Figure 1 and Figure 2).
Figure 1. Number of TB notifications per year, Yorkshire and the Humber, 2001 to 2023
This increase in number of TB notifications and rate in 2023 follows a general decreasing trend in the region since 2009, when incidence peaked at 13.2 cases per 100,000 population. The incidence in Yorkshire and the Humber has been below the England average rate since reporting began, including in 2023 when the England rate was 8.4 per 100,000 (Figure 2). The Yorkshire and the Humber region has also been below the World Health Organization (WHO) definition of a low incidence area (fewer than 10 cases per 100,000 population) since 2014.
Figure 2. TB notification rates per 100,000 population per year, Yorkshire and the Humber, 2001 to 2023 [note 1]
Note 1: error bars represent upper and lower 95% confidence intervals.
Between 2015 and 2022, the TB notification rate was on or below the target rate for the WHO End TB goal of a 90% reduction in incidence by 2035. However, in 2023 the TB notification rate of 6.4 per 100,000 in Yorkshire and the Humber was above the target rate (5.2 per 100,000) and so not in line to meet the 90% reduction (Figure 3).
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, Yorkshire and the Humber, 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.
In 2023, the upper tier local authorities (UTLA) of Bradford and Kirklees had a TB rate higher than the national rate, at 16.4 and 8.8 per 100,000 respectively. Bradford was the only UTLA in Yorkshire and the Humber where the rate was above the WHO definition of a low incidence area (10 per 100,000). The rate in Bradford increased in 2023 following a decreasing trend since 2009 to the highest yearly rate since 2017 (16.8 per 100,000). The incidence rate also increased or stayed similar in most other UTLAs expect for Calderdale (3.8 per 100,000), Doncaster (5.4), Rotherham (3.3) and Sheffield (7.2) where there was a decrease in 2023 (Figure 4).
There were 5 UTLA with higher rates than the Yorkshire and the Humber regional average of 6.4 per 100,000, these were: Bradford (16.4 per 100,000), Kirklees (8.8), Leeds (8.0), Sheffield (7.2), and Kingston upon Hull (6.6) (Figure 5).
Figure 4. TB notification rate by upper tier local authority of residence, Yorkshire and the Humber, 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, Yorkshire and the Humber, 2023
Demographic characteristics
In 2023, 64% of people notified with TB in Yorkshire and the Humber were male (230 out of 357). The largest number and highest rate of TB notifications was in the male age group 20 to 29 years old (54 notifications, 15 per 100,000 population). Among females the largest number of notifications and highest rate was in the 30 to 39 years age group (32 notifications, 8 per 100,000) (Figure 6 and Figure 7). The lowest rate of notification was among the 0 to 9 years old age groups (females 0.3 per 100,000 population; and males 0.9 per 100,000).
Figure 6. Number of TB notifications by age and sex, Yorkshire and the Humber, 2023
Figure 7. TB notification rate by age and sex, Yorkshire and the Humber, 2023
The rates of TB in the non-UK-born population should be interpreted in the context of changes to the pre-UK entry screening policies. In 2005, the UK piloted the pre-entry screening of long-term migrants to the UK for active pulmonary TB in 15 high TB incidence countries. In 2012, this pre-entry screening was extended to all countries with a high incidence of TB (more than 40 cases per 100,000 population).
In 2023, country of birth was recorded for 99.7% notified cases in Yorkshire and the Humber. Where this information was known, 74% of notifications were reported among people who were not born in the UK (263 out of 356). Since 2020, there has been an increasing trend in the number of TB notifications among people not born in the UK, from 194 notifications in 2020 to 263 notifications in 2023. The number of notifications among non-UK-born people is the highest since 2016 (287 notifications). The number of notifications among UK-born people in 2023 (93 notifications) is similar to recent years (2020, 87 notifications; 2021, 88 notifications; 2022, 87 notifications) (Figure 8).
Figure 8. Number of TB notifications in non-UK-born and UK-born people by place of birth, Yorkshire and the Humber, 2001 to 2023
Among the non-UK-born population, the increase in number of TB notifications in 2023 was particularly observed in the 15 to 44 years age group (from 134 notifications in 2022 to 171 notifications in 2023), a smaller increase was also observed in the 45 to 64 years age group (from 47 notifications in 2022 to 57 notifications in 2023). The number of notifications in the 0 to 14 years age group overall in Yorkshire and the Humber decreased from 14 in 2022 to 8 in 2023 (Figure 9).
The percentage of TB notifications among non-UK-born people who had been in the UK for less than 2 years at time of diagnosis increased from 18% of notifications in 2021 to 40% in 2023 (Figure 10).
Figure 9. Number of TB notifications in non-UK-born and UK-born people by place of birth and age group, Yorkshire and the Humber, 2001 to 2023
Figure 10. Proportion of TB notifications by time since entry for people born outside the UK, Yorkshire and the Humber, 2001 to 2023
In 2023, the largest number of TB notifications were among people born in the UK (93 notifications, 26% of total notifications in Yorkshire and the Humber), followed by people with countries of birth of:
- Pakistan (63 notifications, 18%)
- India (47 notifications, 13%)
- Nigeria (23 notifications, 6%)
- Zimbabwe (17 notifications, 5%)
- Romania (12 notifications, 3%)
The median time between entry to the UK and TB notification was 2 years or less for those born in India, Nigeria and Zimbabwe, 3.5 years among people born in Romania and a median of 13 years (inter quartile range (IQR): 1.0 to 29.0 years) among those born in Pakistan (Table 1).
Despite a decreasing trend in the number of TB notifications among people born in Pakistan between 2013 and 2023 (from 159 notifications in 2013 to 63 in 2023), there was an increase in the number of notifications in 2023 compared to 2022 (58 notifications). Similarly, there was an increase in the number of notifications between 2022 and 2023 among people with a country of birth of:
- India (28 notifications in 2022 to 47 in 2023)
- Nigeria (from 7 in 2022 to 23 in 2023)
- Zimbabwe (from 5 in 2022 to 17 in 2023)
There was a decrease in number of notifications among people born in Romania from 16 in 2022 to 12 in 2023 (Figure 11).
Table 1. Most common countries of birth for people with TB and time between entry to the UK and TB notification, Yorkshire and the Humber, 2023 [note 5]
| 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 | 93 | 26.1 | Not applicable | Not applicable |
| Pakistan | 63 | 17.7 | 13.0 | 1.0 to 29.0 |
| India | 47 | 13.2 | 2.0 | 1.0 to 6.0 |
| Nigeria | 23 | 6.5 | 1.0 | 0.8 to 2.2 |
| Zimbabwe | 17 | 4.8 | 1.0 | 0.0 to 17.8 |
| Romania | 12 | 3.4 | 3.5 | 2.2 to 4.8 |
| Sudan | 10 | 2.8 | 7.0 | 5.8 to 17.2 |
| Poland | 9 | 2.5 | 5.5 | 1.8 to 10.0 |
| Eritrea | 6 | 1.7 | 2.0 | 1.0 to 2.0 |
| Ethiopia | 6 | 1.7 | 2.0 | 0.0 to 5.0 |
| Gambia | 6 | 1.7 | 7.5 | 3.8 to 14.2 |
| Other | 64 | 18.0 | 4.0 | 0.0 to 11.0 |
| Total | 356 | 100.0 | Not applicable | Not applicable |
Note 5: other includes all countries with fewer than 6 people notified.
Figure 11. Numbers of TB notifications for the most common countries of birth for people with TB born outside the UK, Yorkshire and the Humber, 2013 to 2023 [note 6]
Note 6: figure shows the top 5 countries in 2023.
Among the top 5 most common non-UK countries of birth, the mean age of people notified with TB was 30 to 39 years old, apart from among people with a country of birth of Pakistan where the mean age was 49 years old. There were a higher percentage of notifications among males, apart from among people born in Zimbabwe where a higher percentage were female (29.4% male), and Romania where numbers of male and female notifications were equal (50% male). Among people with a country of birth of Romania, 91.7% of notifications were pulmonary, compared to between 39% and 57% for the other countries of birth. 70% of notifications with a country of birth of Nigeria were diagnosed with TB less than 2 years after UK entry, whereas notifications from people with a country of birth of Pakistan or Romania were less likely to be new entrants to the UK (Table 2).
Table 2. Characteristics of people with TB from the most common (non-UK) countries of birth, Yorkshire and the Humber, 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 (%) |
|---|---|---|---|---|---|---|
| Pakistan | 63 | 49.0 | 58.7 | 57.1 | 28.9 | 46.2 |
| India | 47 | 39.6 | 61.7 | 51.1 | 41.2 | 64.3 |
| Nigeria | 23 | 35.0 | 56.5 | 39.1 | 70.0 | 35.7 |
| Zimbabwe | 17 | 38.4 | 29.4 | 52.9 | 57.1 | 50.0 |
| Romania | 12 | 35.2 | 50.0 | 91.7 | 16.7 | 100.0 |
In 2023, the most common ethnicities of people notified with TB were Pakistani (84 notifications), Black African (84 notifications), and White (76 notifications). Among people not born in the UK the most common ethnic group was Black African (83 notifications), and among people born in the UK, White (57 notifications) was the most common ethnic group (Figure 12). There was an increase in TB notifications between 2022 and 2023 in all ethnic groups, apart from:
- South Asian UK-born (decrease from 33 to 26 notifications)
- mixed or other ethnicities from all places of birth (decrease from 46 to 42)
- White non-UK-born (decrease from 23 to 19)
This trend is displayed on Figure 13.
Figure 12. Number of TB notifications in ethnic groups by place of birth (UK and non-UK-born), Yorkshire and the Humber, 2023 [note 7]
Note 7: figure ordered by total number of notifications within each ethnicity irrespective of place of birth.
Figure 13. Number of TB notifications in ethnic groups by place of birth (UK and non-UK-born), Yorkshire and the Humber, 2001 to 2023
Of the people notified with TB in Yorkshire and the Humber in 2023, 63% had pulmonary TB and 43% had pulmonary disease only (Table 3); 57% people had extra-pulmonary disease (Table 4).
Table 3. Number of pulmonary TB notifications by site of disease, Yorkshire and the Humber, 2023 [note 8] [note 9]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All pulmonary | 223 | 62.5 |
| Pulmonary only | 152 | 42.6 |
| Miliary only | 14 | 3.9 |
| Laryngeal only | 2 | 0.6 |
Note 8: percentages may not add up to 100 as people with TB may have more than one site of disease.
Note 9: ‘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, Yorkshire and the Humber, 2023 [note 10]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All extra-pulmonary | 205 | 57.4 |
| Other extra-pulmonary | 80 | 22.4 |
| Extra-thoracic lymph nodes | 78 | 21.8 |
| Intra-thoracic lymph nodes | 39 | 10.9 |
| Pleural | 24 | 6.7 |
| Gastrointestinal | 17 | 4.8 |
| Bone - spine | 12 | 3.4 |
| Bone - not spine | 9 | 2.5 |
| Central nervous system - other | 9 | 2.5 |
| Central nervous system - meningitis | 8 | 2.2 |
| Genitourinary | 6 | 1.7 |
| Cryptic disseminated | 0 | 0.0 |
Note 10: percentages may not add up to 100 as people with TB may have more than one site of disease.
The percentage of people notified with pulmonary TB in Yorkshire and the Humber has increased slightly over the last ten years, from 57% notifications in 2013 to 62% in 2023 (Figure 14).
Figure 14. Proportion of people notified with pulmonary TB, Yorkshire and the Humber, 2013 to 2023 [note 11]
Note 11: error bars represent upper and lower 95% confidence intervals.
Among people notified with TB in 2023, 21% were also notified to have at least one of the comorbidities: chronic liver disease, chronic renal disease, diabetes, hepatitis B, hepatitis C or immunosuppression. The most commonly notified was diabetes (14%, 43 notifications) (Table 5). However, between 11.8% and 23.2% of notifications were missing information on presence of these comorbidities.
HIV testing information was recorded for 92% of notifications (330 out of 357) in 2023, of whom 322 people were offered an HIV test (98%). This is similar to the percentage offered a test over recent years (98% in 2021 and 2022), however remains below the 100% target (Figure 15).
Table 5. Number and proportion of people with TB with comorbidities, Yorkshire and the Humber, 2023 [note 12]
| 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 | 357 | 75 | 21.0 | Not applicable | Not applicable |
| Chronic liver disease | 310 | 5 | 1.6 | 47 | 13.2 |
| Chronic renal disease | 313 | 9 | 2.9 | 44 | 12.3 |
| Diabetes | 315 | 43 | 13.7 | 42 | 11.8 |
| Hepatitis B | 277 | 9 | 3.2 | 80 | 22.4 |
| Hepatitis C | 274 | 0 | 0.0 | 83 | 23.2 |
| Immunosuppression | 303 | 20 | 6.6 | 54 | 15.1 |
Note 12: 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.
Figure 15. Proportion of people with TB offered an HIV test by year, Yorkshire and the Humber, 2018 to 2023 [note 13] [note 14]
Note 13: dashed line indicates target of 100% of people offered HIV test.
Note 14: error bars represent upper and lower 95% confidence intervals.
The percentage of people over 15 years old with TB and information recorded about at least one social risk factor (SRF) (current alcohol misuse, current or a history of homelessness, drug misuse, imprisonment, current asylum seeker status, or current mental health needs) was 98% (349 out of 357). Among people where this information was recorded, 16% (56 out of 349 notifications) had at least one of these SRF, and 8% had more than one SRF. The most common SRF recorded was current asylum seeker status (8%, 26 out of 327 notifications), followed by current or previous homelessness (6.5%, 19 out of 293) and current or previous drug misuse (6.1%, 18 out of 294). (Table 6) The prevalence of at least one social risk factor among people notified with TB decreased slightly in 2023 (16%) compared to 2022 (18%), however there has been an increasing trend since 2013 (7%) (Figure 16, Table 7).
Table 6. Number and proportion of people with TB aged 15 years or over with individual social risk factors, Yorkshire and the Humber, 2023 [note 15]
| 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 | 349 | 56 | 16.0 | Not applicable | Not applicable |
| More than one social risk factor | 311 | 25 | 8.0 | 38 | 10.9 |
| Alcohol misuse (current) | 299 | 13 | 4.3 | 50 | 14.3 |
| Asylum seeker (current) | 327 | 26 | 8.0 | 18 | 5.2 |
| Drug misuse (current or previous) | 294 | 18 | 6.1 | 55 | 15.8 |
| Homelessness (current or previous) | 293 | 19 | 6.5 | 56 | 16 |
| Mental health needs (current) | 293 | 6 | 2.0 | 56 | 16 |
| Prison (current or previous) | 282 | 15 | 5.3 | 67 | 19.2 |
Note 15: 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 16. Proportion of people with TB aged 15 years or over with at least one social risk factor (SRF), Yorkshire and the Humber, 2018 to 2023 [note 16] [note 17]
Note 16: error bars represent upper and lower 95% confidence intervals.
Note 17: additional social risk factors have been captured since 2021.
Table 7. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, Yorkshire and the Humber, 2013 to 2023 [note 18]
| 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 | 37 | 7.0 | 532 |
| 2014 | 56 | 11.3 | 495 |
| 2015 | 51 | 12.4 | 410 |
| 2016 | 42 | 10.4 | 405 |
| 2017 | 44 | 13.3 | 330 |
| 2018 | 38 | 11.4 | 332 |
| 2019 | 53 | 15.7 | 338 |
| 2020 | 29 | 10.9 | 267 |
| 2021 | 46 | 14.5 | 317 |
| 2022 | 53 | 18.1 | 293 |
| 2023 | 56 | 16.0 | 349 |
Note 18: not all social risk factors were captured before 2021 and this table includes people with no information recorded in the denominator.
Males with TB notified in 2023 were more likely than females to report experience of drug misuse, alcohol misuse, homelessness, prison, seeking asylum and mental health needs. Among males the most commonly reported SRF in 2023 was being an asylum seeker (11.7%), while among females it was drug and alcohol misuse (2.8% and 2.7%, percentages based on fewer than 5 notifications, respectively). Being an asylum seeker was the most common SRF reported by people aged 15 to 44 years old (10.3%) while in the 45 to 64 year age group the most commonly reported SRFs were drug misuse (10.1%) and prison (10.9%). Among people not born in the UK the most commonly reported social risk factors were being an asylum seeker (10.9%) and homelessness (7.2%), and among the UK-born population, drug misuse was most common (20%). (Numbers not shown)
In 2023, three-quarters of people notified with TB in Yorkshire and the Humber were resident in the 3 most deprived deciles (76%, 270 out of 354). The TB notification rate was highest in the most deprived decile (13.2 per 100,000 population), followed by the second and third most deprived (11.9 and 9.7 per 100,000, respectively), the rate in the remaining 7 deciles ranged between 1.6 and 3.6 per 100,000 (Figure 17).
Figure 17. TB notification rate by deprivation decile, Yorkshire and the Humber, 2023 [note 19]
Note 19: error bars represent upper and lower 95% confidence intervals.
TB diagnosis, microbiology and drug-resistance
In 2023, 71.3% (159 out of 223) people with pulmonary TB in Yorkshire and the Humber were culture-confirmed, which is similar to the percentage in 2022 (70.0%) and remains below the 80% target (Figure 18).
Among culture-confirmed TB cases, between 2017 and 2023, there was consistently between 95% and 100% of records where first line TB drug-sensitivity results were recorded, although there has been variation between years and a slight decrease in percentage between 2022 (100%) and 2023 (97%) (Figure 19). Between 2021 and 2023, there was an increase in the percentage of culture-confirmed results with resistance to at least one of the first line anti-TB antibiotics (isoniazid, rifampicin, ethambutol, pyrazinamide) from 8% in 2021 to 15% in 2023 (Figure 20).
Figure 18. Proportion of people notified with pulmonary TB who were culture-confirmed, Yorkshire and the Humber, 2017 to 2023 [note 20] [note 21]
Note 20: dashed line indicates target of 80% culture confirmation.
Note 21: error bars represent upper and lower 95% confidence.
Figure 19. Proportion of people culture-confirmed with TB with first line drug results, Yorkshire and the Humber, 2017 to 2023 [note 22]
Note 22: error bars represent upper and lower 95% confidence intervals.
Figure 20. Proportion of people notified with culture-confirmed TB with initial resistance to any first line drug, Yorkshire and the Humber, 2017 to 2023 [note 23]
Note 23: error bars represent upper and lower 95% confidence intervals.
Among culture-confirmed notifications in 2023, 37.4% were identified in a 12 single nucleotide polymorphism (SNP) cluster with more than one other person, this is a slight decrease in the percentage compared to 2021 and 2022 (44.1% and 39.8%, respectively) (Table 8).
Table 8. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, Yorkshire and the Humber, 2020 to 2023 [note 24] [note 25]
| 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 | 285 | 165 | 57.9 | 58 | 35.2 | 28.3 to 42.7 |
| 2021 | 327 | 188 | 57.5 | 83 | 44.1 | 37.2 to 51.3 |
| 2022 | 307 | 176 | 57.3 | 70 | 39.8 | 32.8 to 47.1 |
| 2023 | 357 | 214 | 59.9 | 80 | 37.4 | 31.2 to 44 |
| Total | 1,276 | 743 | 58.2 | 291 | 39.2 | 35.7 to 42.7 |
Note 24: a WGS cluster is defined as 2 or more individuals that have isolates with a less than 12 SNP difference.
Note 25: WGS cluster reporting has changed over time. These changes are likely to have affected the most recent year’s data.
TB in children: incidence, epidemiology and microbiology
In 2023, there were 8 children under the age of 15 years old notified with TB in Yorkshire and the Humber (0.8 per 100,000 population); there has been a decreasing trend in the number of children notified with TB since the peak in 2011 (62 notifications) (Figure 21 and Figure 22).
In 2023, there were fewer than 5 UK-born children under 15 years old notified with TB, a decrease from 10 notifications in 2022 and a continuation of the decreasing trend since 2011 (Figure 23). In contrast, there has been an increase in the number of TB notifications among non-UK-born children under 15 years over the last 2 years, from fewer than 5 in 2021 to over 5 in 2023. This is a return to levels similar to pre-pandemic, following a previous decrease in notifications between 2018 (8 notifications) and 2021 (fewer than 5). The only country of birth where there were more than 5 children notified with TB between 2020 and 2023 was the UK (36 notifications, 72% of notifications among children).
Among children under 15 years old in Yorkshire and the Humber, there were 5 children (63%) diagnosed with pulmonary TB (with or without extra-pulmonary sites), fewer than 5 diagnosed with extra-pulmonary TB, and no children diagnosed with severe TB (defined as CNS, spinal, cryptic or miliary TB) in 2023.
Figure 21. Number of TB notifications in children aged under 15 years, Yorkshire and the Humber, 2001 to 2023
Figure 22. TB notification rate in children aged under 15 years, Yorkshire and the Humber, 2001 to 2023 [note 26]
Note 26: error bars represent upper and lower 95% confidence intervals.
Figure 23. Number of TB notifications in UK-born children aged under 15 years, Yorkshire and the Humber, 2001 to 2023
TB treatment
There are recommendations for enhanced case management (ECM) in individuals receiving anti-TB treatment with clinical or social complexities, for example:
- ECM level 1: people with clinical or social issues which may impact on treatment, for example, children with TB, or those taking antiretrovirals
- ECM level 2: people with complex clinical or social issues which are likely to 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 or social issues which highly impact on treatment, for example, social risk factors or multi-drug-resistant (MDR) or rifampicin-resistant (RR) TB which necessitates directly observed therapy (DOT) or video observed therapy (VOT)
In 2023, 24.1% of all people notified with TB in Yorkshire and the Humber received ECM (86 out of 357), of which similar numbers were at ECM level 1 (27, 7.6%), level 2 (28, 7.8%) and level 3 (31, 8.7%). There was a decrease in the number of notifications at ECM level 1 in 2023 compared to 2022 (45, 14.7%) however, the number of TB notifications at ECM level 2 increased from 18 in 2022 to 28 in 2023. The number and percentage of TB notifications at ECM level 3 remained similar between 2022 (26, 8.5%) and 2023 (31, 8.7%) (Table 9).
Table 9. Number of people with TB receiving enhanced case management, Yorkshire and the Humber, 2021 to 2023 [note 31]
| 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 | 327 | 93 | 28.4 | 34 | 10.4 | 20 | 6.1 | 39 | 11.9 | 0 | 0.0 |
| 2022 | 307 | 90 | 29.3 | 45 | 14.7 | 18 | 5.9 | 26 | 8.5 | 1 | 0.3 |
| 2023 | 357 | 86 | 24.1 | 27 | 7.6 | 28 | 7.8 | 31 | 8.7 | 0 | 0.0 |
Note 31: total TB notifications includes all people notified with TB regardless of whether they are receiving ECM or not, or if this information is missing.
In 2023, the percentage of people with pulmonary TB with a treatment delay over 2 months was 60.6%, which was lower than pre-pandemic 2019 (67.4%) (Figure 24). Among people with extra-pulmonary TB, there has been a steady increase in the percentage of people with a treatment delay over 2 months from 62.3% in 2019 to 70.6% in 2023 (Figure 25).
There was a year-on-year increase in the percentage of notifications of pulmonary TB with missing information about treatment delay, with 23.3% missing in 2023 compared to 4.7% missing in 2018. In 2023, 49 pulmonary TB notifications (31.6%) had a treatment delay of 2 to 4 months, and 45 (29.0%) had a treatment delay over 4 months. The percentage with a delay over 4 months was similar to recent years (between 27% and 33% from 2020 to 2022), but lower than 2019 levels (39%) (Table 10). The median time between symptom onset and treatment start in people with pulmonary TB in 2023 was 76 days (IQR 42 to 127), which is higher than the 2027 target of fewer than 56 days between symptom onset and treatment start (Figure 26, Table 12).
Two-thirds (66%) of people with pulmonary TB were notified within 3 days of diagnosis in 2023, which is similar to recent years (between 62% and 68% between 2019 and 2022) (Table 11).
Figure 24. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, Yorkshire and the Humber, 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.
Figure 25. Proportion of people notified with extra-pulmonary TB with a treatment delay over 2 months, Yorkshire and the Humber, 2018 to 2023 [note 34] [note 35]
Note 34: error bars represent upper and lower 95% confidence intervals.
Note 35: delay to treatment is defined by when treatment was started from symptom onset.
Table 10. Number and proportion of people notified with pulmonary TB with a treatment delay, time between symptom onset and treatment start, Yorkshire and the Humber, 2018 to 2023 [note 36]
| 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 | 54 | 29.5 | 53 | 29.0 | 183 | 9 | 4.7 | 192 |
| 2019 | 52 | 28.7 | 70 | 38.7 | 181 | 10 | 5.2 | 191 |
| 2020 | 32 | 20.5 | 42 | 26.9 | 156 | 10 | 6.0 | 166 |
| 2021 | 45 | 28.1 | 51 | 31.9 | 160 | 14 | 8.0 | 174 |
| 2022 | 42 | 32.6 | 42 | 32.6 | 129 | 30 | 18.9 | 159 |
| 2023 | 49 | 31.6 | 45 | 29.0 | 155 | 47 | 23.3 | 202 |
Note 36: 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, Yorkshire and the Humber, 2018 to 2023 [note 37] [note 38] [note 39] [note 40]
Note 37: dashed line represents the target treatment delay of 56 days by 2027.
Note 38: 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 39: delay to treatment is defined by when treatment was started from symptom onset.
Note 40: 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.
Table 11. Proportion of people notified with pulmonary TB within 3 days of diagnosis by year, Yorkshire and the Humber, 2018 to 2023 [note 41]
| Year | Number of people notified | Proportion of people notified (%) | Total |
|---|---|---|---|
| 2018 | 104 | 57.1 | 182 |
| 2019 | 113 | 62.4 | 181 |
| 2020 | 102 | 63.0 | 162 |
| 2021 | 113 | 68.1 | 166 |
| 2022 | 106 | 67.5 | 157 |
| 2023 | 136 | 65.7 | 207 |
Note 41: includes people with pulmonary TB who were not diagnosed at postmortem, and where report delay was known and between 0 and 90 days (inclusive).
Table 12. Time between symptom onset and treatment start in people with pulmonary TB, Yorkshire and the Humber, 2015 to 2023 [note 42]
| 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 | 103 | 45.2 | 71 | 31.1 | 54 | 23.7 | 228 | 66.0 | 37.0 to 119.0 |
| 2016 | 95 | 42.2 | 69 | 30.7 | 61 | 27.1 | 225 | 76.0 | 38.0 to 127.0 |
| 2017 | 83 | 40.3 | 60 | 29.1 | 63 | 30.6 | 206 | 79.0 | 34.2 to 134.8 |
| 2018 | 76 | 41.5 | 54 | 29.5 | 53 | 29.0 | 183 | 72.0 | 41.0 to 131.0 |
| 2019 | 59 | 32.6 | 52 | 28.7 | 70 | 38.7 | 181 | 95.0 | 46.0 to 173.0 |
| 2020 | 82 | 52.6 | 32 | 20.5 | 42 | 26.9 | 156 | 58.5 | 26.5 to 139.5 |
| 2021 | 64 | 40.0 | 45 | 28.1 | 51 | 31.9 | 160 | 79.0 | 35.0 to 158.2 |
| 2022 | 45 | 34.9 | 42 | 32.6 | 42 | 32.6 | 129 | 90.0 | 43.0 to 150.0 |
| 2023 | 61 | 39.4 | 49 | 31.6 | 45 | 29.0 | 155 | 76.0 | 41.5 to 127.0 |
Note 42: 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. It excludes individuals with a delay over 730 days.
TB treatment outcomes
Among people notified in 2022 in Yorkshire and the Humber with an expected treatment duration of less than 12 months, 83% (228 out of 274) had completed treatment by 12 months (Table 13). This is a slight increase in percentage completion at 12 months compared to people notified in 2020 and 2021 (80% and 81%, respectively) but lower than pre-pandemic (90% and 87% in 2018 and 2019, respectively) (Table 14 and Table 15) and remains below the 90% treatment target (Figure 28).
Of people notified in 2022 who had not completed treatment at 12 months, 5% (13 notifications) had died (due to any cause), 4% (10) had stopped treatment, 3% (8) were still on treatment, and 2 people had been lost to follow up (Table 13). The percentage who stopped treatment increased compared to pre-pandemic when it was 1% in 2019, whereas the percentage lost to follow-up decreased compared to the peak of 5.2% (27 out of 524) in 2013 (Figure 29). The percentage of people notified in 2022 who died before completing treatment, among those with an expected treatment duration of less than 12 months, was similar to recent years apart from a peak in 2020 (17 notifications, 7%) (Figure 29 and Figure 30).
Among people with one or more social risk factors and an expected treatment duration of less than 12 months, 78% (36 out of 46 notifications) had completed treatment within 12 months, which is the highest percentage since 2019 (80%) (Figure 27).
Table 13. 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, Yorkshire and the Humber, 2022 [note 43] [note 44]
| 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 | 228 | 83.2 | 237 | 86.5 |
| Died | 13 | 4.7 | 13 | 4.7 |
| Lost to follow up | 2 | 0.7 | 2 | 0.7 |
| Still on treatment | 8 | 2.9 | 0 | 0.0 |
| Treatment stopped | 10 | 3.6 | 10 | 3.6 |
| Not evaluated | 13 | 4.7 | 12 | 4.4 |
| Total | 274 | 100.0 | 274 | 100.0 |
Note 43: 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 44: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.
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, Yorkshire and the Humber, 2018 to 2022 [note 44] [note 45]
Note 44: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.
Note 45: error bars represent upper and lower 95% confidence intervals.
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%, Yorkshire and the Humber, 2018 to 2022 [note 44] [note 46] [note 47]
Note 44: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.
Note 46: dashed line indicates treatment target of 90%.
Note 47: error bars represent upper and lower 95% confidence intervals.
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, Yorkshire and the Humber, 2013 to 2022
Figure 30. Proportion of people with non-MDR or non-RR TB who died at their last recorded treatment outcome and had an expected treatment duration of less than 12 months, Yorkshire and the Humber, 2017 to 2022 [note 48] [note 49] [note 50]
Note 48: death could be due to TB or any other cause.
Note 49: does not include individuals with CNS, spinal, cryptic or miliary TB.
Note 50: error bars represent upper and lower 95% confidence intervals.
In 2022, there were 16 people with CNS, miliary or cryptic disseminated TB disease which was not reported as rifampicin-resistant. At 12 months, 37.5% (6 of 16) people had completed treatment, with a further 37.5% of people still on treatment and 3 people who had died. There were 17 people with MDR or rifampicin-resistant TB notified between 2019 and 2021, of whom 71% had completed treatment at 24 months (Table 16 and Table 17).
Table 14. TB outcome at 12 months for people with non-RR or MDR-TB with expected treatment duration of within 12 months, Yorkshire and the Humber, 2013 to 2022 [note 52]
| 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 | 466 | 25 | 17 | 27 | 8 | 4 | 2 | 524 |
| 2014 | 414 | 42 | 22 | 12 | 5 | 7 | 4 | 464 |
| 2015 | 324 | 36 | 12 | 17 | 17 | 1 | 6 | 377 |
| 2016 | 324 | 31 | 14 | 12 | 6 | 5 | 5 | 366 |
| 2017 | 279 | 36 | 12 | 4 | 4 | 4 | 1 | 304 |
| 2018 | 291 | 31 | 15 | 7 | 5 | 4 | 1 | 323 |
| 2019 | 269 | 35 | 14 | 5 | 6 | 4 | 12 | 310 |
| 2020 | 196 | 13 | 17 | 12 | 2 | 7 | 10 | 244 |
| 2021 | 239 | 26 | 11 | 11 | 0 | 10 | 24 | 295 |
| 2022 | 228 | 36 | 13 | 2 | 8 | 10 | 13 | 274 |
Note 52: 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. ‘Treatment completed with any social risk factor’ is a subset of ‘Treatment completed’.
Table 15. Proportions of TB outcomes at 12 months for people with non-RR or MDR-TB with expected treatment duration of less than 12 months, Yorkshire and the Humber, 2013 to 2022 [note 53]
| 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 | 88.9 | 4.8 | 3.2 | 5.2 | 1.5 | 0.8 | 0.4 |
| 2014 | 89.2 | 9.1 | 4.7 | 2.6 | 1.1 | 1.5 | 0.9 |
| 2015 | 85.9 | 9.5 | 3.2 | 4.5 | 4.5 | 0.3 | 1.6 |
| 2016 | 88.5 | 8.5 | 3.8 | 3.3 | 1.6 | 1.4 | 1.4 |
| 2017 | 91.8 | 11.8 | 3.9 | 1.3 | 1.3 | 1.3 | 0.3 |
| 2018 | 90.1 | 9.6 | 4.6 | 2.2 | 1.5 | 1.2 | 0.3 |
| 2019 | 86.8 | 11.3 | 4.5 | 1.6 | 1.9 | 1.3 | 3.9 |
| 2020 | 80.3 | 5.3 | 7.0 | 4.9 | 0.8 | 2.9 | 4.1 |
| 2021 | 81.0 | 8.8 | 3.7 | 3.7 | 0.0 | 3.4 | 8.1 |
| 2022 | 83.2 | 13.1 | 4.7 | 0.7 | 2.9 | 3.6 | 4.7 |
Note 53: 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. ‘Treatment completed with any social risk factor’ is a subset of ‘Treatment completed’.
Table 16. TB outcomes at 24 months for people treated for RR or MDR drug-resistant TB, Yorkshire and the Humber, 2013 to 2021 [note 54]
| 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 to 2015 | 14 | 2 | 2 | 3 | 1 | 1 | 3 | 24 |
| 2016 to 2018 | 11 | 3 | 1 | 1 | 0 | 0 | 0 | 13 |
| 2019 to 2021 | 12 | 3 | 1 | 1 | 0 | 1 | 2 | 17 |
Note 54: 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 24 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB. ‘Treatment completed with any social risk factor’ is a subset of ‘Treatment completed’.
Table 17. Proportions of TB outcomes at 24 months for people treated for RR or MDR drug-resistant TB, Yorkshire and the Humber, 2013 to 2021 [note 55]
| 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 to 2015 | 58.3 | 8.3 | 8.3 | 12.5 | 4.2 | 4.2 | 12.5 |
| 2016 to 2018 | 84.6 | 23.1 | 7.7 | 7.7 | 0.0 | 0.0 | 0.0 |
| 2019 to 2021 | 70.6 | 17.6 | 5.9 | 5.9 | 0.0 | 5.9 | 11.8 |
Note 55: 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 24 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB. ‘Treatment completed with any social risk factor’ is a subset of ‘Treatment completed’.
TB prevention
Among people with pulmonary TB in Yorkshire and the Humber in 2023, 74% had some contact information recorded, and 16% had 5 or more contacts identified and screened (median number of contacts was 3, inter-quartile range (IQR) 1 to 5). The median number of contacts was 3 for most of the demographic and disease characteristics groups, apart from by sex where the median number of contacts for females was higher than for males (3.5 and 2 contacts, respectively), for children less than 15 years old (median 4 contacts), and among people diagnosed with MDR or RR TB (median 1 contact). A higher percentage of UK-born people had 5 or more contacts identified and screened compared to non-UK-born people (18.4% and 15.1%, respectively). Among people with at least one social risk factor, the percentage with 5 of more contacts identified was also higher than people with no reported social risk factors (18.6% and 15.6%, respectively) (Table 18).
The percentage of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB remained similar between 2018 and 2021 (13.0 to 13.3%). The percentage then increased between 2021 and 2022 (20.3%) before reducing again in 2023 (16.2%) (Figure 31).
Table 18. Contact tracing information for people with pulmonary TB by demographic and disease characteristics, Yorkshire and the Humber, 2023 [note 56] [note 57]
| 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 | 222 | 164 | 73.9 | 36 | 16.2 | 3.0 | 1.0 to 5.0 |
| Female | 75 | 55 | 73.3 | 16 | 21.3 | 3.5 | 2.0 to 7.2 |
| Male | 147 | 109 | 74.1 | 20 | 13.6 | 2.0 | 1.0 to 4.0 |
| Adults | 216 | 161 | 74.5 | 35 | 16.2 | 3.0 | 1.0 to 5.0 |
| Children (15 years or less) | 6 | 3 | 50.0 | 1 | 16.7 | 4.0 | 3.5 to 4.5 |
| Non-UK-born | 146 | 108 | 74.0 | 22 | 15.1 | 3.0 | 1.0 to 5.0 |
| UK-born | 76 | 56 | 73.7 | 14 | 18.4 | 3.0 | 1.0 to 5.0 |
| No social risk factor | 179 | 130 | 72.6 | 28 | 15.6 | 3.0 | 1.0 to 5.0 |
| At least 1 social risk factor | 43 | 34 | 79.1 | 8 | 18.6 | 3.0 | 1.0 to 7.0 |
| Non-MDR or RR TB | 215 | 161 | 74.9 | 36 | 16.7 | 3.0 | 1.0 to 5.0 |
| MDR or RR TB | 7 | 3 | 42.9 | 0 | 0.0 | 1.0 | 1.0 to 2.0 |
Note 56: 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.
Note 57: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
Figure 31. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, Yorkshire and the Humber, 2018 to 2023 [note 58] [note 59]
Note 58: error bars represent upper and lower 95% confidence intervals.
Note 59: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
From people with pulmonary TB, a total of 654 contacts were identified of whom 474 (72%) were adults and 180 (28%) were children. The percentage of all contacts who were diagnosed with active TB was 2.8% (3.3% of adult contacts and 1.5% of child contacts), and 19.1% were diagnosed with latent TB infection (LTBI) (19.4% adult contacts and 18.2% child contacts). Of the 89 contacts who were diagnosed with latent TB, 66 (74%) started treatment and 35 (39%) completed treatment. There was a higher percentage of child contacts who both started LTBI treatment (88%) and completed treatment (48%), compared with adult contacts (69% and 36% started and completed treatment, respectively) (Table 19).
LTBI treatment completion was similar among the contacts of both adult and child index cases (36% and 33%, respectively); whereas LTBI treatment completion was higher among the contacts of UK-born index individuals (53%) compared to non-UK-born index individuals (29%) (Figure 32).
Table 19. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), Yorkshire and the Humber, 2023 [note 60]
| 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 | 474 | Not applicable | 180 | Not applicable | 654 | Not applicable |
| Number of contacts screened for active TB and latent TB | 330 | 69.6 | 137 | 76.1 | 467 | 71.4 |
| Number of contacts with active TB | 11 | 3.3 | 2 | 1.5 | 13 | 2.8 |
| Number of contacts with latent TB | 64 | 19.4 | 25 | 18.2 | 89 | 19.1 |
| Number of contacts who started treatment for latent TB | 44 | 68.8 | 22 | 88 | 66 | 74.2 |
| Number of contacts who completed treatment for latent tuberculosis | 23 | 35.9 | 12 | 48 | 35 | 39.3 |
Note 60: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
Figure 32. LTBI treatment completion in close contacts of adult or child and UK-born or non-UK-born index individuals, Yorkshire and the Humber, 2023 [note 61]
Note 61: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
There was an increasing trend in the percentage of TB notifications occurring among non-UK-born people within 5 years of entry to the UK between 2018 (41.9%) and 2023 (59.9%) (Figure 33).
Figure 33. Proportion of TB notifications occurring within 5 years of entry to the UK for all countries of birth outside of the UK, Yorkshire and the Humber, 2017 to 2023 [note 62] [note 63]
Note 62: error bars represent upper and lower 95% confidence intervals.
Note 63: within 5 years refers to a time since entry of less than 1 year to 5 years inclusive.
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
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.
BCG vaccination coverage was 62% among children under 15 years old with TB in Yorkshire and the Humber in 2023. Among people of all ages with TB, 32% had received previous BCG vaccination (Table 20).
Table 20. BCG vaccination coverage among people with TB, Yorkshire and the Humber, 2023
| Place of birth | Number of vaccinated people with TB under 15 years old | Total number of people with TB under 15 years old | Proportion of vaccinated people with TB under 15 years old | Number of vaccinated people with TB (all ages) | Total number of people with TB (all ages) | Proportion of vaccinated people with TB (all ages) |
|---|---|---|---|---|---|---|
| All cases | 5 | 8 | 62 | 114 | 357 | 32 |
Discussion
There were 357 notifications of TB in Yorkshire and the Humber in 2023, an incidence rate of 6.4 notifications per 100,000 population, which is an increase compared to 2022. This increase followed a steady decline in TB notifications since 2009. In 2023, Yorkshire and the Humber had a lower rate of TB than the England average of 8.4 per 100,000 population; however, the region is no longer on track to meet the WHO End TB goal of a 90% reduction in incidence by 2035.
Only 2 local authorities in Yorkshire and the Humber had a higher TB incidence rate than England, these were Bradford (16.4 per 100,000) and Kirklees (8.8 per 100,000), of which Bradford is the only area that was above the WHO definition of a low incidence area (10 per 100,000 population).
The TB notification rate was highest in the male 20 to 29 year age group (54 notifications, 15 per 100,000 population) and lowest in the 0 to 9 year age groups (0.3 and 0.9 per 100,000 population among females and males, respectively). The majority of people notified with TB in Yorkshire and the Humber in 2023 were born outside the UK (74%), the most common non-UK countries of birth reported were Pakistan, India, Nigeria, Zimbabwe, and Romania. The number of people notified with TB in Yorkshire and the Humber who were born outside the UK increased in 2023, particularly among people who had entered the UK less than 2 years before diagnosis.
Of the people notified with TB in 2023, 63% had pulmonary disease of which 71% were confirmed by culture, compared with 61% culture confirmation in England as reported in the Tuberculosis in England 2024 report, below the 80% target. 29% of people with pulmonary TB experienced a delay of more than 4 months between symptom onset and start of treatment, with a median time of 76 days. Excluding people with rifampicin-resistant, CNS, spinal, cryptic or miliary TB, 83% of people with TB notified in 2022 completed treatment at 12 months, and 5% died before completing treatment.
Among people notified in 2023, 16% reported at least one social risk factor, and 8% reported more than one. The most common social risk factors reported were being a current asylum seeker (overall and among males), and among females was drug and alcohol misuse. Three-quarters of people notified with TB in Yorkshire and the Humber in 2023 were resident in the 3 most deprived deciles (76%), and the TB notification rate was highest in the most deprived decile (13.2 per 100,000 population). Approximately one quarter (24%) of people notified with TB in 2023 received enhanced case management, with 9% receiving level 3 support.
Of people notified in 2022 who had not completed treatment at 12 months, the percentage of people lost to follow-up (0.7%) was lower compared to 3.7% among 2021 notifications. However, the percentage who stopped treatment was 3.6% which was an increase compared to pre-pandemic where it was 1.3% in 2019. Among people with at least one SRF who were expected to complete treatment within 12 months, 78% of people had completed treatment within 12 months.
Between 2021 and 2023, there was an increase in the percentage of culture-confirmed results with resistance to at least one of the first line anti-TB antibiotics (isoniazid, rifampicin, ethambutol, pyrazinamide) from 8% in 2021 to 15% in 2023, which should continue to be monitored.
In conclusion, after years of a decreasing rate of TB notifications in Yorkshire and the Humber, there was an increase in 2023. Persistent inequalities exist in TB disease with populations living in deprived areas and people born outside the UK disproportionately affected.
Recommendations
The main recommendations from the data presented in this report include:
The UK Health Security Agency (UKHSA) Yorkshire and the Humber regional team should continue to monitor TB notifications. Reports will be shared with partners including clinical networks, the TB nurse network and integrated care boards (ICBs) quarterly (for timely information) with more in-depth analysis in the annual report.
These reports should provide a platform on which commissioners, providers and other system partners can review local LTBI programmes (noting the importance of changing epidemiology of TB), implement recommendations from the Getting it Right First Time (GIRFT) report and review workforce needs.
Data on notifications presented to clinical networks should also inform efforts to strengthen contact tracing, reduce delays in diagnosis, improve the proportion of cases with culture-confirmed disease, and improve treatment completion rates.
To achieve this, services are encouraged to ensure that accurate and complete information is provided to the UKHSA National Tuberculosis Surveillance System (NTBS) in a timely manner, with a particular focus on improved reporting of treatment outcomes and ECM rating.
Appendix
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 Yorkshire and the Humber, 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, the Regions data science team for developing the report, Yorkshire and Humber Health Protection Team and the Field Service team for their work supporting TB surveillance.