East Midlands: tuberculosis in 2024
Published 23 March 2026
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Incidence, treatment and prevention of tuberculosis (TB) in the East Midlands using data up until the end of 2024.
Executive summary
In 2024, there were 422 tuberculosis (TB) case notifications for individuals resident in the East Midlands, a rate of 8.3 cases per 100,000 population (95% confidence interval [CI] 7.6 to 9.2). Whilst this is lower than the national rate at 9.4 per 100,000 (95% CI 9.1 to 9.6), it represents the fourth consecutive annual increase since 2020, and a 5% rise compared with 2023 (rate 7.9 per 100,000, 95% CI 7.1 to 8.7), signalling a sustained upward trajectory that requires public health attention.
Leicester local authority had the highest TB rate in the East Midlands in 2024, with 45.8 cases per 100,000; followed by Derby (11.7 per 100,000) and Nottingham (10.9 per 100,000). Leicester alone accounted for more than 4 in 10 regional cases and continues to have the highest average TB incidence in England (2022 to 2024). Increases in cases were observed in 6 of the 10 local authorities in the region between 2023 and 2024, emphasising that the increase in incidence is across the East Midlands rather than geographically isolated.
The highest age and sex specific rates of TB in the East Midlands were recorded in men aged 30 to 39 years (21.9 per 100,000) and women aged 20 to 29 years (12.0 per 100,000).
In 2024, 83.8% of TB cases were born outside the UK, a proportion similar to England overall. Notifications among non‑UK‑born individuals increased by 13.5% (353 vs 311 in 2023), while UK‑born notifications decreased by 19%. The highest incidence continues to be in non‑UK‑born adults aged 15 to 44 years, with India remaining the most common country of birth (approximately 40% of all cases). This was followed by the UK (16.2%) and Pakistan and Romania (both less than [<] 10%).
Among people with TB who were born outside of the UK, the highest proportion of cases occurred in those that had been in the UK for 11 or more years prior to their diagnosis (32.0%), indicating reactivation of latent TB infection as a contributor to the regional burden. There was also an increase in cases that arrived in the UK between 2 to 5 years prior to diagnosis.
In 2024, 56.9% of TB cases diagnosed were pulmonary TB and therefore potentially infectious. Culture confirmation of pulmonary cases has increased to 77.1%, but remained below the national target (80%). This can limit timely drug‑resistance detection and the use of whole genome sequencing (WGS) to identify transmission clusters. Almost 1 in 3 (31.1%) pulmonary TB cases in the East Midlands experienced a treatment delay of more than 4 months from symptom onset to starting treatment, prolonging infectiousness and reflecting potential barriers in the system. The proportion of pulmonary TB cases notified with at least 5 contacts identified and screened has decreased to 17.2% in 2024.
The rate of TB in the East Midlands paediatric cohort (<18 years old) in 2024 is the highest since 2009 at 2.9 per 100,000 (30 cases), with most child cases aged 15 to 17 years (57%) and 40% UK‑born. A high proportion (86.7%) of paediatric cases were pulmonary, raising implications for early detection and contact tracing in household and educational settings.
In 2024, 13.2% of TB cases (aged ≥15 years) reported at least one social risk factor (SRF) (including alcohol misuse, asylum seeker, drug misuse, homelessness, mental health needs, and prison), with homelessness being the most common. SRFs were more common in men (19.8%) and UK‑born individuals (27.9%), indicating ongoing inequalities in exposure, health access and treatment. TB also continued to be strongly associated with deprivation, with the highest TB rates in the most deprived IMD deciles. Around one sixth of TB cases had at least one comorbidity, most frequently diabetes. These conditions can complicate TB management and lead to poorer outcomes, highlighting the need for integrated TB and long‑term condition pathways.
Treatment completion for drug‑sensitive TB cases notified in 2023 with expected therapy duration within 12 months was 79.2%, unchanged from the previous year and remains below the 90% national target. The most common reason for treatment non-completion where it had been evaluated, was the TB case had died (6.4%, 21 out of 327). Enhanced case management (ECM) was required in 36.3% of cases, reflecting the high clinical and social complexity of cases.
In 2024, 7.5% of culture‑confirmed TB cases had resistance to at least one first‑line drug, this has decreased since the highest levels in recent years in 2022 (16.0%). WGS cluster linkage decreased from 39.3% in 2023 to 29.4% in 2024, which may reflect a real reduction in recent transmission.
Recent increases in TB incidence has prompted a positive response and there has been considerable focus and work in this area. However, these findings demonstrate that TB must remain an East Midlands health priority, with rising TB incidence and widening inequalities. TB continues to disproportionately affect populations experiencing social and economic inequities, highlighting the continued need for equitable, targeted and integrated public‑health responses and health services across the East Midlands region, working collaboratively across a range of health and social issues. There is a need for continued focus on surveillance, early diagnosis, delivery of effective packages of care, screening programmes and TB workforce capacity. These elements will be essential to reverse current trends and progress towards the World Health Organization (WHO) End TB Strategy goals for 2035.
TB incidence and epidemiology
The data used in the figures in this report can be found in the accompanying supplementary tables.
This report of TB in the East Midlands includes data up until the end of 2024, the most complete calendar year available.
In 2024, 422 cases of tuberculosis (TB) were notified in residents in the East Midlands, a rate of 8.3 cases per 100,000 population (95% confidence interval [CI] 7.6 to 9.2) (Figure 1). This represents an increase of 27 cases from 2023. The rate of TB in the East Midlands remains lower than the overall rate for England (9.4 per 100,000 [95% CI 9.1 to 9.6]) (Figure 2) (1).
Case numbers had been gradually declining in the East Midlands since the early 2000s but have increased over the past few years, mirroring the national trend. There was a 5% increase in the East Midlands rate between 2023 and 2024 compared to a 13% increase in the number of people with TB in England over the same period (8.3 per 100,000 in 2023 versus 9.4 per 100,000 in 2024) (1).
The TB notification rate in the East Midlands is currently higher than the rate required to meet the WHO End TB 2035 goal of a 90% reduction in TB incidence (2). The required rate for 2024 is 4.5 per 100,000 (Figure 3).
Figure 1. Number of TB notifications per year, East Midlands, 2001 to 2024
Figure 2. TB notification rates per 100,000 population per year, East Midlands and England, 2001 to 2024 [note 1]
Note 1: error bars represent upper and lower 95% confidence intervals.
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, East Midlands, 2015 to 2024 [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.
The local authority with the highest TB notification rate in 2024 was Leicester where the rate of TB was 45.8 per 100,000, followed by Derby (11.7 per 100,000) and Nottingham (10.9 per 100,000) (Figure 4, Figure 5, Table 1). TB cases in Leicester accounted for 42.2% (178 out of 422) of all East Midlands TB cases in 2024. Leicester was the local authority with the highest average TB rate in England between 2022 and 2024 (1).
Case numbers decreased between 2023 and 2024 in 3 out of 10 local authorities, with the largest reduction in numbers observed in Derbyshire (-51.7%, 14 cases versus 29 in 2023). An increase in cases was observed in 6 out of 10 local authorities between 2023 and 2024. The largest increases in cases were observed in West Northamptonshire (+68.2%, 37 cases versus 22 in 2023) and Leicestershire (+21.9%, 39 cases versus 32 in 2023). Rutland also saw a large percentage increase (+100.0%, 2 cases versus 1 in 2023) but small numbers should be interpreted with caution. Case numbers remained the same in 2024 in North Northamptonshire (21 cases).
Figure 4. TB notification rate per 100,000 population by upper tier local authority of residence, East Midlands, 2001 to 2024 [note 4]
Note 4: the blue line represents the upper tier local authority noted and the grey lines represent the other upper tier local authorities in the region.
Figure 5. TB notification rate per 100,000 population by upper tier local authority of residence, East Midlands, 2024
Table 1. Number of TB notifications and rate per 100,000 population by upper tier local authority of residence, East Midlands, 2024
| Upper tier local authority | Number of TB notifications | TB notification rate per 100,000 population | Lower 95% CI | Upper 95% CI |
|---|---|---|---|---|
| Leicester | 178 | 45.8 | 39.3 | 53.1 |
| Derby | 32 | 11.7 | 8.0 | 16.5 |
| Nottingham | 36 | 10.9 | 7.6 | 15.1 |
| West Northamptonshire | 37 | 8.4 | 5.9 | 11.6 |
| North Northamptonshire | 21 | 5.6 | 3.5 | 8.6 |
| Leicestershire | 39 | 5.2 | 3.7 | 7.2 |
| Rutland | 2 | 4.8 | 0.6 | 17.4 |
| Lincolnshire | 34 | 4.3 | 3.0 | 6.0 |
| Nottinghamshire | 29 | 3.4 | 2.3 | 4.9 |
| Derbyshire | 14 | 1.7 | 0.9 | 2.9 |
In 2024, 59% (249 out of 422) of people with TB in the East Midlands were male, and the rate was higher among males than for females (Figure 6 and Figure 7). Using 10-year age groups, rates and absolute numbers were highest for those aged 30 to 39 years for males (72 cases, 21.9 per 100,000). In females, rates were highest for those aged 20 to 29 years (36 cases, 12.0 per 100,000). There were more male cases than female cases in all age groups except the 0 to 9 years and 80 years and over age groups where 62.5% (5 out of 8) and 66.7% (6 out of 9) were female respectively.
Figure 6. Number of TB notifications by age and sex, East Midlands, 2024
Figure 7. TB notification rate by age and sex, East Midlands, 2024
The rates of TB among people born outside the UK 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 (greater than [>] 40 cases per 100,000 population) (3).
In 2024, 99.8% (421 out of 422) of TB cases had a recorded country of birth, and of these, over 3 quarters (83.8%, 353 out of 421) were born outside the UK which is similar to the proportion nationally (81.9%) (Figure 8). In 2024, the number of TB notifications increased by 13.5% in people born outside of the UK (353 in 2024 versus 311 in 2023) and decreased by 19% in those that are UK born (68 in 2024 versus 84 in 2023).
Since 2020, there has been an increasing trend in the number of people in the East Midlands with TB that were born outside of the UK.
Figure 8. Number of TB notifications in non-UK born and UK born people by place of birth, East Midlands, 2001 to 2024
In 2024, the number of TB notifications in both cases born outside of the UK and within the UK were highest in the 15 to 44 years age group (229 cases non-UK born and 33 cases UK born) (Figure 9).
The age distribution of TB cases varied between patients born within and outside the UK. For the 0 to 14 years age group the proportion was higher in UK born cases compared to non-UK born cases (10.3% UK born versus 1.7% non-UK born). The proportion of cases 15 to 44 years old was higher in non-UK born cases compared to UK born cases (48.5% UK born versus 64.9% non-UK born). For the 45 to 64 years age group the proportion of cases was broadly similar between the UK born and non-UK born cases (19.1% UK born versus 23.5% non-UK born). The proportion of cases in the 65 years and over age group was much higher in UK born cases compared to non-UK born cases (22.1% UK born versus 9.9% non-UK born).
The number of non-UK born cases aged 15 to 44 years has increased year-on-year since 2020. The numbers have remained relatively stable or decreased in the other age groupings.
Figure 9. Number of TB notifications in non-UK born and UK born people by place of birth and age group, East Midlands, 2001 to 2024
In cases notified in 2024, the year of entry to the UK was reported by 77% (272 out of 353) of TB patients born outside of the UK. Of those, the largest proportion (32%, 87 out of 272) had arrived in the UK 11 or more years prior to their TB diagnosis, this suggests these cases could be reactivation of latent disease, although some could be new acquisitions (Figure 10). This represents a slight increase in cases that had arrived in the UK 11 or more years prior to diagnosis compared to 2023 (27.6%, 67 out of 243).
The second largest proportion (26.1%, 71 out of 272) had arrived in the UK less than 2 years prior to their TB diagnosis, this represents a decrease compared to 2023 following an increase in recent years. The combined group of those that entered the UK within 5 years of diagnosis (less than 2 years and 2 to 5 years) accounted for 51.8% of the TB cases born outside of the UK in the East Midlands in 2024 which is similar to 2023 (51.4%).
Figure 10. Proportion of TB notifications by time since entry for people born outside the UK, East Midlands, 2001 to 2024
In 2024, as in previous years, the most common country of birth for all TB cases notified in the East Midlands was India (40.1%, 169 out of 421), and the median time since entry to the UK was 4 years (interquartile range [IQR] 1 to 14.8 years) (Table 2). The next most frequently reported countries of birth were the United Kingdom (16.2%, 68 out of 421), Pakistan (8.3%, 35 out of 421), Romania (4.3%, 18 out of 422), and Poland and Zimbabwe (2.6%, 11 out of 421). The 6 most common countries of birth made up 74.1% of all cases (312 out of 421). There were 10 or less TB cases notified from all other countries of birth. The median time between entry to the UK and TB notification was the highest in people with TB born in Kenya (13.5 years) whilst the lowest was in people with TB born in Zimbabwe (1 year), followed by Bangladesh (2.5 years).
Table 2. Most common countries of birth for people with TB and time between entry to the UK and TB notification, East Midlands, 2024 [note 5] [note 6] [note 7] [note 8] [note 9]
| 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 |
|---|---|---|---|---|
| India | 169 | 40.1 | 4.0 | 1.0 to 14.8 |
| United Kingdom | 68 | 16.2 | Not applicable | Not applicable |
| Pakistan | 35 | 8.3 | 5.0 | 3.0 to 13.0 |
| Romania | 18 | 4.3 | 7.0 | 6.0 to 8.0 |
| Poland | 11 | 2.6 | 7.0 | 5.2 to 10.2 |
| Zimbabwe | 11 | 2.6 | 1.0 | 0.5 to 9.0 |
| Eritrea | 10 | 2.4 | 3.0 | 0.2 to 6.8 |
| Kenya | 10 | 2.4 | 13.5 | 1.8 to 45.2 |
| Bangladesh | 9 | 2.1 | 2.5 | 1.0 to 11.2 |
| Sudan | 9 | 2.1 | 5.0 | 1.8 to 8.0 |
| Other | 71 | 16.9 | 7.0 | 2.0 to 21.0 |
| Total | 421 | 100.0 | Not applicable | Not applicable |
Note 5: other includes all countries with less than 9 people notified.
Note 6: place of birth (UK or non-UK) and/or country of birth is missing for 1 notification in 2024.
Note 7: lower quartile is the 25th percentile and upper quartile is the 75th percentile, representing the interquartile range (IQR).
Note 8: time between entry to the UK and TB notification is calculated as whole years (only year of entry is reported to the National TB Surveillance (NTBS)).
Note 9: time since entry to the UK was not known for 81 people in 2024.
When removing the UK born cases and only looking at TB patients born outside of the UK, the 5 most common countries of birth for TB patients in 2024, were India (47.9%, 169 out of 353), Pakistan (9.9%, 35 out of 353), Romania (5.1%, 18 out of 353), Poland and Zimbabwe (3.1%, 11 out of 353) (Figure 11 and Table 3). Numbers of TB cases born in India, Pakistan, Poland and Zimbabwe increased compared to the previous year, and the number of TB cases born in Romania decreased compared to 2023.
The characteristics for people with TB from the most common non-UK countries of birth varied (Table 3). The median age for cases was highest in people with TB born in Pakistan (43.8 years) and lowest in people with TB born in Romania (32.5 years). The majority (over 50%) of the cases across each of the 5 most common countries of birth were male with the exception of Romania where only 27.8% were male. For cases born in Romania, Poland and Zimbabwe, the majority (over 50%) had pulmonary TB, with 100% of cases born in Poland diagnosed with pulmonary TB. In people with TB who entered the UK less than 2 years prior to their notification, the majority of cases born in Zimbabwe had pulmonary TB, whilst in those born in India and Pakistan this was 45% and 25% respectively. There were no cases born in Romania and Poland that entered the UK less than 2 years prior to their TB diagnosis.
The 5 most common countries of birth outside of the UK make up 58% of all TB cases notified in 2024 in the East Midlands (244 out of 421).
Figure 11. Numbers of TB notifications for the most common countries of birth for people with TB born outside the UK, East Midlands, 2014 to 2024 [note 10]
Note 10: figure shows the top 5 countries in 2024.
Table 3. Characteristics of people with TB from the most common (non-UK) countries of birth, East Midlands, 2024
| 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 | 169 | 40.4 | 53.8 | 46.2 | 29.0 | 45.0 |
| Pakistan | 35 | 43.8 | 60.0 | 48.6 | 19.0 | 25.0 |
| Romania | 18 | 32.5 | 27.8 | 77.8 | 0.0 | 0.0 |
| Poland | 11 | 39.5 | 81.8 | 100.0 | 0.0 | 0.0 |
| Zimbabwe | 11 | 39.0 | 63.6 | 72.7 | 57.1 | 75.0 |
In 2024, 98.1% (414 out of 422) of patients with TB had an ethnicity recorded, of which 4.8% (20 out of 414) were recorded as mixed or other. The highest number of TB notifications in the East Midlands were in patients with a recorded Indian ethnicity which accounted for 44.7% of cases (185 out of 414), followed by the White (20.5%, 85 out of 414) and Black African ethnic groups (14.3%, 59 out of 414) (Figure 12).
When ethnicity and country of birth rate were combined, data was known for 413 cases. Collectively, patients with a recorded South Asian ethnicity made up 56.4% of cases (233 out of 413), of which 5.6% (13 out of 233) were UK born (Figure 13). Patients of White ethnicity made up 20.6% of cases (85 out of 413), of whom the majority (56.5%, 48 out of 85) were UK born. Patients of Black ethnicity made up 15.3% of cases (63 out of 413 cases), of whom 1.6% (1 out of 63) were UK born.
Between 2023 and 2024, the Black and South Asian ethnic groups saw increases in the number of TB cases (Figure 13). The greatest increase was in the South Asian ethnic group with an increase of 50 cases, particularly in non-UK born TB cases. There was a small increase in the Black ethnic group with an increase of 1 case. The Mixed or Other and White ethnic groups saw decreases in the number of TB cases between 2023 and 2024. Case numbers decreased by 20 cases in the White ethnic group and decreased by 10 cases in the Mixed or Other ethnic group.
Figure 12. Number of TB notifications in ethnic groups by place of birth (UK and non-UK born), East Midlands, 2024 [note 11] [note 12]
Note 11: 9 cases have been excluded from the above figure due to missing ethnicity and/or place of birth data.
Note 12: 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), East Midlands, 2001 to 2024 [note 13] [note 14]
Note 13: 9 cases have been excluded from the above figure due to missing ethnicity and/or place of birth data.
Note 14: the South Asian ethnicity group comprises people of Indian, Pakistani and Bangladeshi ethnicities.
In 2024, site of disease was recorded for all 422 cases. The majority (56.9%, 240 out of 422) of patients had pulmonary TB disease (with or without extra-pulmonary sites) which is a decrease from 2023 (62.3%) (Figure 14) and 35.1% of TB cases had pulmonary TB disease only (148 out of 422) (Table 4). People with pulmonary TB have the potential to be infectious to others. In 2024, 64.9% (274 out of 422) of TB cases had extra-pulmonary TB disease (with or without pulmonary sites) (Table 5). Lymph nodes were the next most common site of disease (41.9%, 177 out of 422), of which 35.6% (63 out of 177) were intra-thoracic and 64.4% were extra-thoracic (114 out of 177). Other extra-pulmonary sites of unknown origin also make up a large proportion of cases (26.3%, 111 out of 422).
Table 4. Number of pulmonary TB notifications by site of disease, East Midlands, 2024 [note 15] [note 16]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All pulmonary | 240 | 56.9 |
| Pulmonary only | 148 | 35.1 |
| Miliary only | 14 | 3.3 |
| Laryngeal only | 0 | 0.0 |
Note 15: percentages may not add up to 100 as people with TB may have more than one site of disease.
Note 16: ‘pulmonary only’ includes people notified with only pulmonary TB and therefore have not also been notified with miliary, laryngeal and/or extra-pulmonary TB.
Table 5. Number of extra-pulmonary TB notifications by site of disease, East Midlands, 2024 [note 17]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All extra-pulmonary | 274 | 64.9 |
| Extra-thoracic lymph nodes | 114 | 27.0 |
| Other extra-pulmonary | 111 | 26.3 |
| Intra-thoracic lymph nodes | 63 | 14.9 |
| Pleural | 25 | 5.9 |
| Gastrointestinal | 17 | 4.0 |
| Bone - spine | 16 | 3.8 |
| Genitourinary | 11 | 2.6 |
| Cryptic disseminated | 8 | 1.9 |
| Bone - not spine | 7 | 1.7 |
| Central nervous system - meningitis | 5 | 1.2 |
| Central nervous system - other | 4 | 0.9 |
Note 17: percentages may not add up to 100 as people with TB may have more than one site of disease.
Figure 14. Proportion of people notified with pulmonary TB, East Midlands, 2014 to 2024 [note 18]
Note 18: error bars represent upper and lower 95% confidence intervals.
Data for several comorbidities (diabetes, hepatitis B and C, chronic liver disease, chronic renal disease, and immunosuppression) is routinely collected as part of TB surveillance. In 2024, the numbers of TB cases reporting data for each of the named comorbidities varied (Table 6). Of all TB cases notified in 2024, 17.1% of TB cases reported having at least one of the named comorbidities (72 out of 422). The most commonly reported comorbidity was diabetes with 11.7% (43 out of 368) of TB cases reporting this, followed by immunosuppression (6.7%, 24 out of 357).
Table 6. Number and proportion of people with TB with comorbidities, East Midlands, 2024 [note 19]
| 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 | 422 | 72 | 17.1 | Not applicable | Not applicable |
| Chronic liver disease | 357 | 3 | 0.8 | 65 | 15.4 |
| Chronic renal disease | 361 | 8 | 2.2 | 61 | 14.5 |
| Diabetes | 368 | 43 | 11.7 | 54 | 12.8 |
| Hepatitis B | 332 | 6 | 1.8 | 90 | 21.3 |
| Hepatitis C | 330 | 4 | 1.2 | 92 | 21.8 |
| Immunosuppression | 357 | 24 | 6.7 | 65 | 15.4 |
Note 19: people with TB are reported as having at least one of the named comorbidities if any of the 6 comorbidities (current 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.
For some patients who have TB, treatment can be more complicated because they also have HIV infection. However, both conditions can be successfully treated with a combination of antiretroviral therapy (ART) and appropriate TB antibiotic treatment (4). To optimise their outcome and reduce the risk of TB and HIV transmission to others, it is essential that all patients with TB undergo HIV testing to allow curative TB treatment and ART to be started as soon as possible.
In 2024, HIV testing status was recorded for 91.7% of TB cases (387 out of 422). HIV tests were offered or results were already known for 97.4% (377 out of 387) of these, whilst 10 cases were not offered a test (2.6%, 10 out of 387) (Figure 15). Of the cases that were offered a test, 1.1% (4 out of 377) did not receive the test. The proportion of people with TB that were offered a test was similar to previous years.
Figure 15. Proportion of people with TB offered an HIV test by year, East Midlands, 2019 to 2024 [note 20] [note 21]
Note 20: dashed line indicates target of 100% of people offered HIV test.
Note 21: error bars represent upper and lower 95% confidence intervals.
Data for social risk factors (alcohol misuse, asylum seeker status, drug misuse, homelessness, mental health needs, and prison) is routinely collected as part of TB surveillance. In 2024 in the East Midlands, 13.2% of TB cases aged 15 years or over reported at least one social risk factor (54 out of 409) and 5.1% of TB cases reported having more than one social risk factor (18 out of 356) (Table 7). The most common social risk factor reported was current or previous homelessness (5.1%, 17 out of 336), followed by current alcohol misuse (4.4%, 15 out of 343).
The prevalence of social risk factors decreased in 2024 (13.2%, 54 out of 409) compared to 2023 when the highest proportion since 2014 was reported with 17.4% (67 out of 385) reporting at least one social risk factor (Figure 16 and Table 8).
Table 7. Number and proportion of people with TB aged 15 years or over with individual social risk factors, East Midlands, 2024 [note 22] [note 23]
| 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 | 409 | 54 | 13.2 | Not applicable | Not applicable |
| More than one social risk factor | 356 | 18 | 5.1 | 53 | 13 |
| Alcohol misuse (current) | 343 | 15 | 4.4 | 66 | 16.1 |
| Asylum seeker (current) | 348 | 11 | 3.2 | 28 | 7.4 |
| Drug misuse (current or previous) | 338 | 14 | 4.1 | 71 | 17.4 |
| Homelessness (current or previous) | 336 | 17 | 5.1 | 73 | 17.8 |
| Mental health needs (current) | 329 | 9 | 2.7 | 80 | 19.6 |
| Prison (current or previous) | 332 | 14 | 4.2 | 77 | 18.8 |
Note 22: people with TB are reported as having ‘at least one named social risk factor’ 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 for this metric is all TB 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.
Note 23: the denominator for people with TB reported as having ‘more than one social risk factor’ is the number of people with TB for whom data is recorded for at least 2 out of the 6 social risk factors collected. This differs to the ‘at least one named social risk factor’ metric described above.
Figure 16. Proportion of people with TB aged 15 years or over with at least one social risk factor (SRF), East Midlands, 2019 to 2024 [note 24] [note 25]
Note 24: error bars represent upper and lower 95% confidence intervals.
Note 25: not all social risk factors were captured before 2021.
Table 8. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, East Midlands, 2014 to 2024 [note 26]
| 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 |
|---|---|---|---|
| 2014 | 38 | 9.8 | 386 |
| 2015 | 34 | 9.8 | 346 |
| 2016 | 35 | 10.9 | 320 |
| 2017 | 52 | 15.7 | 332 |
| 2018 | 50 | 15.2 | 329 |
| 2019 | 49 | 14.3 | 343 |
| 2020 | 41 | 13.5 | 304 |
| 2021 | 37 | 10.7 | 346 |
| 2022 | 54 | 14.5 | 372 |
| 2023 | 67 | 17.4 | 385 |
| 2024 | 54 | 13.2 | 409 |
Note 26: not all social risk factors were captured before 2021 and that this table includes people with no information recorded in the denominator.
In 2024, male TB cases were more likely to report social risk factors compared to female TB cases (19.8% of males versus 3.6% of females) (Table 9). The age group that reported the highest proportion of social risk factors was those aged 45 to 64 years (16.5%, 16 out of 97) whilst those aged 65 years and above reported the lowest proportion of social risk factors (4%, 2 out of 50). UK-born TB cases reported a higher proportion of social risk factors (27.9%, 17 out of 61) compared to non-UK-born TB cases (10.7%, 37 out of 347).
Table 9. Number and proportion of people with TB aged 15 years or over with a social risk factor (SRF) by demographic characteristics, East Midlands, 2024 [note 27]
| Demographic characteristics | Number of people with demographic characteristic who have any social risk factor | Total number of people with demographic characteristic | Proportion of people with demographic characteristic who have any social risk factor |
|---|---|---|---|
| Female | 6 | 166 | 3.6 |
| Male | 48 | 243 | 19.8 |
| Aged 15 to 44 | 36 | 262 | 13.7 |
| Aged 45 to 64 | 16 | 97 | 16.5 |
| Aged 65 or older | 2 | 50 | 4.0 |
| Non-UK-born | 37 | 347 | 10.7 |
| UK-born | 17 | 61 | 27.9 |
Note 27: one case has been excluded from the above table due to missing demographic characteristic data.
Based on the Index of Multiple Deprivation (IMD 2025) deciles assigned to geographical areas in the East Midlands, the deprivation decile with the highest rate of TB was decile 2 (24.6 per 100,000), followed by deciles 1 (17.3 per 100,000), and 3 (13.3 per 100,000) (Figure 17). As in previous years, generally there is a higher TB case rate among residents in more deprived areas in the East Midlands.
Figure 17. TB notification rate by deprivation decile, East Midlands, 2024 [note 28] [note 29]
Note 28: error bars represent upper and lower 95% confidence intervals.
Note 29: the Index of Multiple Deprivation (IMD) ranks small areas in England by deprivation using 7 key domains including, but not limited to, income, housing, employment, crime and environment. Each area is scored and ranked nationally from most to least deprived.
TB diagnosis, microbiology and drug resistance
In 2024, 66.1% (279 out of 422) of people with TB in the East Midlands had their diagnosis culture confirmed. For pulmonary TB cases, 77.1% (185 out of 240) were confirmed by culture of a TB isolate which is slightly lower than the 80% target (Figure 18). This proportion is consistent with previous years though represents an increase from last year (75.6%) following a decrease in 2022, where 67.2% (156 out of 232) of pulmonary TB cases were culture confirmed.
Figure 18. Proportion of people notified with pulmonary TB who were culture confirmed, East Midlands, 2018 to 2024 [note 30] [note 31]
Note 30: dashed line indicates target of 80% culture confirmation.
Note 31: error bars represent upper and lower 95% confidence.
There are several groups of TB antibiotics, and resistance to TB antibiotic drugs may occur to one or more of these drugs and in different combinations. A distinction is made between first, second and third line TB antibiotic drugs depending upon their clinical effectiveness (5). First-line drugs include rifampicin, isoniazid, pyrazinamide and ethambutol. Second line drugs include injectable agents (for example, amikacin, capreomycin, kanamycin), fluoroquinolones (for example, moxifloxacin, ofloxacin, ciprofloxacin) and other oral bacteriostatic agents. Multidrug-resistant cases (MDR-TB) are initially resistant to at least isoniazid and rifampicin. Extensively drug-resistant TB cases (XDR-TB) are both MDR and resistant to at least one injectable agent, one of which must be a fluoroquinolone (6).
In 2024, of the TB patients confirmed by culture, 98.9% (276 out of 279) received first-line drug results, which is a similar proportion to previous years (Figure 19). Of the 279 culture-confirmed TB cases in the East Midlands, 7.5% (21 out of 279) had initial resistance to at least one first-line drug (Figure 20). This proportion has decreased since 2022 where 16.0% (39 out of 244) of culture-confirmed TB cases had resistance to at least one first-line drug, which was the highest proportion in recent years. However, pyrazinamide resistance has not been reported for 2023 and 2024.
Figure 19. Proportion of people culture-confirmed with TB with first-line drug results, East Midlands, 2018 to 2024 [note 32] [note 33]
Note 32: error bars represent upper and lower 95% confidence intervals.
Note 33: We are not reporting on the proportion with resistance to pyrazinamide (and therefore the category of any first-line agent only includes rifampicin, isoniazid, and ethambutol) in 2023 and 2024 because the laboratory testing was adversely impacted by a problem with quality control in the supply chain for the media used for pDST for this drug. The manufacturer issued a Field Safety Notice in July 2024 stating that there may have been false detection of resistance from June 2023.
Figure 20. Proportion of people notified with culture-confirmed TB with initial resistance to any first-line drug, East Midlands, 2018 to 2024 [note 34] [note 35]
Note 34: error bars represent upper and lower 95% confidence intervals.
Note 35: due to quality control issues, resistance to any first-line drug excludes pyrazinamide for 2023 and 2024.
Between 2018 and 2024 in the East Midlands, there were a total of 125 culture-confirmed TB cases with initial drug resistance (7.7%, 125 out of 1615) (Table 10). The most common type of resistance was isoniazid resistance (5.5%, 89 out of 1615). There were also 4 cases (0.2%, 4 out of 1615) of pre-XDR TB reported between 2018 and 2024.
Table 10. Number and proportion of people with culture-confirmed TB with initial drug resistance, East Midlands, 2018 to 2024
| Initial drug resistance | Number of cases | Percentage of total cultured cases |
|---|---|---|
| Isoniazid resistance without MDR TB | 89 | 5.5 |
| Rifampicin-resistant MDR TB | 32 | 2.0 |
| Pre-XDR | 4 | 0.2 |
| XDR | 0 | 0.0 |
TB cases are assigned to whole genome sequencing (WGS) clusters when 2 or more individuals have isolates with less than 12 single nucleotide polymorphisms (SNP) difference. In 2024, 29.4% (82 out of 279) of culture-confirmed TB cases were identified in a cluster with more than one other person by WGS (Table 11). The proportion of TB cases identified as being part of a cluster was similar between 2021 and 2023 but has decreased in 2024 compared to 2023 where 39.3% (103 out of 262) of people with culture-confirmed TB were in a WGS cluster.
Table 11. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, East Midlands, 2021 to 2024 [note 36] [note 37]
| 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 |
|---|---|---|---|---|---|---|
| 2021 | 350 | 231 | 66.0 | 88 | 38.1 | 32.1 to 44.5 |
| 2022 | 383 | 244 | 63.7 | 93 | 38.1 | 32.2 to 44.3 |
| 2023 | 395 | 262 | 66.3 | 103 | 39.3 | 33.6 to 45.3 |
| 2024 | 422 | 279 | 66.1 | 82 | 29.4 | 24.4 to 35 |
| Total | 1,550 | 1,016 | 65.5 | 366 | 36.0 | 33.1 to 39 |
Note 36: a WGS cluster is defined as 2 or more individuals that have isolates with a less than 12 SNP difference.
Note 37: WGS cluster reporting has changed over time. These changes are likely to have affected the most recent year’s data.
TB in children aged 0 to 17: incidence, epidemiology and microbiology
In 2024 in the East Midlands, there were 30 cases of TB in children aged under 18 years, this represents a TB case rate of 2.9 per 100,000 in this age group (Figure 21 and Figure 22). The rate of TB in children aged under 18 years in the East Midlands has decreased overall between 2001 and 2024, however the rate in 2024 represents an increase compared to recent years and is the highest rate since 2009.
Figure 21. Number of TB notifications in children aged under 18 years, East Midlands, 2001 to 2024
Figure 22. TB notification rate in children aged under 18 years, East Midlands, 2001 to 2024 [note 38]
Note 38: error bars represent upper and lower 95% confidence intervals.
In 2024, 12 (40%, 12 out of 30) of the TB cases in children aged under 18 years were born in the UK (Figure 23). Between 2001 and 2024 there has been an overall decrease in the number of TB cases aged under 18 years that are born in the UK, however numbers have started to increase in recent years. There were 18 (60%, 18 out of 30) TB cases in children under 18 years who were born outside of the UK, this represents an increase since 2001 (Figure 24). The most common country of birth for children under 18 years with TB was the United Kingdom (40%, 12 out of 30), followed by India (26.7%, 8 out of 30) (Table 12).
Figure 23. Number of TB notifications in UK born children aged under 18 years, East Midlands, 2001 to 2024
Figure 24. Number of TB notifications in non-UK born children aged under 18 years, East Midlands, 2001 to 2024
Table 12. Most common countries of birth for children aged under 18 years with TB, East Midlands, 2024 [note 39]
| Country of birth | Number of TB notifications in children | Proportion of notifications in children (%) |
|---|---|---|
| United Kingdom | 12 | 40.0 |
| India | 8 | 26.7 |
Note 39: where there are fewer than 5 cases by country of birth, these have been suppressed. This may lead to no data being shown in the table.
Of the 30 children aged under 18 years with TB, 13.3% (4 out of 30) were aged between 0 and 4 years, 13.3% (4 out of 30) were aged between 5 and 9 years, 16.7% (5 out of 30) were aged 10 to 14 years, and 56.7% (17 out 30) were aged between 15 and 17 years. In 2024, 86.7% (26 out of 30) of children aged under 18 years with TB had pulmonary TB with or without extrapulmonary sites, and 6.7% (2 out of 30) had severe TB. Severe TB includes cases with CNS, spinal, cryptic and miliary TB.
TB treatment
The Royal College of Nursing TB case management tool provides standardised recommendations for enhanced case management (ECM) in individuals receiving anti-TB treatment with clinical and/or social complexities.
In 2024, 36.3% of TB cases (153 out of 422) in the East Midlands received ECM (Table 13). The highest proportion of TB cases received level 3 ECM (14.2%, 60 out of 422). In 2024, the proportions of cases receiving level 1 and 3 ECM were similar to 2023, whilst there was a slight decrease in 2024 of those receiving level 2 ECM. Overall, there was an increase in TB cases receiving ECM compared to 2021 where 28.9% of TB cases (101 out of 350) received any ECM. Information on ECM was not recorded for 2 TB cases in 2024.
Table 13. Number of people with TB receiving enhanced case management, East Midlands, 2022 to 2024 [note 40]
| 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 | 350 | 101 | 28.9 | 22 | 6.3 | 36 | 10.3 | 42 | 12.0 | 1 | 0.3 |
| 2022 | 383 | 149 | 38.9 | 52 | 13.6 | 50 | 13.1 | 46 | 12.0 | 1 | 0.3 |
| 2023 | 395 | 158 | 40.0 | 50 | 12.7 | 55 | 13.9 | 51 | 12.9 | 2 | 0.5 |
| 2024 | 422 | 153 | 36.3 | 53 | 12.6 | 38 | 9.0 | 60 | 14.2 | 2 | 0.5 |
Note 40: 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 is defined as the time from symptom onset to treatment start. Information on delay was calculated for 167 pulmonary TB cases where symptom onset and treatment start dates were available and who did not have a postmortem diagnosis. In 2024, 62.9% (105 out of 167) of pulmonary TB cases had a treatment delay of over 2 months (Figure 25). This is a similar proportion to the last 2 years and represents a decrease from the highest proportion since 2019 seen in 2021 where 68.9% of pulmonary TB cases had a treatment delay of over 2 months.
Figure 25. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, East Midlands, 2019 to 2024 [note 41] [note 42] [note 43]
Note 41: error bars represent upper and lower 95% confidence intervals.
Note 42: delay to treatment is defined by when treatment was started from symptom onset.
Note 43: all cases where delay to treatment is greater than 730 days have been removed from this analysis.
In 2024, 31.7% (53 out of 167) of pulmonary TB cases started treatment with a 2 to 4 month delay (61 to 121 days), and 31.1% (52 out of 167) started treatment more than 4 months (122 to 730 days) after symptom onset, indicating a prolonged period of infectiousness (Table 14). These proportions were similar to those seen the previous year.
Table 14. Time between symptom onset and treatment start in people with pulmonary TB, East Midlands, 2016 to 2024 [note 44]
| 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 |
|---|---|---|---|---|---|---|---|---|---|
| 2016 | 73 | 40.6 | 56 | 31.1 | 51 | 28.3 | 180 | 79.5 | 36.8 to 131.0 |
| 2017 | 64 | 33.2 | 61 | 31.6 | 68 | 35.2 | 193 | 92.0 | 47.0 to 151.0 |
| 2018 | 78 | 42.4 | 54 | 29.3 | 52 | 28.3 | 184 | 71.5 | 32.8 to 125.0 |
| 2019 | 76 | 42.7 | 53 | 29.8 | 49 | 27.5 | 178 | 66.5 | 34.0 to 142.5 |
| 2020 | 55 | 32.2 | 56 | 32.7 | 60 | 35.1 | 171 | 84.0 | 45.5 to 158.0 |
| 2021 | 52 | 31.1 | 60 | 35.9 | 55 | 32.9 | 167 | 85.0 | 48.0 to 156.0 |
| 2022 | 67 | 38.3 | 57 | 32.6 | 51 | 29.1 | 175 | 78.0 | 43.0 to 147.0 |
| 2023 | 71 | 35.9 | 67 | 33.8 | 60 | 30.3 | 198 | 74.5 | 43.0 to 141.5 |
| 2024 | 62 | 37.1 | 53 | 31.7 | 52 | 31.1 | 167 | 78.0 | 46.5 to 133.5 |
Note 44: 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.
In 2024, the median treatment delay for pulmonary TB cases was 78 days (IQR 46.5 to 133.5) (Figure 26). This was a similar treatment delay compared to last year where the median treatment delay was 74.5 days for cases with pulmonary TB. This is above the target treatment delay of achieving a median of 56 days delay by 2027 (7).
Figure 26. Median treatment delays among people notified with pulmonary TB, East Midlands, 2019 to 2024 [note 45] [note 46] [note 47] [note 48]
Note 45: dashed line represents the target treatment delay of 56 days by 2027.
Note 46: ends of the whiskers represent the theoretical lower and upper limits for detecting outliers (lower/upper quartile negative/positive 1.5 times the interquartile range). Outliers falling outside of these limits have been removed.
Note 47: delay to treatment is defined by when treatment was started from symptom onset.
Note 48: 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.
TB treatment outcomes
For the purposes of TB outcome reporting, drug sensitive cases are defined as sensitive to rifampicin. Drug-resistant strains are defined as those with resistance to rifampicin and cases with suspected rifampicin resistance (RR) (initial or acquired) including non-culture-confirmed patients treated for presumptive MDR-TB (6).
Treatment outcomes for people with non-severe and non-MDR/non-RR TB are presented only among people who would usually have standard treatment regimens for TB: this excludes people who were treated for multidrug-resistant (MDR) and rifampicin-resistant (RR) TB, as well as those with severe disease (defined as CNS, spinal, miliary or cryptic disseminated disease among adults, and TB meningitis, miliary or cryptic disseminated among children aged 0 to 14 years), where expected treatment durations are longer (treatment outcomes for these patients are reported separately). This definition of severe disease may not capture all clinically severe or extensive disease involving other sites of disease.
Among people notified in 2023, 79.2% (259 out of 327) of non-multidrug-resistant (MDR) or non-rifampicin-resistant (RR) TB cases with an expected treatment duration of less than 12 months had completed treatment at 12 months (Table 15). This proportion is similar for those notified in 2022 though it is slightly lower compared to previous years and remains below the target of 90% (Figure 27).
There were 68 TB cases who were recorded as not completing treatment at 12 months. The most common reason for not completing treatment at 12 months was the outcome had not been evaluated (7.3%, 24 out of 327), followed by the TB case had died (6.4%, 21 out of 327).
At the last recorded outcome, a further 13 cases had completed treatment, bringing treatment completion to 83.2% (272 out of 327), and a further 1 case had stopped treatment (2.8%, 9 out of 327). This treatment completion was similar to 2022.
Table 15. Treatment outcome at 12 months and last recorded outcome for people notified with non-severe TB treated for non-MDR or non-RR TB, East Midlands, 2023 [note 49] [note 50]
| 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 | 259 | 79.2 | 272 | 83.2 |
| Died | 21 | 6.4 | 21 | 6.4 |
| Lost to follow up | 12 | 3.7 | 12 | 3.7 |
| Still on treatment | 3 | 0.9 | 3 | 0.9 |
| Treatment stopped | 8 | 2.4 | 9 | 2.8 |
| Not evaluated | 24 | 7.3 | 10 | 3.1 |
| Total | 327 | 100.0 | 327 | 100.0 |
Note 49: 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 50: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
Figure 27. 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%, East Midlands, 2019 to 2023 [note 51] [note 52] [note 53]
Note 51: dashed line indicates treatment target of 90%.
Note 52: error bars represent upper and lower 95% confidence intervals.
Note 53: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
Among those notified in 2023, there were 58 non-MDR or non-RR TB cases without CNS disease with one or more social risk factors, and of these 75.9% (44 out of 58) had completed treatment at 12 months (Figure 28). This was a similar proportion compared to the last few years, however, represents an overall increase since 2019 when 71.4% (30 out of 42) of cases with social risk factors had completed treatment at 12 months.
Figure 28. Proportion of people with non-severe TB treated for non-MDR or non-RR TB and with one or more social risk factors who completed treatment within 12 months, East Midlands, 2019 to 2023 [note 54] [note 55] [note 56]
Note 54: Not all social risk factors were captured before 2021.
Note 55: error bars represent upper and lower 95% confidence intervals.
Note 56: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
In the East Midlands, of those notified in 2023, 3.7% (12 out of 327) were lost to follow up at 12 months, this was a decrease compared to 2022 (4.6%, 15 out of 328) (Figure 29).
The proportion that had stopped treatment at 12 months decreased in 2023 (2.4%, 8 out of 327) compared to 2022 (5.2%, 17 out of 328).
In 2023, 6.4% (21 out of 327) of TB cases died before completing treatment, this was an increase compared to the previous year (3.4%, 11 out of 328).
In 2023, there were also 0.9% (3 out of 327) of cases still on treatment at 12 months which was a decrease compared to 2022 where 2.1% (7 out of 328) remained on treatment.
Figure 29. Outcomes of people evaluated who did not complete treatment by 12 months for people with non-severe TB treated for non-MDR or non-RR TB, East Midlands, 2014 to 2023 [note 57]
Note 57: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
Table 16. TB outcome at 12 months for people with non-severe TB treated for non-MDR or non-RR TB, East Midlands, 2014 to 2023 [note 58]
| 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) |
|---|---|---|---|---|---|---|---|---|
| 2014 | 280 | 24 | 11 | 18 | 17 | 3 | 0 | 329 |
| 2015 | 232 | 17 | 12 | 20 | 27 | 6 | 4 | 301 |
| 2016 | 229 | 20 | 19 | 14 | 25 | 4 | 9 | 300 |
| 2017 | 234 | 34 | 18 | 18 | 13 | 5 | 1 | 289 |
| 2018 | 251 | 31 | 15 | 14 | 14 | 6 | 4 | 304 |
| 2019 | 255 | 30 | 9 | 12 | 22 | 3 | 8 | 309 |
| 2020 | 230 | 29 | 14 | 7 | 11 | 4 | 4 | 270 |
| 2021 | 244 | 27 | 8 | 7 | 17 | 6 | 13 | 295 |
| 2022 | 259 | 37 | 11 | 15 | 7 | 17 | 19 | 328 |
| 2023 | 259 | 44 | 21 | 12 | 3 | 8 | 24 | 327 |
Note 58: 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. Non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
Table 17. Proportions of TB outcomes at 12 months for people with non-severe TB treated for non-MDR or non-RR TB, East Midlands, 2014 to 2023 [note 59]
| 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) |
|---|---|---|---|---|---|---|---|
| 2014 | 85.1 | 7.3 | 3.3 | 5.5 | 5.2 | 0.9 | 0.0 |
| 2015 | 77.1 | 5.6 | 4.0 | 6.6 | 9.0 | 2.0 | 1.3 |
| 2016 | 76.3 | 6.7 | 6.3 | 4.7 | 8.3 | 1.3 | 3.0 |
| 2017 | 81.0 | 11.8 | 6.2 | 6.2 | 4.5 | 1.7 | 0.3 |
| 2018 | 82.6 | 10.2 | 4.9 | 4.6 | 4.6 | 2.0 | 1.3 |
| 2019 | 82.5 | 9.7 | 2.9 | 3.9 | 7.1 | 1.0 | 2.6 |
| 2020 | 85.2 | 10.7 | 5.2 | 2.6 | 4.1 | 1.5 | 1.5 |
| 2021 | 82.7 | 9.2 | 2.7 | 2.4 | 5.8 | 2.0 | 4.4 |
| 2022 | 79.0 | 11.3 | 3.4 | 4.6 | 2.1 | 5.2 | 5.8 |
| 2023 | 79.2 | 13.5 | 6.4 | 3.7 | 0.9 | 2.4 | 7.3 |
Note 59: 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. Non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic and/or miliary disease.
There were 48 people notified in 2023 with CNS, miliary or cryptic disseminated TB, that was non-MDR or non-RR. At the last recorded outcome, 68.8% (33 out of 48) had completed treatment, 4.2% (2 out of 48) had died, 8.3% (4 out of 48) were lost to follow up and 12.5% (6 out of 48) were still on treatment (Table 18). There were 6.2% (3 out of 48) of cases where the treatment outcome was not evaluated, not recorded or is unknown at the last recorded outcome. Treatment is expected to take longer than 12 months for people with these types of TB.
Table 18. Last recorded outcome for people treated for non-MDR or non-RR TB with severe disease, East Midlands, 2023 [note 60] [note 61]
| Last recorded outcome | Number of TB notifications | Proportion of TB notifications |
|---|---|---|
| Treatment completed | 33 | 68.8 |
| Died | 2 | 4.2 |
| Lost to follow up | 4 | 8.3 |
| Still on treatment | 6 | 12.5 |
| Not evaluated | 3 | 6.2 |
| Total | 48 | 100.0 |
Note 60: 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 61: severe TB is defined as those cases with central nervous system (CNS), spinal, cryptic and/or miliary disease.
For people with MDR and rifampicin-resistant TB, treatment outcome is measured at 24 months, so outcomes are presented for people notified up to 2022. In 2022 in the East Midlands there were 5 patients diagnosed with RR or MDR TB that did not have CNS, spinal, cryptic or miliary TB, this was a higher number compared to the previous year (n=1). At 24 months, 100% of cases had completed treatment, 40% (2 out of 5) of which had reported having any social risk factor. This is the highest proportion of MDR or RR TB cases that had completed treatment at 24 months in recent years.
TB prevention
In 2024 in the East Midlands, 17.2% (41 out of 293) of pulmonary TB cases had 5 or more contacts identified and screened for active and latent TB (Figure 30). This proportion is similar to previous years.
There was a total of 812 contacts of pulmonary TB cases identified in 2024 in the East Midlands including 602 adults and 210 children (Table 19). Of these 62.7% (509 out of 812) were screened for active and latent TB, this was a decrease from 73.5% in 2023 (608 out of 827). As a result of this screening, 6.5% (33 out of 509) were diagnosed with active TB and 17.7% (90 out of 509) were diagnosed with latent TB. Of the contacts diagnosed with latent TB, 54.4% (49 out of 90) started treatment and 36.7% (33 out of 90) completed latent TB treatment.
The proportion of contacts that started and completed latent TB treatment was higher in child contacts (95.2%, 20 out of 21 started and 52.4%, 11 out of 21 completed) compared to adult contacts (42.0%, 29 out of 69 started and 31.9%, 22 out of 69 completed).
Figure 30. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, East Midlands, 2019 to 2024 [note 62] [note 63]
Note 62: error bars represent upper and lower 95% confidence intervals.
Note 63: 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 19. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), East Midlands, 2024 [note 64] [note 65] [note 66] [note 67]
| 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 | 602 | Not applicable | 210 | Not applicable | 812 | Not applicable |
| Number of contacts screened for active TB and latent TB | 370 | 61.5 | 139 | 66.2 | 509 | 62.7 |
| Number of contacts with active TB | 7 | 1.9 | 26 | 18.7 | 33 | 6.5 |
| Number of contacts with latent TB | 69 | 18.6 | 21 | 15.1 | 90 | 17.7 |
| Number of contacts who started treatment for latent TB | 29 | 42 | 20 | 95.2 | 49 | 54.4 |
| Number of contacts who completed treatment for latent tuberculosis | 22 | 31.9 | 11 | 52.4 | 33 | 36.7 |
Note 64: the denominator for the proportion of contacts screened for active TB and latent TB infection (LTBI) is number of contacts identified.
Note 65: the denominator for the proportion of contacts positive for active TB and LTBI is the number of contacts screened.
Note 66: the denominator for the proportion of contacts who started and completed treatment is the number of contacts positive for LTBI.
Note 67: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
In 2024, the highest proportion of contacts that were screened for latent TB were contacts of child TB cases (86.7%, 65 out of 75), followed by contacts of UK born TB cases (76.3%, 145 out of 190), contacts of adult TB cases (60.2%, 444 out of 737), and contacts of non-UK born TB cases (58.5%, 364 out of 622). Following this screening it was identified that 32.3% of contacts of child TB cases, 15.9% of contacts of UK born TB cases, 15.5% of contacts of adult TB cases and 18.4% of contacts of non-UK born TB cases were found to have latent TB.
The proportion of close contacts that completed latent TB treatment was highest in contacts of UK born TB cases (43.5%, 10 out of 23) and adult TB cases (43.5%, 30 out of 69) (Figure 31).
Figure 31. LTBI treatment completion in close contacts of adult or child and UK born or non-UK born index individuals with pulmonary TB, East Midlands, 2024 [note 68]
Note 68: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
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 (8). Coverage data for BCG is available from the Cover of vaccination evaluated rapidly (COVER) programme.
In 2024 in the East Midlands, 42% (177 out of 422) of all TB cases had received the BCG vaccination. There was a higher BCG vaccination coverage in TB cases born outside of the UK (43%, 152 out of 353) compared to UK born TB cases (37%, 25 out of 68). In 2024, 54% of children under 15 years old diagnosed with TB were vaccinated (7 out of 13).
Discussion
This report of TB in the East Midlands includes data up until the end of 2024 and provides the latest epidemiological picture of TB in the region.
TB incidence in the East Midlands has continued to increase in 2024, with a 5% increase in TB notifications compared to 2023 and continues the upward trend observed since 2020. This continued upward trend is of concern if we are to meet the year-on-year decrease required by WHO to meet the WHO End TB 2035 goal of a 90% reduction in incidence. The continuation of this upward trend in 2024 reinforces that TB remains a significant public‑health issue, requiring sustained and coordinated action, particularly targeted at the populations most affected.
Although overall the East Midlands figures remain below the TB rate for England, there is significant variation in TB across the East Midlands with the highest rates of TB concentrated in the large urban areas of Leicester City, Derby City and Nottingham City. Leicester City local authority accounts for over 4 in 10 of the TB cases across the East Midlands and has the highest average TB incidence rate in England between 2022 and 2024. Leicester City has experienced a further increase in TB incidence since 2023 which is also observed in 6 out of 10 East Midlands’ UTLAs and emphasises that the rise in TB transmission is not confined to a single locality but reflects wider demographic, socioeconomic and structural determinants operating across the region.
There was a 13.5% increase in the number of TB cases in people who were born outside the UK in the East Midlands in 2024, compared with 2023, with over 3 quarters of TB cases born outside of the UK. Amongst those non-UK born, the age group with the highest incidence of TB remains in the 15 to 44 year olds which has seen a year-on-year increase in notifications since 2022. TB notifications were highest amongst people born in India accounting for over one third of cases in the East Midlands (Leicester City accounted for approximately 70% of cases born in India). This represents a higher proportion than observed nationally, suggesting migration patterns may differ in the East Midlands compared with England.
In 2024, the proportion of non-UK born TB cases that had entered the UK 11 or more years prior to their diagnosis increased, overtaking the proportion of cases that had entered the UK less than 2 years ago, however these cases still accounted for the second highest proportion. While the proportion of TB in recent entrants (less than 2 years in the UK) decreased slightly in 2024, the combined group of those that entered the UK within 5 years of diagnosis accounts for half of the non-UK born TB cases in the East Midlands in 2024. This dual pattern suggests both recent infection and reactivation of long‑standing latent TB infection. Thus, interventions are required that address both diagnosis of active disease and systematic latent TB testing, alongside culturally competent services tailored to diverse communities, enhancing equitable access to care.
The number of cases in UK-born people is substantially lower than those not born in the UK, UK born cases has seen a 19% decrease in numbers for 2024 which differs from the national trend. Although case numbers remain smaller, social risk factors are more common for UK-born individuals, which indicates that domestic transmission continues to affect groups experiencing socio‑economic disadvantage.
The rate of TB in children in 2024 is the highest since 2009 for the East Midlands. The increase in cases in UK-born children is of particular concern as it is generally considered a marker of domestic transmission. The presence of TB in children underscores the need for strengthened contact tracing, improved early case finding, and timely BCG vaccination in eligible groups.
Over half of the TB cases in the East Midlands are pulmonary underscoring the ongoing risk of transmission. Although the proportion of pulmonary TB cases that were culture confirmed increased in 2024, culture confirmation remained below the national target. Lower‑than‑target culture confirmation limits the ability to detect drug resistance and identify clusters through WGS, potentially slowing effective treatment regimens put in place, plus outbreak detection and response.
Treatment delays remain a substantial barrier to TB control with almost 1 in 3 pulmonary TB cases in 2024 experiencing a treatment delay of over 4 months from symptom start. The median delay for pulmonary cases has increased in 2024 and is not on track to meet the 2027 target. These delays prolong the period of infectiousness, opportunity for transmission, and increase the risk of severe disease. Delays may reflect barriers in healthcare access, variations in health‑seeking behaviour, language and cultural barriers, and reduced awareness of TB symptoms among communities and clinicians. Strengthened primary care awareness, better access to diagnostic services, and culturally appropriate communication are therefore essential.
TB treatment completion for drug sensitive patients within 12 months has remained stable for those notified in 2023 but is below the 90% treatment target. The most common reason for treatment non-completion was the outcome had not been evaluated, followed by that the TB case had died.
TB is associated with deprivation, and this is observed in the East Midlands, with higher TB rates amongst residents in more deprived areas. TB cases often have complex health and social needs. Social risk factors (homelessness, alcohol or drug misuse, imprisonment, asylum seeker status and mental health needs) continue to play a significant role in TB and were reported in 13.2% of cases overall, with higher prevalence in men and UK‑born individuals. The most frequently reported social risk factor was current or previous homelessness. These findings indicate continued need for targeted outreach, improved access to early diagnosis, and holistic case support addressing social need.
Around one sixth of cases reported a named comorbidity, most commonly diabetes. Enhanced case management was required by a third of cases in the East Midlands in 2024, reflecting the complexity of health and social needs, although this was slightly lower than the national proportion. These patterns reinforce the need for inclusion‑health approaches and integrated management of long‑term conditions alongside TB care.
There has been a decline in 2024 in the proportion of TB contacts screened for active and latent TB and fewer pulmonary TB cases having 5 or more contacts screened. Contact tracing is important for preventing further cases through identifying those at highest risk of exposure, finding people with disease earlier and treating latent infection. Sufficient capacity is required for these activities to streamline referral, initiation and adherence support for LTBI therapy.
The 2024 findings reflect the unique challenges posed by TB, both as a serious infectious disease requiring precise clinical management and as an important and worsening public health issue. The East Midlands is experiencing an increasing TB burden, driven by multiple overlapping determinants: migration, deprivation, comorbidity, social vulnerability, and diagnostic delays. The rise in TB reflects both recent transmission and reactivation of disease, with clear evidence that structural inequalities continue to shape risk. Longstanding challenges remain in treatment timeliness, treatment completion rates and contact tracing.
TB must remain a health priority for partners in the East Midlands region. The concentration of disease among non‑UK‑born adults, people living in deprived areas, and those with social risk factors highlights the need for both targeted local action and structural interventions addressing health inequalities. The increase in TB incidence in the East Midlands is of concern and sustained efforts are required to reverse this trend and move towards the WHO End TB Strategy pre-elimination goal by 2035. A continued effort is needed to support the early diagnosis of TB and deliver effective packages of TB care to maximise treatment completion and minimise transmission. Collaboration between NHS services, public health teams, community organisations and local authorities will be critical to delivering these goals.
Recommendations
To reverse the increasing trend in TB there are some important themes to focus on, which are summarised in the following recommendations linked to the 5 priority areas in the TB action plan Tuberculosis: action plan for England, 2021 to 2026:
1. Recovery from COVID-19
Continue and strengthen the multi-agency oversight of TB control in the East Midlands, prioritising regional forums, such as the East Midlands TB Control Board, the East Midlands Regional TB Network, and the Midlands TB Regional Strategic Oversight Group (RSOG) in 2026.
Re-establish and strengthen local TB clinical networks, focusing on areas with increasing TB rates to formalise reporting and governance arrangements to support local risk escalation.
UKHSA teams should continue to monitor TB notifications and provide timely information, including more in-depth annual reports, to partners including local TB Networks and TB Control Board.
With Leicester having the highest TB incidence in England, partners should continue to work collaboratively in Leicester, Leicestershire and Rutland (LLR) to implement their local TB Strategy and share learning with other systems.
2. Prevent TB
Through multi agency working, identify opportunities to offer appropriate screening for high-risk groups, such as those with social risk factors, and consider integrating TB symptom screening to service specifications supporting inclusion health groups.
TB services and commissioners should identify areas for improving and expanding new migrant LTBI screening, where there is a need.
Provide targeted training on TB signs and symptoms for professional groups, including large employers, to increase awareness of TB and promote early diagnosis.
Improve screening opportunities for contacts of pulmonary TB cases, to increase the proportion that are screened for active and latent TB.
3. Detect TB
Partners and TB services should try to improve early detection of TB by investigating and understanding the components that contribute to delays between symptom onset and the start of treatment.
TB services should continue efforts to achieve the target of 80% of pulmonary TB cases being culture confirmed, to enable WGS and the identification of clusters and drug resistance.
4. Control TB
Partners and TB services should work to understand barriers in current TB treatment completion rates, identify areas for collaboration and work with system partners, such as drug support services and community outreach teams, with the aim of improving treatment completion rates for TB drug sensitive cases and meeting the 90% target.
5. Workforce
TB services, NHS Trust management, ICBs and wider stakeholders should continue to engage in the NHSE commissioned Getting It Right First Time (GIRFT) TB review to ensure that services are equipped to meet the needs of local communities.
Methods and acknowledgements
Methods
Full details of the data sources and methodologies used in this report, including definitions, are available in:
Acknowledgements
We are grateful to all those who contribute information on people with tuberculosis in the East Midlands, 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 data set, the East Midlands Health Protection Team and the Field Service (Midlands) team for their work supporting Enhanced Tuberculosis Surveillance.
References
1. UKHSA (2025). Tuberculosis in England, 2025 report (presenting data to end of 2024)
2. WHO (2015). The End TB strategy
3. UKHSA (2021). UK pre-entry tuberculosis screening report 2020
4. WHO (2025). WHO consolidated guidelines on tuberculosis. Module 4: treatment and care
5. Joint Formulary Committee. British National Formulary 2018 3 October 2018
6. WHO (2013). Definitions and reporting framework for tuberculosis – 2013 revision
7. UKHSA (2021). TB Action Plan for England, 2021 to 2026
8. UKHSA (2021). BCG vaccination programme