Research and analysis

South East of England: tuberculosis in 2024

Published 23 March 2026

Incidence, treatment and prevention of tuberculosis (TB) in the South East of England using data up until the end of 2024.

Executive summary

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

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

TB incidence and epidemiology in the South East of England

A total of 587 people were notified with TB disease in the South East in 2024, an increase of 10% from 2023 and continuing a rise since 2020. The rate was 6.3 per 100,000 population, the highest observed since 2016, but still lower than the average for England (9.4 per 100,000 in 2024). As for England, the South East is not on track to meet the 90% reduction in incidence target.

Most South East local authorities have very low rates of TB, but increases in these areas, although small numbers, can put great pressure on local services.

Rates remain higher among young adults aged 15 to 44, and those born outside the UK (more than 8 in 10 South East cases occurred in people born outside the UK).

Since 2020, there has been a marked increase in numbers of cases occurring in young adults born outside the UK, after a sustained decline in this group from 2011. There has also been an increase in the proportion of people who were diagnosed within 5 years of entering the UK. This likely reflects the increased migration from higher incidence countries and effects of global disruptions in TB care due to the COVID-19 pandemic.

Tuberculosis continues to be strongly associated with inequalities, and the TB rate in the South East was lowest in the least deprived areas. The proportion of people aged 15 and over with TB, who had at least one social risk factors reported (alcohol misuse, drug misuse, homelessness, imprisonment, mental health needs and asylum seeker status) was 15% in 2024. These are significant issues that impact on identifying and successfully treating disease for these individuals.

TB detection

Timely and accurate detection and management of TB improves disease outcomes and reduces onward transmission. Diagnostic delays for people with pulmonary TB, time from symptom onset to starting treatment, are longer in the South East (median of 81 days) than for England (72 days).

Laboratory culture confirmation of TB disease provides information on drug resistance and likely transmission. In 2024, 74% of individuals with pulmonary TB had their diagnosis confirmed on culture, below the 80% target.

Of those with culture confirmed TB, just 6.9% had initial resistance to any first-line drug. Numbers of rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in England remain low overall, and the proportion of culture-confirmed RR or MDR TB among people in the South East between 2018 and 2024 was 1.7%. This should continue to be carefully monitored and supports the need to obtain culture confirmation where possible.

Whole genome sequencing (WGS) on culture-confirmed specimens is used to identify genetically similar TB strains, suggestive of recent transmission. The proportion of individuals with a positive TB culture in the South East who were part of a genomic cluster has declined since 2021 and is now 25%. This likely reflects a combination of changes in transmission patterns because of more TB notifications resulting from importation of new strains from recent migrants and, possibly, better awareness regarding airborne transmission and how to limit this due to the COVID-19 pandemic. Analysis of data for England showed that the presence of any social risk factor nearly doubled the likelihood of being in a cluster (relative risk 1.93).

TB in children

Children are particularly vulnerable to TB, especially those aged under 5 years, who are at greatest risk of developing severe TB disease. Data continues to be reported for children aged 0 to 17 years. In 2024 there were just 26 cases of TB in children in the South East, a slight increase from 20 in 2023 (seen among those born in the UK only). A total of 18 were older children, aged between 15 and 17 (69%), with only 5 children aged less than 5 years old notified.

TB treatment

Similar to recent years, in 2024, 42% of people with TB in the South East received enhanced case management.

The proportion of individuals who completed treatment was 86% at 12 months in people expected to complete treatment within this period. Lower treatment completion rates have continued in those with social risk factors (74%). Both were a decrease compared to 2022, and below the target of 90%. Treatment outcomes were also lower in people with severe TB (CNS, spinal, miliary or cryptic disseminated disease), with just 77% of those notified in 2023 having completed treatment at their last recorded outcome.

In 2024, for all people notified in 2023 in the non-MDR or RR TB cohort, 3.5% had died at their last reported treatment outcome. This was lower than the average for England (4.6%) but an increase compared from 2.5% among people notified in 2022. Treatment completion at 24 months for those being treated with a regimen for MDR or RR TB was 75% for those notified in 2022, but numbers remain small.

TB prevention

Active TB disease can also be prevented by identifying, testing and treating people with TB infection but without signs of active disease, who have been in contact with a known infectious individual.

In 2024, of the 1,331 people (of whom 19% were children) who were identified as contacts of a person with active pulmonary TB disease and tested for active disease and TB infection, 2% had active disease and 19% were positive for TB infection. These proportions are similar to those for England.

Conclusion

Increasing TB rates in the South East and across England are concerning and warrant renewed effort from partners. A continued emphasis on early diagnosis and support through treatment must remain a priority for the South East, and in particular focused work to reduce the inequities associated with TB.

TB incidence and epidemiology

The data used in the figures in this report can be found in the accompanying supplementary tables.

In 2024, there were 587 cases of tuberculosis (TB) notified in South East residents, a 9% increase from 2023 (Figure 1).

Figure 1. Number of TB notifications per year, South East, 2001 to 2024

This was a rate of 6.3 per 100,000 of the population, the highest rate in the South East since 2016, and a 26% increase from 2020 (5 per 100,000) (Figure 2). The South East TB rate was 33% lower than for England and accounted for 11% of the 5,490 cases in England in 2024.

Since 2021, the TB notification rate for the South East has been above the required TB notification rates to meet the World Health Organization (WHO) ‘End TB 2035’ goal of a 90% reduction in the incidence of TB (Figure 3).

Figure 2. TB notification rates per 100,000 population per year, South East 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, South East, 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.

Demographic characteristics: where people with TB live in the South East

Slough remained the local authority with the highest rate of TB in the South East (33.5 per 100,000) followed by Reading (20.2 per 100,000) (Figure 4, Table 1). Rates increased in 9 of the 18 upper tier local authorities in the South East in 2024, compared to 2023, but this often involved very small numbers as most areas have very low rates of TB.

Figure 4. TB notification rate per 100,000 population by upper tier local authority of residence, South East, 2024

Table 1. Number of TB notifications and rate per 100,000 population by upper tier local authority of residence, South East, 2024

Upper tier local authority	Number of TB notifications	TB notification rate per 100,000 population	Lower 95% CI	Upper 95% CI
Slough	56	33.5	25.3	43.5
Reading	37	20.2	14.2	27.9
Southampton	32	12.3	8.4	17.4
Windsor and Maidenhead	13	8.2	4.4	14.0
Portsmouth	16	7.5	4.3	12.1
Buckinghamshire	43	7.4	5.4	10.0
Oxfordshire	53	6.9	5.2	9.1
Medway	20	6.8	4.2	10.6
Kent	89	5.4	4.4	6.7
West Sussex	49	5.4	4.0	7.1
Wokingham	10	5.3	2.6	9.8
Surrey	62	5.0	3.8	6.4
Brighton and Hove	13	4.6	2.4	7.8
Bracknell Forest	6	4.6	1.7	10.0
East Sussex	25	4.5	2.9	6.6
Hampshire	58	4.0	3.0	5.2
West Berkshire	<5	Not shown	Not shown	Not shown
Isle of Wight	<5	Not shown	Not shown	Not shown

Demographic characteristics: age and sex of people with TB

In 2024, 57% (336) of people with TB in the South East were male, and the rate was higher among males (Figure 5 and Figure 6). TB rates were highest among those aged 20 to 29 for both males (14.3 per 100,000) and females (11.8 per 100,000). Absolute numbers were highest in 30 to 39 year olds for females (62) and 20 to 29 year olds for males (75).

Figure 5. Number of TB notifications by age and sex, South East, 2024

Figure 6. TB notification rate by age and sex, South East, 2024

Demographic characteristics: place of birth and ethnicity of people with TB

In 2024, 83% (488 cases) of all people with TB in the South East were born outside the UK, similar to the proportion in England (82%). Since 2020, there has been an overall increasing trend in the number of people in the South East with TB that were born abroad (Figure 7). The number of cases among people who were born in the UK has stayed constant at around 100 people per year, from 2021 to 2024.

Figure 7. Number of TB notifications in non-UK born and UK born people by place of birth, South East, 2001 to 2024

Figure 8. Number of TB notifications in non-UK born and UK born people by place of birth and age group, South East, 2001 to 2024

The largest number of cases was in those aged 15 to 44 years old, and numbers of cases in this group have increased the most from 2020 to 2024 (Figure 8). This was mostly driven by case numbers among people who were born outside of the UK. There was a 20% increase from 269 cases in people aged 15 to 44 born abroad in 2023, to 322 in 2024.

In 2024, information on the time since entry to the UK and notification date of TB was available for 97% of people born abroad (472 out of 488). The median time since entry to the UK was 5 years (inter-quartile range (IQR): 1 to 25). 

There has been an increasing proportion, since 2021, of people with TB who were born abroad and entered the UK less than 2 years before being notified with TB (Figure 9). In 2024, 1 in 3 people (33%) born abroad with TB had entered the UK less than 2 years before notification. The proportion of people with TB that had been in the UK for more than 10 years before notification with TB has decreased since 2018, and now accounts for a third of those born outside the UK (33%, 158 out of 472).

Figure 9. Proportion of TB notifications by time since entry for people born outside the UK, South East, 2001 to 2024

As in previous years, the most common country of birth for people with TB in 2024 was India (26%, 155 out of 587), and the median time since entry to notification for people born here was 2 years (IQR 1 to 13 years) (Table 2). For those born in Pakistan, the second most common country of birth outside of the UK (8%), the median time since entry was 9 years.

Table 2. Most common countries of birth for people with TB and time between entry to the UK and TB notification, South East, 2024 [note 4] [note 5] [note 6] [note 7]

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	155	26.4	2.0	1.0 to 13.2
United Kingdom	99	16.9	Not applicable	Not applicable
Pakistan	47	8.0	9.0	1.0 to 39.0
Nepal	30	5.1	5.5	2.0 to 11.0
Philippines	25	4.3	6.0	1.0 to 20.0
Romania	22	3.7	8.0	7.0 to 9.0
Nigeria	21	3.6	2.0	1.0 to 12.8
Zimbabwe	14	2.4	2.5	0.8 to 15.2
Bangladesh	12	2.0	3.0	2.0 to 19.0
South Africa	12	2.0	11.5	2.0 to 25.2
Timor-Leste	12	2.0	2.0	1.0 to 8.0
Other	138	23.5	6.0	1.0 to 18.0
Total	587	100.0	Not applicable	Not applicable

Note 4: other includes all countries with less than 12 people notified.

Note 5: lower quartile is the 25th percentile and upper quartile is the 75th percentile, representing the interquartile range (IQR).

Note 6: 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 7: time since entry to the UK was not known for 16 people in 2024.

There has been an increasing trend of people with TB born in India since 2020, with a 21% increase in numbers from 2023 to 2024 (Figure 10). Although numbers were smaller, and therefore trends should be interpreted cautiously, there was also an increase for those born in the Philippines (19%), Pakistan (14%) and Romania (10%). There was a 16% decrease in the number of people with TB from Nepal.

Figure 10. Numbers of TB notifications for the most common countries of birth for people with TB born outside the UK, South East, 2014 to 2024 [note 8]

Note 8: figure shows the top 5 countries in 2024.

Table 3. Characteristics of people with TB from the most common (non-UK) countries of birth, South East, 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	155	38.0	56.1	40.6	38.2	44.8
Pakistan	47	47.5	63.8	48.9	34.0	43.8
Nepal	30	45.3	30.0	50.0	23.3	42.9
Philippines	25	41.6	44.0	40.0	30.4	42.9
Romania	22	40.0	45.5	77.3	4.8	100.0

In 2024, the most common ethnic group of people with TB in the South East overall, and among those born outside the UK, was South Asian (Figure 13). Among people born abroad, this was followed by Mixed/Other and Black as the next most common ethnic groups. Among people with TB who were born in the UK, White was the most common ethnic group.

Figure 11. Number of TB notifications in ethnic groups by place of birth (UK and non-UK born), South East, 2001 to 2024 [note 9]

Note 9: the South Asian ethnicity group comprises people of Indian, Pakistani and Bangladeshi ethnicities.

Figure 12. Number of TB notifications in ethnic groups by place of birth (UK and non-UK born), South East, 2024 [note 10]

Note 10: figure ordered by total number of notifications within each ethnicity irrespective of place of birth.

Clinical characteristics of people with TB: site of disease, co-morbidities and HIV testing

Just over half (52%) of those notified with TB in 2024 had pulmonary disease, (Table 4). The most common sites for extra-pulmonary TB were extra-thoracic lymph nodes (24%) and intra-thoracic lymph nodes (14%) (Table 4).

Table 4. Number of pulmonary TB notifications by site of disease, South East, 2024 [note 11] [note 12]

Site of disease	Number of people notified with TB	Proportion of people notified with TB (%)
All pulmonary	303	51.6
Pulmonary only	215	36.6
Miliary only	18	3.1
Laryngeal only	3	0.5

Note 11: percentages may not add up to 100 as people with TB may have more than one site of disease.

Note 12: ‘pulmonary only’ includes people notified with only pulmonary TB and therefore have not also been notified with miliary, laryngeal or extra-pulmonary TB.

Table 5. Number of extra-pulmonary TB notifications by site of disease, South East, 2024 [note 13]

Site of disease	Number of people notified with TB	Proportion of people notified with TB (%)
All extra-pulmonary	372	63.4
Extra-thoracic lymph nodes	141	24.0
Intra-thoracic lymph nodes	84	14.3
Other extra-pulmonary	58	9.9
Pleural	42	7.2
Gastrointestinal	38	6.5
Bone - spine	18	3.1
Central nervous system - meningitis	11	1.9
Bone - not spine	8	1.4
Genitourinary	8	1.4
Cryptic disseminated	7	1.2
Central nervous system - other	5	0.9

Note 13: percentages may not add up to 100 as people with TB may have more than one site of disease.

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. 1 in 5 (21%) people with TB had at least one of these comorbidities. The most common were diabetes (10%) and immunosuppression (9%) (Table 6).

HIV tests were offered or result already known for 97% of cases, similar to previous years (98% in 2023 and 99% 2022).

Table 6. Number and proportion of people with TB with comorbidities, South East, 2024 [note 14]

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	587	126	21.5	Not applicable	Not applicable
Chronic liver disease	547	10	1.8	40	6.8
Chronic renal disease	549	12	2.2	38	6.5
Diabetes	556	55	9.9	31	5.3
Hepatitis B	516	13	2.5	71	12.1
Hepatitis C	513	7	1.4	74	12.6
Immunosuppression	548	51	9.3	39	6.6

Note 14: 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.

Inclusion health characteristics of people with TB

Data for several social risk factors (alcohol misuse, asylum seeker, drug misuse, homelessness, mental health needs and prison) is routinely collected as part of TB surveillance.

The proportion of people with TB, aged over 15 years, with at least one social risk factor was 15% in 2024 (Table 7). The prevalence of social risk factors has decreased a little since 2022, when it was 19%, although numbers have remained similar (note that not all social risk factors were captured prior to 2021).

The most common social risk factor was current alcohol misuse (6%) followed by current or previous homelessness (5%) and current or previous drug misuse (5%) (Table 8). More than one social risk factor was recorded for 32 (6%) individuals with TB.

Table 7. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, South East, 2014 to 2024 [note 15]

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	46	7.2	641
2015	62	10.7	578
2016	49	9.0	545
2017	49	9.4	519
2018	48	10.0	480
2019	54	11.0	491
2020	45	10.4	431
2021	52	10.5	496
2022	88	18.9	466
2023	84	16.2	519
2024	84	14.5	579

Note 15: not all social risk factors were captured before 2021 and that this table includes people with no information recorded in the denominator.

Table 8. Number and proportion of people with TB aged 15 years or over with individual social risk factors, South East, 2024 [note 16] [note 17]

Social risk factor	Total with data reported	Number of people with social risk factors	Proportion of people with social risk factors (%)	Number of people missing social risk factor data	Proportion of people missing social risk factor data (%)
At least one named social risk factor	579	84	14.5	Not applicable	Not applicable
More than one social risk factor	558	32	5.7	21	3.6
Alcohol misuse (current)	548	32	5.8	31	5.4
Asylum seeker (current)	562	24	4.3	11	1.9
Drug misuse (current or previous)	546	26	4.8	33	5.7
Homelessness (current or previous)	548	28	5.1	31	5.4
Mental health needs (current)	542	19	3.5	37	6.4
Prison (current or previous)	539	16	3.0	40	6.9

Note 16: 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 17: 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 are 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.

Deprivation was assessed using the 2025 Index of Multiple Deprivation. In 2024, the rate was highest in decile 3, the third most deprived (12 per 100,000) (Figure 13). Excluding deciles 1 and 2, the rate progressively decreased along with decreasing deprivation, reaching 3.2 per 100,000 in deciles 9 and 10.

Figure 13. TB notification rate by deprivation decile, South East, 2024 [note 18] [note 19]

Note 18: error bars represent upper and lower 95% confidence intervals.

Note 19: 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 detection

Delays in starting treatment for TB

Treatment delay is defined as the time from symptom onset to treatment start. This includes from symptom onset to first presentation to healthcare and from the first presentation to diagnosis and start of TB treatment. 

The median time from symptom onset to start of treatment for people with pulmonary TB was 81 days (Figure 14). This was longer for people in the South East than for England (72 days). In 2024, 60% of people notified with pulmonary TB had a treatment delay over 2 months. This was the lowest proportion since 2019. People notified with extra-pulmonary TB were more likely to have delays over 2 months (72%, 203 out of 282).

Figure 14. Median treatment delays among people notified with pulmonary TB, South East, 2019 to 2024 [note 20] [note 21] [note 22] [note 23]

Note 20: dashed line represents the target treatment delay of 56 days by 2027.

Note 21: 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 22: delay to treatment is defined by when treatment was started from symptom onset.

Note 23: 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.

Figure 15. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, South East, 2019 to 2024 [note 24] [note 25]

Note 24: error bars represent upper and lower 95% confidence intervals.

Note 25: delay to treatment is defined by when treatment was started from symptom onset.

The proportion of people with pulmonary TB who experienced a delay of 2 to 4 months was similar to previous years (Table 9, 29%), but the proportion who experienced a delay of over 4 months was the lowest since 2019 (31%).

Table 9. Number and proportion of people notified with pulmonary TB with a treatment delay, time between symptom onset and treatment start, South East, 2019 to 2024 [note 26]

Year	2 to 4 months delay (number)	2 to 4 months delay (proportion)	Over 4 months delay (number)	Over 4 months delay (proportion)	Total
2019	73	28.1	93	35.8	260
2020	65	34.0	66	34.6	191
2021	73	32.7	75	33.6	223
2022	59	29.2	72	35.6	202
2023	56	25.9	88	40.7	216
2024	72	29.4	76	31.0	245

Note 26: people included in this table are those with pulmonary TB who did not have a postmortem diagnosis and started treatment. People included within ‘Total’ includes these individuals and where the time from symptom onset to treatment start was also known. Percentages for ‘2 to 4 month delay’ and ‘over 4 months’ delay were calculated using the ‘Total’ figure. ‘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.

Diagnosis, microbiology and drug resistance

In 2024, 347 people with TB in the South East had their diagnosis confirmed by culture (59%). This was 74% among people with pulmonary TB, lower than the 80% target (Figure 16).

Figure 16. Proportion of people notified with pulmonary TB who were culture confirmed, South East, 2018 to 2024 [note 27] [note 28]

Note 27: dashed line indicates target of 80% culture confirmation.

Note 28: error bars represent upper and lower 95% confidence.

Use of molecular testing, including polymerase chain reaction (PCR), can provide a more rapid diagnosis than culture and reduce delay between symptom onset and start of treatment. The National Institute for Health and Care Excellence (NICE) recommends that respiratory samples should have a PCR in all cases for diagnosis of TB in children. PCR is recommended in adults if any of the following conditions are met: resistance to rifampicin is suspected, the patient has HIV, the result would change management, or a large contact tracing exercise is being planned. For non-respiratory samples, PCR is indicated if it would change management.

PCR information relies on user entry into NTBS and therefore numbers recorded may underestimate diagnostic testing. In the South East, data on PCR testing was recorded for 29% (173 of 587) notifications. Overall, in 2024, 61.8% (107 of 173) of people with TB who had a PCR result recorded were PCR positive.

Of the people with culture confirmed TB in 2024, 98.8% had first-line drug results. 6.9% of people with culture confirmed TB had initial resistance to at least one first-line drug, lower than 2023 (12.9%) (Figure 20).

Figure 17. Proportion of people notified with culture confirmed TB with initial resistance to any first-line drug, South East, 2018 to 2024 [note 29] [note 30]

Note 29: error bars represent upper and lower 95% confidence intervals.

Note 30: 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.

Between 2018 and 2024, 6.2% (129 cases) of people with culture confirmed TB in the South East had isoniazid resistance without MDR TB. A further 1.7% (35 cases) had MDR TB, resistance to both isoniazid and rifampicin (Table 10).

Table 10. Number and proportion of people with culture-confirmed TB with initial drug resistance, South East, 2018 to 2024

Initial drug resistance	Number of cases	Percentage of total cultured cases
Isoniazid resistance
without MDR TB	129	6.2
MDR TB	35	1.7
Pre-XDR	8	0.4
XDR	0	0.0

Clustering

Individuals are assigned to a Whole Genome Sequencing (WGS) cluster if their isolate is found to be within 12 single nucleotide polymorphisms (SNPs) of an isolate from another person in the database.

Local teams reviewing clusters may use smaller SNP distance thresholds as evidence of recent transmission, when risk assessing and agreeing further investigation.

Out of 347 people with culture confirmed TB in the South East in 2024, 86 (25%) were less than 12 SNPs from another person with TB in England (Table 11). This is lower than the proportion clustered from 2021 to 2023.

Table 11. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, South East, 2021 to 2024 [note 31] [note 32]

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	504	302	59.9	84	27.8	23.1 to 33.1
2022	480	279	58.1	85	30.5	25.4 to 36.1
2023	533	299	56.1	97	32.4	27.4 to 37.9
2024	587	347	59.1	86	24.8	20.5 to 29.6
Total	2,104	1,227	58.3	352	28.7	26.2 to 31.3

Note 31: a WGS cluster is defined as 2 or more individuals that have isolates with a less than 12 SNP difference.

Note 32: WGS cluster reporting has changed over time. These changes are likely to have affected the most recent year’s data.

TB in children

In 2024, there were 26 cases of TB notified in children under the age of 18 years old, resident in the South East (Figure 18). TB rates in children remain very low in the South East (1.3 per 100,000 of the population) (Figure 19).

Most TB notifications for children under 18 were in those aged 15 to 17 years old (69%, 18), with just 5 aged less than 5 years of age.

Figure 18. Number of TB notifications in children aged under 18 years, South East, 2001 to 2024

Figure 19. TB notification rate in children aged under 18 years, South East, 2001 to 2024 [note 33]

Note 33: error bars represent upper and lower 95% confidence intervals.

Of the 26 children notified in 2024, 12 were born in the UK. All other countries of birth had fewer than 5 cases.

81% (21) had pulmonary TB (with or without other extra-pulmonary disease as well). 6 children (23%) had severe TB, defined as cases with CNS, cryptic or miliary TB. Of the 26 children with TB, 54% (14) were recorded as having had a BCG vaccine. There were 6 children with severe TB, of which 4 were recorded as having had a BCG vaccine.

TB treatment

Enhanced case management: extra support for people with TB

The Royal College of Nursing TB case management tool Case Management TB Publications, Royal College of Nursing provides standardised recommendations for enhanced case management (ECM) in individuals being treated for TB who have additional clinical or social complexities.

The ECM levels are:

• 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 MDR or RR TB which necessitates directly observed therapy (DOT) or virtually observed therapy (VOT)

In 2024, 42% of people with TB in the South East received ECM (245 out of 587) (Table 12). 15% (90) received level 3, the highest level of support.

Table 12. Number of people with TB receiving enhanced case management, South East, 2022 to 2024 [note 34]

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	504	151	30.0	46	9.1	39	7.7	63	12.5	3	0.6
2022	480	211	44.0	64	13.3	54	11.2	92	19.2	1	0.2
2023	533	220	41.3	64	12.0	57	10.7	99	18.6	0	0.0
2024	587	245	41.7	94	16.0	61	10.4	90	15.3	0	0.0

Note 34: total TB notifications include all people notified with TB regardless of whether they are receiving ECM or not, or if this information is missing.

TB treatment outcomes

Outcomes for people with non-severe and non-MDR/non-RR TB

These outcomes are presented only among people who would usually have standard treatment regimens for TB: this excluded 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. This definition of severe disease may not capture all clinically severe or extensive disease involving other sites of disease. People notified with a postmortem diagnosis of TB were also excluded.

Among people notified in 2023, 86% (400 out of 463) of people with non-severe TB treated for non-MDR or non-RR TB had completed treatment by 12 months. The proportion of people who completed treatment, declined slightly in 2023, as was between 88 and 91% from 2019 to 2022 (Figure 29). 

Figure 20. 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%, South East, 2019 to 2023 [note 35] [note 36] [note 37]

Note 35: dashed line indicates treatment target of 90%.

Note 36: error bars represent upper and lower 95% confidence intervals.

Note 37: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease or people notified with a postmortem diagnosis of TB.

For people with one or more social risk factors, just 74% had completed treatment at 12 months, down from 83% in 2022 (Figure 21).

Figure 21. 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, South East, 2019 to 2023 [note 38] [note 39]

Note 38: error bars represent upper and lower 95% confidence intervals.

Note 39: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease or people notified with a postmortem diagnosis of TB.

The most common reasons for not completing at 12 months was death (3.5%) (Table 13). At the last recorded treatment outcome, a further 17 people completed treatment, bringing completion to 90%.

The proportion of people who died before completing treatment at 12 months in 2023 (3.5%, 16 cases) was higher than in 2022 (2.5%, 11 cases) but remained lower than for those notified before 2020 (Figure 21). Loss to follow up was slightly lower among people notified in 2023 (2.8%, 13 cases) compared to 2022 (3.4%, 15 cases).

The proportion of people still on TB treatment at 12 months remained similar for those notified in 2023 (4.1%, 19 cases) to 2022 (4.4%, 19 cases). The proportion with treatment stopped increased in 2023 (1.5%) and was the highest it has been since 2020.

Table 13. Treatment outcome at 12 months and last recorded outcome for people notified in 2023 treated for non-MDR or non-RR TB with expected treatment duration of less than 12 months, South East, 2023 [note 40] [note 41]

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	400	86.4	418	90.3
Died	16	3.5	16	3.5
Lost to follow up	13	2.8	14	3.0
Still on treatment	19	4.1	3	0.6
Treatment stopped	7	1.5	7	1.5
Not evaluated	8	1.7	5	1.1
Total	463	100.0	463	100.0

Note 40: 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 41: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.

Figure 22. Outcomes of people evaluated who did not complete treatment by 12 months for people treated for non-MDR or non-RR TB and expected treatment duration of less than 12 months, South East, 2014 to 2023

Table 14. TB outcome at 12 months for people with non-severe TB treated for non-MDR or non-RR TB, South East, 2014 to 2023 [note 42]

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	526	33	24	22	13	3	8	596
2015	441	43	36	15	18	2	2	514
2016	431	39	27	14	24	1	3	500
2017	407	33	20	23	13	2	4	469
2018	383	35	23	16	19	3	1	445
2019	396	38	17	15	14	4	3	449
2020	336	28	20	4	7	6	1	374
2021	391	35	12	4	20	4	1	432
2022	384	66	11	15	19	3	3	435
2023	400	53	16	13	19	7	8	463

Note 42: 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, or people notified with a postmortem diagnosis of TB.

Table 15. Proportions of TB outcomes at 12 months for people treated for non-MDR or non-RR TB with expected treatment duration of less than 12 months, South East, 2014 to 2023 [note 43]

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	88.3	5.5	4.0	3.7	2.2	0.5	1.3
2015	85.8	8.4	7.0	2.9	3.5	0.4	0.4
2016	86.2	7.8	5.4	2.8	4.8	0.2	0.6
2017	86.8	7.0	4.3	4.9	2.8	0.4	0.9
2018	86.1	7.9	5.2	3.6	4.3	0.7	0.2
2019	88.2	8.5	3.8	3.3	3.1	0.9	0.7
2020	89.8	7.5	5.3	1.1	1.9	1.6	0.3
2021	90.5	8.1	2.8	0.9	4.6	0.9	0.2
2022	88.3	15.2	2.5	3.4	4.4	0.7	0.7
2023	86.4	11.4	3.5	2.8	4.1	1.5	1.7

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’ or ‘died’ within the timeframe of 12 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.

Outcomes for people with severe TB

Severe TB was defined as central nervous system (CNS), spinal, cryptic or miliary disease. For the 55 people treated for non-MDR or non-RR TB with severe disease, notified in 2023, 76% (42) had completed treatment at their last recorded outcome (Table 16). The next most common outcome was death (7%, 4 cases).

Table 16. Last recorded outcome for people treated for non-MDR or non-RR TB with severe disease, South East, 2023 [note 44, note 45]

Outcome at 12 months	Number of TB notifications	Proportion of TB notifications
Treatment completed	42	76.4
Died	4	7.3
Lost to follow up	3	5.5
Still on treatment	3	5.5
Not evaluated	3	5.5
Total	55	100.0

Note 44: 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 45: severe TB is defined as those cases with central nervous system (CNS), spinal, cryptic or miliary disease.

Outcomes for people with drug-resistant TB

For people with MDR and RR TB, treatment may last longer than 12 months, so outcomes are presented for people notified up to 2022 at 24 months after notification.

In 2022, 4 individuals in the South East were notified with MDR or rifampicin-resistant TB (excluding those with severe disease). Of those 4, 75% (3) had completed treatment at 24 months.

TB prevention

Contact tracing around people with pulmonary TB

Contact information is presented for people with pulmonary TB, where contact tracing is routinely carried out to identify others who may have been exposed. Larger incidents, such as workplaces or other settings where large numbers of individuals were screened are excluded from this data, which should reflect close contacts of people such as their household and close social or work contacts.

The proportion of people with pulmonary TB with at least 5 contacts identified and assessed increased between 2019 (15%) to 2023 (28%) and remained similar in 2024 (27%).

Figure 23. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, South East, 2019 to 2024 [note 46, note 47]

Note 46: error bars represent upper and lower 95% confidence intervals.

Note 47: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.

A total of 1,331 contacts were identified as part of routine close contact screening around 303 people with pulmonary TB. Of these, 81% were adults (1,077) and 19% were children (254). The proportion of close contacts diagnosed with active TB disease was 2%. TB infection (without signs of disease) was found in 19% of contacts; this was higher in children (29%) than in adults (17%). Amongst those with TB infection, 80% started treatment (97% of children, 73% of adults) (Table 17).

Table 25. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), South East, 2024 [note 48] [note 49] [note 50] [note 51]

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	1,077	Not applicable	254	Not applicable	1,331	Not applicable
Number of contacts screened	791	73.4	210	82.7	1,001	75.2
Number of contacts with active TB disease	14	1.8	5	2.4	19	1.9
Number of contacts with TB infection	131	16.6	60	28.6	191	19.1
Number of contacts who started treatment for TB infection	95	72.5	58	96.7	153	80.1
Number of contacts who completed treatment for TB infection	56	42.7	38	63.3	94	49.2

Note 48: the denominator for the proportion of contacts screened for active TB and latent TB infection (LTBI) is number of contacts identified.

Note 49: the denominator for the proportion of contacts positive for active TB and LTBI is the number of contacts screened.

Note 50: the denominator for the proportion of contacts who started and completed treatment is the number of contacts positive for LTBI.

Note 51: 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 vaccination coverage in the South East

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. 

Coverage data for BCG is available from the Cover of vaccination evaluated rapidly (COVER) programme Childhood Vaccination Coverage Statistics, England, 2023-24 - NHS England Digital.

BCG vaccination coverage is assessed at 3 months. Overall coverage for the South East was 79.3% of the eligible population in 2023-2024. This was higher than the coverage for England at 75.5%. This varied by local authority, from 91% in Portsmouth to 63% in West Berkshire.

BCG vaccination history among people with TB

Of all South East residents notified with TB in 2024, 57% (337 out of 587) had received a BCG. This proportion was higher amongst people born outside of the UK (60%) compared to people born in the UK (46%) (Table 26). Among the 5 children with TB who were aged under 5 years, 3 had been vaccinated: the 2 children who did not have a BCG vaccination were born in the UK.

Table 26. BCG vaccination coverage among people with TB, South East, 2024

Place of birth	Number of vaccinated people with TB under 5 years old	Total number of people with TB under 5 years old	Proportion of vaccinated people with TB under 5 years old	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)
Non-UK born	1	1	100	2	2	100	291	488	60
UK born	2	4	50	4	6	67	46	99	46
All cases	3	5	60	6	8	75	337	587	57

Discussion

Since 2021, the TB landscape in England has changed, and TB rates have continued to rise. Although the South East of England remains a mostly very low incidence area for TB, with rates below the England average, it has also experienced an increase in cases and is no longer on track to meet the WHO ‘End TB 2035’ goal of a 90% reduction in incidence.

Most South East local authorities (outside of Slough and Reading) have very low rates of TB, but increases in these areas, although small numbers, can put great pressure on local services.

Rates vary across the South East, but remain highest in young adults and those born outside the UK. More than 8 in 10 cases occurred in people born outside the UK, with a growing proportion in people who had more recently come to the UK. India remains the most common country of birth among people with TB in the South East.

Delays between symptom onset and starting on treatment have consistently been longer in the South East compared to most other parts of England, requiring a continued focus on awareness raising among health services.

Treatment completion rates decreased among those notified in 2023. These remained below the target of 90% and were even lower in those with social risk factors. Higher TB rates are found in the more deprived communities, and additionally people with TB frequently have complex medical and social needs and require extra support to complete their treatment.

Increasing TB rates in the South East and across England are concerning and warrant renewed effort from partners. A continued emphasis on early diagnosis and support through treatment must remain a priority for the South East, and in particular focused work to reduce the inequities associated with TB.

Recommendations

The next 5-year action plan on TB, which will run from 2026 to 2031, is currently being developed. The recommendations listed below link to the 5 priority areas in the Tuberculosis: action plan for England, 2021 to 2026:

1. Recovery from COVID-19

UKHSA South East teams should continue to monitor TB notifications: reports will be shared with partners quarterly (for timely information) and more in-depth analysis annually, to be reviewed at the South East Control Board and network meetings across the South East.

2. Prevent TB

As noted in the 2023 data report, the increase in TB among recently arrived migrants requires a continued focus in this area.

Local NHS, UKHSA, local authority and ICB teams should ensure those eligible receive screening for TB infection in those areas with a programme and encourage commissioning of appropriate new entrant screening where there is a need. Local LTBI programmes should review local epidemiology, alongside their uptake and testing results, to evaluate their efforts. 

ICBs should also ensure they have identified and commissioned appropriate screening for other high risk groups (including people experiencing homelessness, those in contact with the criminal justice system, people seeking asylum, but also those starting biological therapies). They should work with TB service providers, local authorities and others to deliver these.

Contact tracing efforts should continue to be monitored through local cohort reviews, as well as in routine TB reporting (such as the South East quarterly report). We recommend UKHSA add the functionality to report incident screening data within NTBS, to support local teams in reviewing their full contact tracing efforts.

3. Detect TB

Improve early detection of TB by identifying, investigating and acting on the evidence and components that contribute to delays in diagnosis. Oversight of, and understanding of reasons for, delays should remain a core part of TB cohort review. Surveillance reports should continue to include indicators on delays, to monitor trends over time.

TB services should work with local laboratories to try to improve culture confirmation rates for all people with TB (to above 80% for pulmonary), and ensure PCR use for all people with potentially pulmonary/ infectious TB.

4. Control TB disease

TB services should work to improve current TB completion rates, to achieve the target of 90% for TB drug sensitive cases by 2026. However services should also monitor completion among inclusion health groups using the social risk factor information collected through NTBS.

ICBs should ensure there are hardship funds in place, MOUs for patients with no recourse to public funds needing support with accommodation and pathways to address housing issues and additional support needs, so patients receive adequate support through treatment which will support improved TB completion rates.

Ensure effective management of cases of multidrug-resistant (MDR-TB) in association with the British Thoracic Society (BTS) MDR-TB Clinical Advice Service (CAS), including active participation in the joint South East and London MDR TB cohort review as a forum to maintain oversight of management of MDR cases, and provide learning and educational opportunities to TB services where management of these cases is rare and experience may be limited.

5. Workforce

Workforce review by ICBs should assess the numbers and complexity of cases in their areas to ensure a sufficient TB workforce to manage the rising numbers of cases/complex cases. This should also consider the workforce needed to implement any LTBI screening programmes as well as incident screening and support people through treatment in a timely manner.

ICBs should review the data provided by the NHSE ‘Getting it right first time’ (GIRFT) review, and work with TB services and wider stakeholders to help ensure that services are equipped to meet needs of local communities. Progress should be monitored at the South East TB Control Board.

This will be a priority area of work as it is an opportunity to look at capacity and other recommendations also address the priority areas above.

Methods and acknowledgements

Methods

Full details of the data sources and methodologies used in this report, including definitions, are available in:

• Tuberculosis in England 2025 report
• Methodology and definitions

Acknowledgements

We are grateful to all those who contribute information on people with tuberculosis in the South East, including nurses, physicians, microbiologists, scientists, outreach and social care and administrative staff. We also acknowledge colleagues at the UKHSA National Mycobacterium Reference Service for information on culture confirmation and drug susceptibility testing. Further thanks are due to the UKHSA National TB Unit for providing the cleaned matched dataset, South East Health Protection Teams and the Field Service team for their work supporting TB surveillance.

Appendix. Local authority rate figures

Appendix Figure 1. TB notification rate per 100,000 population by upper tier local authority of residence, South East, 2001 to 2024