Yorkshire and the Humber: tuberculosis in 2024
Published 23 March 2026
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Incidence, treatment and prevention of tuberculosis (TB) in Yorkshire and the Humber using data up until the end of 2024.
Executive summary
There were 422 notifications of TB in Yorkshire and the Humber in 2024, an incidence rate of 7.4 notifications per 100,000 population, which is an increase compared to 2023. The rate has been increasing since 2022, although this increase has followed a steady decline in TB notifications since 2009. Yorkshire and the Humber had a lower rate of TB than the England average of 9.4 per 100,000 population in 2024. Five local authorities in the region had a rate higher than the England average. These were Bradford (15.6 per 100,000), Sheffield (11.8 per 100,000), Kirklees (10.5), Kingston upon Hull (9.8), and Leeds (9.5).
The TB notification rate was highest in the male 30 to 39 year age group (64 notifications, 17.1 per 100,000 population) and lowest in the 0 to 9 year age groups (0.7 and 0.0 per 100,000 population among females and males, respectively). The majority of people notified with TB in Yorkshire and the Humber in 2024 were born outside of the UK (76%). The most common countries of birth reported were Pakistan, India, Nigeria, Eritrea, and Romania. The number of people notified with TB in Yorkshire and the Humber who were born outside the UK increased in 2024 and has been increasing since 2022. The highest proportion of TB notifications from non-UK born individuals were among those who had been in the UK for less than 2 years (40%).
Of people notified with TB in 2024, 58% had pulmonary disease, of which 73% were confirmed by culture, compared with 62% culture confirmation in England as reported in the Tuberculosis in England 2025 report. The proportion of people with pulmonary TB who experienced a delay of more than 4 months between symptom onset and start of treatment was 30%, with a median delay time of 73 days.
Among cases notified in 2024, 15% of people reported at least one social risk factor, and 6% reported more than one. The most common social risk factors reported were being an asylum seeker (6.5%), followed by current or previous drug misuse (6.3%), and prison history (5.0%). Almost three-quarters (73%) of people notified with TB in Yorkshire and the Humber in 2024 were resident in the 3 most deprived deciles, and the TB notification rate was highest in the most deprived decile (17 per 100,000 population). Of people notified with TB in 2024, 28% received enhanced case management, which involves extra resources or support being put in place due to clinical or social complexities.
Excluding people with rifampicin-resistant, central nervous system (CNS), spinal, cryptic or miliary TB, 80% of people with TB notified in 2023 completed treatment at 12 months, and 4% died before completing treatment.
In conclusion, the rate of TB has continued to rise in Yorkshire and the Humber in 2024, following years of a decreasing rate between 2011 and 2022. A key recommendation from this report is the need to strengthen multi-agency partnership working, especially at a strategic level, with concerted efforts from partners across the system to address the 5 priority areas in the ‘TB Action Plan for England 2021 to 2026’.
The data used in the figures in this report can be found in the accompanying supplementary tables.
TB incidence and epidemiology
Overall numbers, rates, and geographical distribution
In 2024, 422 people in Yorkshire and the Humber were diagnosed with TB within the region, a rate of 7.4 per 100,000 population (95% confidence interval (CI) 6.7 to 8.2). Compared to 2023, this is an increase in both the number of notifications and the rate (354 notifications, 6.3 per 100,000 population) (Figure 1 and Figure 2).
Figure 1. Number of TB notifications per year, Yorkshire and the Humber, 2001 to 2024
The number and rate of TB notifications also increased between 2022 and 2023 (5.4 to 6.3 per 100,000 population). However, prior to this there was a general decreasing trend in the region since 2009, when incidence peaked at 13.2 cases per 100,000 population. The incidence in Yorkshire and the Humber has been below the England average rate since reporting began, including in 2024 when the England rate was 9.4 per 100,000 (Figure 2). The Yorkshire and the Humber region has also been below the World Health Organisation (WHO) definition of a low incidence area (fewer than 10 cases per 100,000 population) since 2014.
Figure 2. TB notification rates per 100,000 population per year, Yorkshire and the Humber and England, 2001 to 2024 [note 1]
Note 1: error bars represent upper and lower 95% confidence intervals.
Between 2015 and 2022, the TB notification rate was on or below the target rate for the WHO End TB goal of a 90% reduction in incidence by 2035. However, in 2023 and 2024 the TB notification rates in Yorkshire and the Humber (6.3 and 7.4 per 100,000 respectively) were above the target rates (5.2 and 4.8 per 100,000) and so not in line to meet the 90% reduction (Figure 3).
Figure 3. Observed TB notification rate compared with required TB notification rates to meet the WHO End TB 2035 goal of 90% reduction in incidence by 2035, Yorkshire and the Humber, 2015 to 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.
In 2024, 5 upper tier local authorities (UTLA) in Yorkshire and the Humber had a TB rate higher than the national average (9.4 per 100,000). These were Bradford (15.6 per 100,000), Sheffield (11.8), Kirklees (10.5), Kingston upon Hull (9.8), and Leeds (9.5). All 5 of these local authorities plus Doncaster (7.5) also had a TB rate higher than the regional average (7.4 per 100,000) (Table 1 and Figure 4). Except for Bradford where the rate decreased slightly, the incidence rate of the above local authorities all increased in 2024 compared to 2023. The incidence rate in Calderdale (6.6) and North Yorkshire (3.6) also increased in 2024, whereas rates in all other local authorities remained similar or decreased (Figure 5).
Bradford, Sheffield, and Kirklees had rates above the WHO definition of a low incidence area (10 per 100,000).
Data on number of notifications and rates of TB by NHS Integrated Care Board of residence between 2001 and 2024 is provided in the supplementary tables.
Figure 4. TB notification rate per 100,000 population by UTLA of residence, Yorkshire and the Humber, 2024
Table 1. Number of TB notifications and rate per 100,000 population by UTLA of residence, Yorkshire and the Humber, 2024
| UTLA | Number of TB notifications | TB notification rate per 100,000 population | Lower 95% CI | Upper 95% CI |
|---|---|---|---|---|
| Bradford | 88 | 15.6 | 12.5 | 19.2 |
| Sheffield | 69 | 11.8 | 9.2 | 15.0 |
| Kirklees | 47 | 10.5 | 7.7 | 14.0 |
| Kingston upon Hull | 27 | 9.8 | 6.5 | 14.3 |
| Leeds | 80 | 9.5 | 7.5 | 11.8 |
| Doncaster | 24 | 7.5 | 4.8 | 11.2 |
| Calderdale | 14 | 6.6 | 3.6 | 11.1 |
| North East Lincolnshire | 9 | 5.6 | 2.6 | 10.7 |
| York | 8 | 3.8 | 1.7 | 7.5 |
| North Yorkshire | 23 | 3.6 | 2.3 | 5.4 |
| Rotherham | 7 | 2.5 | 1.0 | 5.2 |
| Barnsley | 6 | 2.4 | 0.9 | 5.2 |
| North Lincolnshire | 4 | 2.3 | 0.6 | 6.0 |
| East Riding of Yorkshire | 8 | 2.2 | 1.0 | 4.4 |
| Wakefield | 8 | 2.2 | 0.9 | 4.3 |
Figure 5. TB notification rate per 100,000 population by UTLA of residence, Yorkshire and the Humber, 2001 to 2024 [note 4]
Note 4: grey lines represent the other UTLAs in the region.
In 2024, 60% of people notified with TB in Yorkshire and the Humber were male (254 out of 422). The largest number and highest rate of TB notifications was in the male 30 to 39 years old age group (64 notifications, 17.1 per 100,000 population). Among females the largest number of notifications and highest rate was in the 20 to 29 years age group (47 notifications, 13.1 per 100,000). The lowest rate of notification was among the 0 to 9 years old age group (females 0.7 per 100,000 population; and there were no notifications among males 0 to 9 years old) (Figures 6 and 7).
Figure 6. Number of TB notifications by age and sex, Yorkshire and the Humber, 2024
Figure 7. TB notification rate by age and sex, Yorkshire and the Humber, 2024
The rates of TB in the non-UK born population should be interpreted in the context of changes to the pre-UK entry screening policies. In 2005, the UK piloted the pre-entry screening of long-term migrants to the UK for active pulmonary TB in 15 high TB incidence countries. In 2012, this pre-entry screening was extended to all countries with a high incidence of TB (more than 40 cases per 100,000 population).
In 2024, country of birth was recorded for 99.8% of notified cases in Yorkshire and the Humber. Where this information was known, 76% of notifications were reported among people who were not born in the UK (321 out of 421). This was a slight increase compared to 2023 (73%). Since 2000, there has been an increasing trend in the number of TB notifications among people not born in the UK, from 194 (69%) notifications in 2020. The number of notifications among non-UK-born people is the highest since 2013 (360 notifications, 66%). The number of notifications among UK-born people in 2024 has also increased slightly but is similar to recent years (2020, 87 notifications; 2021, 87 notifications; 2022, 88 notifications; 2023, 94 notifications; 2024, 100 notifications) (Figure 8).
Figure 8. Number of TB notifications in non-UK born and UK born people by place of birth, Yorkshire and the Humber, 2001 to 2024
Among the non-UK born population, the increase in the number of TB notifications in 2024 was particularly observed in the 15 to 44 years age group (from 167 to 204 notifications) and the 45 to 64 years age group (from 56 to 80 notifications). In the 0 to 14 years age group and in the 65 and older age group, the number of TB notifications remained similar overall between 2023 and 2024 in Yorkshire and the Humber (0 to 14 age group, 6 in 2023 and 5 in 2024; 65 and older age group, 29 in 2023 and 32 in 2024) (Figure 9).
In both 2023 and 2024, the highest proportion of TB notifications for non-UK-born people was among those who had been in the UK for less than 2 years (40% in both 2023 and 2024). In contrast, between 2009 and 2022, the highest proportion of TB notifications was among those who had been in the UK for 11 or more years (between 30 and 44%) with a lower proportion among those who had been in the UK less than 2 years (18 to 32%) (Figure 10).
Figure 9. Number of TB notifications in non-UK born and UK born people by place of birth and age group, Yorkshire and the Humber, 2001 to 2024
Figure 10. Proportion of TB notifications by time since entry for people born outside the UK, Yorkshire and the Humber, 2001 to 2024
In 2024, the largest number of TB notifications were among people born in the UK (100 notifications, 24% of total notifications in Yorkshire and the Humber), followed by people with countries of birth of:
- Pakistan (80 notifications, 19%)
- India (59 notifications, 14%)
- Nigeria (28 notifications, 7%)
- Eritrea (19 notifications, 5%)
- Romania (17 notifications, 4%)
The median time between entry to the UK and TB notification was 1 year for those born in India and Nigeria, 3 years among people born in Eritrea, 9.5 years among people born in Romania, and 13 years among those born in Pakistan (Table 2).
Despite a decreasing trend in the number of TB notifications among people born in Pakistan between 2014 and 2022 (from 132 notifications in 2014 to 57 in 2022), there has been an increase between 2022 and 2024 (63 notifications in 2023 and 80 in 2024) (Figure 11). Similarly, there was an increase in the number of notifications between 2023 and 2024 among people with a country of birth of:
- India (45 notifications in 2023 to 59 in 2024)
- Nigeria (from 22 in 2023 to 28 in 2024)
- Romania (from 12 in 2023 to 17 in 2024)
- Eritrea (from 6 in 2023 to 19 in 2024).
Table 2. Most common countries of birth for people with TB and time between entry to the UK and TB notification, Yorkshire and the Humber, 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 |
|---|---|---|---|---|
| United Kingdom | 100 | 23.8 | Not applicable | Not applicable |
| Pakistan | 80 | 19.0 | 13.0 | 1.0 to 29.0 |
| India | 59 | 14.0 | 1.0 | 0.0 to 10.0 |
| Nigeria | 28 | 6.7 | 1.0 | 1.0 to 3.0 |
| Eritrea | 19 | 4.5 | 3.0 | 2.0 to 4.8 |
| Romania | 17 | 4.0 | 9.5 | 5.8 to 11.2 |
| Zimbabwe | 15 | 3.6 | 2.0 | 1.0 to 18.8 |
| Sudan | 12 | 2.9 | 1.0 | 0.2 to 2.8 |
| Poland | 9 | 2.1 | 8.5 | 2.0 to 12.0 |
| Afghanistan | 8 | 1.9 | 1.5 | 1.0 to 2.0 |
| Other | 74 | 17.6 | 3.0 | 1.0 to 13.0 |
| Total | 421 | 100.0 | Not applicable | Not applicable |
Note 5: other includes all countries with fewer than 8 people notified.
Note 6: place of birth (UK or non-UK) or country of birth is missing for one 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 System (NTBS)).
Note 9: time since entry to the UK was not known for 79 people in 2024.
Figure 11. Number of TB notifications for the most common countries of birth for people with TB born outside the UK, Yorkshire and the Humber, 2014 to 2024 [note 10]
Note 10: figure shows the top 5 non-UK countries in 2024.
Among the top 5 most common non-UK countries of birth, the mean age of people notified with TB was 32 to 46 years old. There was a higher percentage of notifications among males, apart from among people born in India where similar proportions were male and female (49% male). Among people with a country of birth of Romania, 71% of notifications were pulmonary TB, compared to between 32% and 55% for the other countries of birth. Among people with a country of birth of India and Nigeria, 58% and 57% respectively of TB diagnoses were less than 2 years after UK entry, compared to 22% and 30% of TB notifications from people with a country of birth of Eritrea and Pakistan (Table 3).
Table 3. Characteristics of people with TB from the most common (non-UK) countries of birth, Yorkshire and the Humber, 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 (%) |
|---|---|---|---|---|---|---|
| Pakistan | 80 | 46.0 | 61.3 | 55.0 | 29.5 | 61.1 |
| India | 59 | 39.0 | 49.2 | 45.8 | 57.8 | 38.5 |
| Nigeria | 28 | 39.5 | 67.9 | 32.1 | 57.1 | 50.0 |
| Eritrea | 19 | 31.5 | 78.9 | 47.4 | 22.2 | 50.0 |
| Romania | 17 | 41.8 | 58.8 | 70.6 | 0.0 | NA |
In 2024, the most common ethnicities of people notified with TB were Pakistani (103 notifications), White (93 notifications), and Black African (92 notifications). Among people not born in the UK the most common ethnic group was Black African (90 notifications), and among people born in the UK, White (65 notifications) was the most common ethnic group (data not shown). There was an increase or similar number of TB notifications between 2023 and 2024 in all ethnic groups (Figure 12).
Figure 12. Number of TB notifications in ethnic groups by place of birth (UK and non-UK born), Yorkshire and the Humber, 2001 to 2024 [note 11] [note 12] [note 13]
Note 11: 3 cases have been excluded from the above figure due to missing ethnicity or place of birth data.
Note 12: the South Asian ethnicity group comprises people of Indian, Pakistani and Bangladeshi ethnicities.
Note 13: the Mixed/Other ethnic group comprises people of Mixed/Other, Chinese, and Asian-Other ethnicities.
Of the people notified with TB in Yorkshire and the Humber in 2024, 58% had pulmonary TB (with or without extra-pulmonary disease) and 41% had pulmonary disease only (Table 4); 60% people had extra-pulmonary disease (with or without pulmonary disease) (Table 5).
Table 4. Number of pulmonary TB notifications by site of disease, Yorkshire and the Humber, 2024 [note 14] [note 15]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All pulmonary | 243 | 57.6 |
| Pulmonary only | 171 | 40.5 |
| Miliary only | 14 | 3.3 |
| Laryngeal only | 2 | 0.5 |
Note 14: percentages may not add up to 100 as people with TB may have more than one site of disease.
Note 15: ‘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, Yorkshire and the Humber, 2024 [note 16]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All extra-pulmonary | 251 | 59.5 |
| Other extra-pulmonary | 105 | 24.9 |
| Extra-thoracic lymph nodes | 87 | 20.6 |
| Intra-thoracic lymph nodes | 50 | 11.8 |
| Gastrointestinal | 33 | 7.8 |
| Bone - spine | 21 | 5.0 |
| Pleural | 16 | 3.8 |
| Bone - not spine | 9 | 2.1 |
| Genitourinary | 8 | 1.9 |
| Central nervous system | 7 | 1.7 |
| Cryptic disseminated | 0 | 0.0 |
Note 16: percentages may not add up to 100 as people with TB may have more than one site of disease.
The percentage of people notified with pulmonary TB in Yorkshire and the Humber has remained relatively constant over the last 10 years, fluctuating between 56% and 63%. Between 2023 and 2024, the percentage of people notified with pulmonary TB decreased from 63% (222 of 354 notifications) to 58% (243 of 422 notifications) (Figure 13).
Figure 13. Proportion of people notified with pulmonary TB, Yorkshire and the Humber, 2014 to 2024 [note 17]
Note 17: error bars represent upper and lower 95% confidence intervals.
Among people notified with TB in 2024, 19% were also notified to have at least one of the comorbidities: chronic liver disease, chronic renal disease, diabetes, hepatitis B, hepatitis C, or immunosuppression. The most commonly notified comorbidity was diabetes (11%, 41 notifications) (Table 6). However, between 14.0% and 18.7% of notifications were missing information on presence of these comorbidities.
HIV testing information was recorded for 93% of notifications (394 out of 422) in 2024, of whom 383 people were offered an HIV test (97%). This is similar to the percentage offered a test over recent years (98% in 2022 and 97% in 2023), however remains below the 100% target (Figure 14).
Table 6. Number and proportion of people with TB with comorbidities, Yorkshire and the Humber, 2024 [note 18]
| 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 | 79 | 18.7 | Not applicable | Not applicable |
| Chronic liver disease | 355 | 3 | 0.8 | 67 | 15.9 |
| Chronic renal disease | 363 | 11 | 3.0 | 59 | 14 |
| Diabetes | 363 | 41 | 11.3 | 59 | 14 |
| Hepatitis B | 343 | 11 | 3.2 | 79 | 18.7 |
| Hepatitis C | 343 | 4 | 1.2 | 79 | 18.7 |
| Immunosuppression | 358 | 25 | 7.0 | 64 | 15.2 |
Note 18: people with TB are reported as having at least one of the named comorbidities if any of the 6 comorbidities (chronic liver disease, chronic renal disease, diabetes, hepatitis B, hepatitis C or immunosuppression) had ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual comorbidities were a ‘no’ and may result in under-estimation.
Figure 14. Proportion of people with TB offered an HIV test by year, Yorkshire and the Humber, 2019 to 2024 [note 19] [note 20]
Note 19: dashed line indicates target of 100% of people offered an HIV test.
Note 20: error bars represent upper and lower 95% confidence intervals.
The percentage of people over 15 years old with TB and information recorded about at least one social risk factor (SRF) (current alcohol misuse, asylum seeker status, and mental health needs; and current or a history of homelessness, drug misuse, and prison history) was 98% (415 out of 422). Among people where this information was recorded, 15% (62 out of 415 notifications) had at least one of these SRFs, and 6% had more than one SRF. The most common SRF recorded was current asylum seeker status (6.5%, 24 out of 369 notifications), followed by current or previous drug misuse (6.3%, 22 out of 348), and current or previous prison (5.0%, 17 out of 339) (Table 7). The prevalence of at least one social risk factor among people notified with TB decreased slightly in 2024 (15%) compared to 2023 (17%), following a previous increasing trend since 2014 (11%) (Figure 15, Table 8).
Table 7. Number and proportion of people with TB aged 15 years or over with individual social risk factors, Yorkshire and the Humber, 2024 [note 21] [note 22]
| 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 | 415 | 62 | 14.9 | Not applicable | Not applicable |
| More than one social risk factor | 360 | 23 | 6.4 | 55 | 13.3 |
| Alcohol misuse (current) | 350 | 11 | 3.1 | 65 | 15.7 |
| Asylum seeker (current) | 369 | 24 | 6.5 | 36 | 8.9 |
| Drug misuse (current or previous) | 348 | 22 | 6.3 | 67 | 16.1 |
| Homelessness (current or previous) | 347 | 16 | 4.6 | 68 | 16.4 |
| Mental health needs (current) | 351 | 8 | 2.3 | 64 | 15.4 |
| Prison (current or previous) | 339 | 17 | 5.0 | 76 | 18.3 |
Note 21: 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 22: 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 15. Proportion of people with TB aged 15 years or over with at least one social risk factor (SRF), Yorkshire and the Humber, 2019 to 2024 [note 23] [note 24]
Note 23: error bars represent upper and lower 95% confidence intervals.
Note 24: additional social risk factors have been captured since 2021.
Table 8. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, Yorkshire and the Humber, 2014 to 2024 [note 25]
| 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 | 56 | 11.3 | 495 |
| 2015 | 51 | 12.5 | 409 |
| 2016 | 42 | 10.4 | 405 |
| 2017 | 44 | 13.3 | 330 |
| 2018 | 38 | 11.4 | 332 |
| 2019 | 53 | 15.7 | 338 |
| 2020 | 29 | 10.9 | 267 |
| 2021 | 47 | 14.9 | 315 |
| 2022 | 51 | 17.8 | 286 |
| 2023 | 59 | 17.1 | 346 |
| 2024 | 62 | 14.9 | 415 |
Note 25: additional social risk factors have been captured since 2021 and this table includes people with no information recorded in the denominator.
In 2024, males notified with TB were more likely than females to report having any social risk factor (21% of males compared to 5% of females). The presence of any social risk factor was more likely to be reported among the 15 to 44 (17%) and 45 to 64 (15%) age groups, compared to the 65 and older age group (less than 10%, based on fewer than 5 notifications). The presence of any social risk factor was also more common among UK-born people notified with TB (25%) compared to non-UK-born people (12%) (Table 9).
In 2024, almost three-quarters of people notified with TB in Yorkshire and the Humber were resident in the 3 most deprived deciles (73%, 308 out of 422). The TB notification rate was highest in the most deprived decile (17 per 100,000 population), followed by the second and third most deprived (14 and 8 per 100,000, respectively). Compared to last year’s report, the inequalities have widened, with increased TB notification rates in the 2 most deprived deciles. The rate in the remaining 7 deciles ranged between 1.6 and 6.6 per 100,000 (compared to between 1.6 and 3.6 per 100,000 in last year’s report) (Figure 16).
Table 9. Number and proportion of people with TB aged 15 years or over with a social risk factor (SRF) by demographic characteristics, Yorkshire and the Humber, 2024 [note 26]
| 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 | 8 | 162 | 4.9 |
| Male | 54 | 253 | 21.3 |
| Aged 15 to 44 | 42 | 253 | 16.6 |
| Aged 45 to 64 | 17 | 112 | 15.2 |
| Aged 65 or older | Suppressed | 50 | Less than 10.0 |
| Non-UK-born | 38 | 316 | 12.0 |
| UK-born | 24 | 98 | 24.5 |
Note 26: one case has been excluded from the above table due to missing demographic characteristic data.
Figure 16. TB notification rate by deprivation decile, Yorkshire and the Humber, 2024 [note 27] [note 28]
Note 27: error bars represent upper and lower 95% confidence intervals.
Note 28: 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, 72.8% (177 out of 243) people with pulmonary TB in Yorkshire and the Humber were culture-confirmed, which is similar to the percentage in 2023 (72.5%) and remains below the 80% target (Figure 17).
Among culture-confirmed TB cases, between 2018 and 2024, there was consistently between 97% and 100% of records where first line TB drug-sensitivity results were recorded, although there has been variation between years and a slight increase in percentage between 2023 (98%) and 2024 (100%) (Figure 18). In 2024, the percentage of culture-confirmed TB with resistance to first line anti-TB antibiotics was 7% (Figure 19).
Figure 17. Proportion of people notified with pulmonary TB who were culture confirmed, Yorkshire and the Humber, 2018 to 2024 [note 29] [note 30]
Note 29: dashed line indicates target of 80% culture confirmation.
Note 30: error bars represent upper and lower 95% confidence.
Figure 18. Proportion of people culture confirmed with TB with first line drug results, Yorkshire and the Humber, 2018 to 2024 [note 31] [note 32]
Note 31: error bars represent upper and lower 95% confidence intervals.
Note 32: 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 there may have been false detection of resistance from June 2023.
Figure 19. Proportion of people notified with culture confirmed TB with initial resistance to any first line drug, Yorkshire and the Humber, 2018 to 2024 [note 33] [note 34]
Note 33: error bars represent upper and lower 95% confidence intervals.
Note 34: due to quality control issues, resistance to any first-line drug excludes pyrazinamide for 2023 and 2024.
Among culture-confirmed notifications in 2024, 36.6% were identified in a 12 single nucleotide polymorphism (SNP) cluster with more than one other person, compared to 41.1% in 2022 and 41.2% in 2023 (Table 10).
Table 10. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, Yorkshire and the Humber, 2021 to 2024 [note 35] [note 36]
| 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 | 325 | 187 | 57.5 | 85 | 45.5 | 38.5 to 52.6 |
| 2022 | 300 | 175 | 58.3 | 72 | 41.1 | 34.1 to 48.5 |
| 2023 | 354 | 216 | 61.0 | 89 | 41.2 | 34.8 to 47.9 |
| 2024 | 422 | 257 | 60.9 | 94 | 36.6 | 30.9 to 42.6 |
| Total | 1,401 | 835 | 59.6 | 340 | 40.7 | 37.4 to 44.1 |
Note 35: a WGS cluster is defined as 2 or more individuals that have isolates with a SNP difference of 12 or less.
Note 36: 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, there were 15 children under the age of 18 years old notified with TB in Yorkshire and the Humber (1.3 per 100,000 population); there has been a decreasing trend in the number of children notified with TB since a peak in 2011 (76 notifications) (Figure 20 and Figure 21).
In 2024, there were fewer than 5 UK-born children under 18 years old notified with TB, a decrease from 7 notifications in 2023 and a continuation of the decreasing trend since 2011 (Figure 22). In contrast, there has been an increase in the number of TB notifications among non-UK-born children under 18 years over the last 4 years, from fewer than 5 in 2021 to 11 in 2024 (data not shown). There were no countries of birth where there were more than 5 children notified with TB in 2024 (data not shown).
Among children under 18 years old in Yorkshire and the Humber, there were 9 children (60%) diagnosed with pulmonary TB (with or without extra-pulmonary disease), 9 diagnosed with extra-pulmonary TB, and fewer than 5 children diagnosed with severe TB (defined as TB meningitis, miliary or cryptic disseminated disease) in 2024 (data not shown).
Figure 20. Number of TB notifications in children aged under 18 years, Yorkshire and the Humber, 2001 to 2024
Figure 21. TB notification rate in children aged under 18 years, Yorkshire and the Humber, 2001 to 2024 [note 37]
Note 37: error bars represent upper and lower 95% confidence intervals.
Figure 22. Number of TB notifications in UK born children aged under 18 years, Yorkshire and the Humber, 2001 to 2024
TB treatment
There are recommendations for enhanced case management (ECM) in individuals receiving anti-TB treatment with clinical or social complexities, for example:
- ECM level 1: people with clinical or social issues which may impact on treatment, for example, children with TB, or those taking antiretrovirals
- ECM level 2: people with complex clinical or social issues which are likely to impact on treatment, for example, complex side effects or single drug-resistance, which may necessitate weekly visits
- ECM level 3: people with very complex clinical or social issues which highly impact on treatment, for example, social risk factors or multidrug resistance (MDR) or rifampicin-resistant (RR) TB which necessitates directly observed therapy (DOT) or video observed therapy (VOT)
In 2024, 27.7% of all people notified with TB in Yorkshire and the Humber received ECM (117 out of 422), of which similar numbers were at ECM level 1 (40, 9.5%), level 2 (33, 7.8%) and level 3 (43, 10.2%). There was an increase in the number of notifications at ECM level 1 and ECM level 3 in 2024 compared to 2023 (29, 8.2% at ECM level 1 and 32, 9% at ECM level 3). Between 2021 and 2024, the number of people with any ECM has increased from 93 to 117. (Table 11)
Table 11. Number of people with TB receiving enhanced case management, Yorkshire and the Humber, 2021 to 2024 [note 38]
| 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 | 325 | 93 | 28.6 | 34 | 10.5 | 20 | 6.2 | 39 | 12.0 | 0 | 0.0 |
| 2022 | 300 | 89 | 29.7 | 45 | 15.0 | 19 | 6.3 | 24 | 8.0 | 1 | 0.3 |
| 2023 | 354 | 95 | 26.8 | 29 | 8.2 | 34 | 9.6 | 32 | 9.0 | 0 | 0.0 |
| 2024 | 422 | 117 | 27.7 | 40 | 9.5 | 33 | 7.8 | 43 | 10.2 | 1 | 0.2 |
Note 38: total TB notifications includes all people notified with TB regardless of whether they are receiving ECM or not, or if this information is missing.
In 2024, the percentage of people with pulmonary TB with a treatment delay over 2 months was 59.4%, which was lower than 2019 (67.4%) (Figure 23). Among people with extra-pulmonary TB, the percentage of people with a treatment delay over 2 months decreased between 2023 (72%) and 2024 (68%). This followed a steady increase in the percentage of people with a treatment delay over 2 months from 62.3% in 2019 to 71.7% in 2023 (Figure 24).
In 2024, 49 pulmonary TB notifications (29.7%) had a treatment delay of 2 to 4 months, and 49 (29.7%) had a treatment delay over 4 months. The percentage of TB notifications with a treatment delay over 4 months was similar to recent years (between 27% and 33% from 2020 to 2023), but lower than 2019 levels (39%) (Table 12). The median time between symptom onset and treatment start in people with pulmonary TB in 2024 was 73 days (IQR 34 to 152). This is a decrease compared to 2023 (83 days) and 2022 (90 days) but is higher than the 2027 target of fewer than 56 days between symptom onset and treatment start (Figure 25, Table 12).
The proportion of people with pulmonary TB notified within 3 days of diagnosis in 2024 was 60%. This is a decrease from recent years (between 65% and 68% between 2021 and 2023) (Table 13).
Figure 23. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, Yorkshire and the Humber, 2019 to 2024 [note 39] [note 40] [note 41]
Note 39: error bars represent upper and lower 95% confidence intervals.
Note 40: delay to treatment is defined by when treatment was started from symptom onset.
Note 41: all cases where delay to treatment is greater than 730 days have been removed from this analysis.
Figure 24. Proportion of people notified with extra-pulmonary TB with a treatment delay over 2 months, Yorkshire and the Humber, 2019 to 2024 [note 42] [note 43] [note 44]
Note 42: error bars represent upper and lower 95% confidence intervals.
Note 43: delay to treatment is defined by when treatment was started from symptom onset.
Note 44: all cases where delay to treatment is greater than 730 days have been removed from this analysis.
Figure 25. Median treatment delays among people notified with pulmonary TB, Yorkshire and the Humber, 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.
Table 12. Time between symptom onset and treatment start in people with pulmonary TB, Yorkshire and the Humber, 2016 to 2024 [note 49]
| 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 | 95 | 42.2 | 69 | 30.7 | 61 | 27.1 | 225 | 76.0 | 38.0 to 127.0 |
| 2017 | 83 | 40.3 | 60 | 29.1 | 63 | 30.6 | 206 | 79.0 | 34.2 to 134.8 |
| 2018 | 76 | 41.5 | 54 | 29.5 | 53 | 29.0 | 183 | 72.0 | 41.0 to 131.0 |
| 2019 | 59 | 32.6 | 52 | 28.7 | 70 | 38.7 | 181 | 95.0 | 46.0 to 173.0 |
| 2020 | 82 | 52.6 | 32 | 20.5 | 42 | 26.9 | 156 | 58.5 | 26.5 to 139.5 |
| 2021 | 64 | 40.3 | 44 | 27.7 | 51 | 32.1 | 159 | 79.0 | 35.0 to 158.5 |
| 2022 | 44 | 34.4 | 42 | 32.8 | 42 | 32.8 | 128 | 90.0 | 43.0 to 150.2 |
| 2023 | 60 | 38.2 | 49 | 31.2 | 48 | 30.6 | 157 | 83.0 | 43.0 to 128.0 |
| 2024 | 67 | 40.6 | 49 | 29.7 | 49 | 29.7 | 165 | 73.0 | 34.0 to 152.0 |
Note 49: 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.
Table 13. Proportion of people notified with pulmonary TB within 3 days of diagnosis by year, Yorkshire and the Humber, 2019 to 2024 [note 50]
| Year | Number of people notified | Proportion of people notified (%) | Total |
|---|---|---|---|
| 2019 | 113 | 62.4 | 181 |
| 2020 | 102 | 63.0 | 162 |
| 2021 | 112 | 67.9 | 165 |
| 2022 | 105 | 67.3 | 156 |
| 2023 | 134 | 65.4 | 205 |
| 2024 | 134 | 60.4 | 222 |
Note 50: includes people with pulmonary TB who were not diagnosed at postmortem, and where report delay was known and between 0 and 90 days (inclusive).
TB treatment outcomes
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 disease 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.
Among people treated for non-multidrug resistant (non-MDR) or non-rifampicin resistant (non-RR) non-severe TB in 2023 in Yorkshire and the Humber, 80% (247 out of 308) had completed treatment by 12 months (Table 14). This is a decrease in percentage completion at 12 months compared to people notified in 2021 and 2022 (82% and 87%, respectively) (Table 15 and Table 16) and remains below the 90% treatment target (Figure 26).
Among people with one or more social risk factors and an expected treatment duration of less than 12 months, 81.5% (44 out of 54 notifications) had completed treatment within 12 months, which was a slight decrease compared to 2022 (84.4%) (Figure 27).
Of people notified in 2023 who had not completed treatment at 12 months, 3.6% (11 notifications) had died (due to any cause), 3.9% (12 notifications) had stopped treatment, 1.6% (5 notifications) were still on treatment, and 1.9% (6 notifications) had been lost to follow up (Table 14). The percentage who stopped treatment had increased compared to pre-pandemic when it was 1% in 2019. The percentage lost to follow-up increased in 2023 (1.9%) compared to 2022 (0.7%) following a decreasing trend since 2020 (4.9%). The percentage of people notified in 2023 who died before completing treatment, among those with an expected treatment duration of less than 12 months, was similar to recent years apart from a peak in 2020 (17 notifications, 7%) (Figure 28 and Figure 29).
Table 14. Treatment outcome at 12 months and last recorded outcome for people notified with non-severe TB treated for non-MDR or non-RR TB, Yorkshire and the Humber, 2023 [note 51] [note 52]
| 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 | 247 | 80.2 | 269 | 87.3 |
| Died | 11 | 3.6 | 11 | 3.6 |
| Lost to follow up | 6 | 1.9 | 7 | 2.3 |
| Still on treatment | 5 | 1.6 | 0 | 0.0 |
| Treatment stopped | 12 | 3.9 | 13 | 4.2 |
| Not evaluated | 27 | 8.8 | 8 | 2.6 |
| Total | 308 | 100.0 | 308 | 100.0 |
Note 51: 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 52: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Figure 26. Proportion of people with non-severe TB treated for non-MDR or non-RR TB who completed treatment within 12 months compared with the target of 90%, Yorkshire and the Humber, 2019 to 2023 [note 53] [note 54] [note 55]
Note 53: dashed line indicates treatment target of 90%.
Note 54: error bars represent upper and lower 95% confidence intervals.
Note 55: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Figure 27. 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, Yorkshire and the Humber, 2019 to 2023 [note 56] [note 57] [note 58]
Note 56: error bars represent upper and lower 95% confidence intervals.
Note 57: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease.
Note 58: additional social risk factors have been captured since 2021.
Figure 28. 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, Yorkshire and the Humber, 2014 to 2023 [note 59]
Note 59: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Figure 29. Proportion of people with non-severe TB treated for non-MDR or non-RR TB who died at their last recorded treatment outcome, Yorkshire and the Humber, 2018 to 2023 [note 60] [note 61] [note 62]
Note 60: death could be due to TB or any other cause.
Note 61: non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Note 62: error bars represent upper and lower 95% confidence intervals.
In 2023, there were 31 people notified with CNS, miliary or cryptic disseminated TB disease (severe-TB) which was not reported as rifampicin-resistant. This definition of severe disease may not capture all clinically severe or extensive disease involving other sites of disease. At last recorded outcome, 81% (25 of 31) people had completed treatment (data not shown).
There were 14 people with MDR or rifampicin-resistant TB notified between 2020 and 2022, of whom 86% had completed treatment at 24 months (Table 17 and Table 18).
Among people with culture-confirmed TB diagnosed between 2018 and 2024 in Yorkshire and the Humber, 5% (67 people) had isoniazid resistant TB, 3% (39 people) had rifampicin resistant multidrug-resistant TB, and 0.6% (8 people) had pre-extensively drug-resistant (pre-XDR) TB. There were no TB cases with extensively drug-resistant (XDR) TB between 2018 and 2024 in Yorkshire and the Humber (data not shown).
Table 15. TB outcome at 12 months for people with non-severe TB treated for non-MDR or non-RR TB, Yorkshire and the Humber, 2014 to 2023 [note 63]
| 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 | 414 | 42 | 22 | 12 | 5 | 7 | 4 | 464 |
| 2015 | 323 | 36 | 12 | 17 | 17 | 1 | 6 | 376 |
| 2016 | 324 | 31 | 15 | 12 | 6 | 5 | 5 | 367 |
| 2017 | 277 | 36 | 12 | 4 | 4 | 4 | 2 | 303 |
| 2018 | 291 | 31 | 15 | 7 | 5 | 4 | 1 | 323 |
| 2019 | 269 | 35 | 14 | 5 | 6 | 4 | 12 | 310 |
| 2020 | 196 | 13 | 17 | 12 | 2 | 7 | 10 | 244 |
| 2021 | 241 | 27 | 11 | 11 | 0 | 10 | 21 | 294 |
| 2022 | 233 | 38 | 13 | 2 | 11 | 8 | 2 | 269 |
| 2023 | 247 | 44 | 11 | 6 | 5 | 12 | 27 | 308 |
Note 63: 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 or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Table 16. Proportions of TB outcomes at 12 months for people with non-severe TB treated for non-MDR or non-RR TB, Yorkshire and the Humber, 2014 to 2023 [note 64]
| 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 | 89.2 | 9.1 | 4.7 | 2.6 | 1.1 | 1.5 | 0.9 |
| 2015 | 85.9 | 9.6 | 3.2 | 4.5 | 4.5 | 0.3 | 1.6 |
| 2016 | 88.3 | 8.4 | 4.1 | 3.3 | 1.6 | 1.4 | 1.4 |
| 2017 | 91.4 | 11.9 | 4.0 | 1.3 | 1.3 | 1.3 | 0.7 |
| 2018 | 90.1 | 9.6 | 4.6 | 2.2 | 1.5 | 1.2 | 0.3 |
| 2019 | 86.8 | 11.3 | 4.5 | 1.6 | 1.9 | 1.3 | 3.9 |
| 2020 | 80.3 | 5.3 | 7.0 | 4.9 | 0.8 | 2.9 | 4.1 |
| 2021 | 82.0 | 9.2 | 3.7 | 3.7 | 0.0 | 3.4 | 7.1 |
| 2022 | 86.6 | 14.1 | 4.8 | 0.7 | 4.1 | 3.0 | 0.7 |
| 2023 | 80.2 | 14.3 | 3.6 | 1.9 | 1.6 | 3.9 | 8.8 |
Note 64: 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 or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Table 17. TB outcomes at 24 months for people with non-severe TB treated for MDR or RR (drug resistant) TB, Yorkshire and the Humber, 2014 to 2022 [note 65]
| 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 to 2016 | 18 | 3 | 1 | 2 | 0 | 1 | 3 | 25 |
| 2017 to 2019 | 9 | 3 | 2 | 2 | 0 | 0 | 2 | 15 |
| 2020 to 2022 | 12 | 1 | 0 | 0 | 1 | 1 | 0 | 14 |
Note 65: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 24 months. Non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
Table 18. Proportions of TB outcomes at 24 months for people with non-severe TB treated for MDR or RR (drug resistant) TB, Yorkshire and the Humber, 2014 to 2022 [note 66]
| 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 to 2016 | 72.0 | 12.0 | 4.0 | 8.0 | 0.0 | 4.0 | 12.0 |
| 2017 to 2019 | 60.0 | 20.0 | 13.3 | 13.3 | 0.0 | 0.0 | 13.3 |
| 2020 to 2022 | 85.7 | 7.1 | 0.0 | 0.0 | 7.1 | 7.1 | 0.0 |
Note 66: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 24 months. Non-severe TB is defined as those cases without central nervous system (CNS), spinal, cryptic or miliary disease among adults, and TB meningitis, miliary or cryptic disseminated disease among children aged 0 to 14 years.
TB prevention
Among the 243 people with pulmonary TB in Yorkshire and the Humber in 2024, 21% had 5 or more contacts identified and screened for active and latent TB. This was similar to recent years (21% in 2022 and 22% in 2023) and an increase compared to earlier years (17% in 2019, 12% in 2020 and 13% in 2021) (Figure 30).
Figure 30. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, Yorkshire and the Humber, 2019 to 2024 [note 67] [note 68]
Note 67: error bars represent upper and lower 95% confidence intervals.
Note 68: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of routine contact tracing.
From people with pulmonary TB, a total of 925 contacts were identified of whom 737 (80%) were adults and 188 (20%) were children. The percentage of all contacts who were diagnosed with active TB was 1% (0.9% of adult contacts and 1.3% of child contacts) and 15% were diagnosed with latent TB infection (LTBI) (15% adult contacts and 17% child contacts). Of the 108 contacts who were diagnosed with latent TB, 91 (84%) started treatment and 81 (75%) completed treatment. There was a higher percentage of child contacts who both started LTBI treatment (96%) and completed treatment (92%) compared with adult contacts (81% and 70% started and completed treatment, respectively) (Table 19).
Table 19. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), Yorkshire and the Humber, 2024 [note 69] [note 70] [note 71] [note 72]
| 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 | 737 | Not applicable | 188 | Not applicable | 925 | Not applicable |
| Number of contacts screened for active TB and latent TB | 548 | 74.4 | 158 | 84 | 706 | 76.3 |
| Number of contacts with active TB | 5 | 0.9 | 2 | 1.3 | 7 | 1 |
| Number of contacts with latent TB | 82 | 15 | 26 | 16.5 | 108 | 15.3 |
| Number of contacts who started treatment for latent TB | 66 | 80.5 | 25 | 96.2 | 91 | 84.3 |
| Number of contacts who completed treatment for latent tuberculosis | 57 | 69.5 | 24 | 92.3 | 81 | 75 |
Note 69: the denominator for the proportion of contacts screened for active TB and latent TB infection (LTBI) is number of contacts identified.
Note 70: the denominator for the proportion of contacts positive for active TB and LTBI is the number of contacts screened.
Note 71: the denominator for the proportion of contacts who started and completed treatment is the number of contacts positive for LTBI.
Note 72: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of routine contact tracing.
The proportion of TB notifications occurring among non-UK-born people within 5 years of entry to the UK in 2024 was 60% (144 of 242 notifications). This was a slight decrease compared to 2023, however prior to this there was an increasing trend (from 42% in 2018 to 61% in 2023) (Figure 31).
Figure 31. Proportion of TB notifications occurring within 5 years of entry to the UK for all countries of birth outside of the UK, Yorkshire and the Humber, 2018 to 2024 [note 73] [note 74]
Note 73: error bars represent upper and lower 95% confidence intervals.
Note 74: within 5 years refers to a time since entry of less than 1 year to 5 years inclusive.
BCG immunisation is recommended for people at higher risk of exposure to TB, particularly to protect against serious forms of disease in infants. Those eligible are:
- all infants (up to 12 months) with a parent or grandparent born in a country where incidence of TB is over 40 cases per 100,000 population per year
- all infants living in an area of the UK with an incidence above 40 per 100,000 population
The timing of the neonatal BCG immunisation was changed to a 28-day immunisation programme in September 2021. This change was prompted by the addition of screening for severe combined immunodeficiency (SCID) to the routine newborn screening test at 5 days of age.
Among the 422 people notified with TB in Yorkshire and the Humber in 2024, BCG vaccination coverage was 29% (Table 20). The proportion vaccinated was slightly higher among non-UK born cases (31%) compared to UK born cases (24%) (data not shown).
Table 20. BCG vaccination coverage among people with TB, Yorkshire and the Humber, 2024
| Place of birth | Number of vaccinated people with TB (all ages) | Total number of people with TB (all ages) | Proportion of vaccinated people with TB (all ages) |
|---|---|---|---|
| All cases | 123 | 422 | 29 |
Discussion
There were 422 notifications of TB in Yorkshire and the Humber in 2024, an incidence rate of 7.4 notifications per 100,000 population, which is an increase compared to 2023. The rate of TB has now been increasing since 2022, following a previous steady decline since 2009. In 2024, Yorkshire and the Humber had a lower rate of TB than the England average of 9.4 per 100,000 population; however, since 2023 the region has no longer been on track to meet the WHO End TB goal of a 90% reduction in incidence by 2035.
Five local authorities in Yorkshire and the Humber had a higher TB incidence rate than England. These were Bradford, (15.6 per 100,000), Sheffield (11.8), Kirklees (10.5), Kingston upon Hull (9.8), and Leeds (9.5). Bradford, Sheffield and Kirklees had rates above the WHO definition of a low incidence area (10 per 100,000 population).
The TB notification rate was highest in the male 30 to 39 years old age group (64 notifications, 17 per 100,000 population) and lowest in the 0 to 9 year age groups (0.7 and 0.0 per 100,000 population among females and males, respectively). The majority of people notified with TB in Yorkshire and the Humber in 2024 were born outside the UK (76%). The most common non-UK countries of birth reported were Pakistan, India, Nigeria, Eritrea, and Romania. The number of people notified with TB in Yorkshire and the Humber who were born outside the UK increased in 2024.
Of the people notified with TB in 2024, 58% had pulmonary disease of which 73% were confirmed by culture, compared with 62% culture confirmation in England as reported in the Tuberculosis in England 2025 report, which is below the 80% target. The proportion of people with pulmonary TB who experienced a delay of more than 4 months between symptom onset and start of treatment was 30%, with a median time of 73 days. Excluding people with rifampicin resistant, CNS, spinal, cryptic or miliary TB, 80% of people with TB notified in 2023 completed treatment at 12 months, and 4% died before completing treatment.
Among people notified in 2024, 15% reported at least one social risk factor, and 6% reported more than one. The most common social risk factors reported were being an asylum seeker, current or previous drug misuse, and current or previous prison sentence. Almost three-quarters (73%) of people notified with TB in Yorkshire and the Humber in 2024 were resident in the 3 most deprived deciles, and the TB notification rate was highest in the most deprived decile (17 per 100,000 population). Over a quarter (28%) of people notified with TB in 2024 received enhanced case management, with 10% receiving level 3 support.
Of people notified in 2023 who had not completed treatment at 12 months, the proportion who had stopped treatment was 3.9% which was an increase since 2022 (3.0%) and has been increasing since pre-pandemic when it was 1.3% in 2019. Among people with at least one SRF who were expected to complete treatment within 12 months, 82% of people had completed treatment within 12 months.
The proportion of culture-confirmed TB with resistance to at least one of the first line anti-TB antibiotics (isoniazid, rifampicin, ethambutol, pyrazinamide) was 7% in 2024.
In conclusion, after years of a decreasing rate of TB notifications in Yorkshire and the Humber, rates have now been increasing since 2022. Persistent inequalities exist in TB disease with populations living in deprived areas and people born outside the UK disproportionately affected.
Recommendations
Recommendations for this annual report are structured around the 5 priority areas in the ‘TB Action Plan for England 2021 to 2026’. Underpinning all of the recommendations is the need to strengthen multi-agency partnership working, especially at a strategic level. The rising incidence of TB highlighted in this report should be a catalyst for concerted efforts from partners across the system. The anticipated update to the National Action Plan will provide a renewed foundation on which partners can build to improve TB control efforts.
1. Recovery from COVID-19
Strengthen multi-agency oversight of TB control across the region. UKHSA teams should continue routine quarterly and annual reporting to partners to ensure epidemiological trends are understood across the system in a timely manner. Continue local TB clinical network meetings and the TB nurse network meetings to share situational awareness, learning and good practice across partner organisations. TB teams should work to ensure that accurate and complete information is provided to the UKHSA National Tuberculosis Surveillance System (NTBS) in a timely manner, with a particular focus on improved reporting of treatment outcomes and Enhanced Case Management (ECM) level.
2. Prevent TB
Through multi-agency working, identify opportunities to offer and improve uptake of screening for people in groups who are at higher risk of having TB, including those who have recently arrived in the UK. Continue to manage TB cases, incidents and outbreaks with a focus on maximising the number of contacts identified for screening for each pulmonary TB case. Through system working, ensure that TB is on health inequalities agendas, noting the association with deprivation.
3. Detect TB
Continue to ensure that understanding of diagnostic delays and culture confirmation rates are core parts of the TB clinical network through the provision of surveillance reports.
4. Control TB
Continue to ensure that understanding of treatment completion rates is a core part of the TB clinical network through the provision of surveillance reports. Through multi-agency working and sharing of best practice, partners should continue to develop directly observed therapy and video observed therapy pathways. Through multi-agency working and sharing of best practice, partners should ensure pathways are in place for patients with complex social risk factors.
5. Workforce
ICBs and TB services should continue to implement the GIRFT (Getting it Right First Time) workforce recommendations to ensure that services are equipped to meet the needs of local communities. Partners should strengthen efforts to raise awareness of TB in primary care and people in groups who are at higher risk of having TB including people seeking asylum and those in contact with the criminal justice system.
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 Yorkshire and the Humber, including nurses, physicians, microbiologists, scientists, outreach and social care and administrative staff. We also acknowledge colleagues at the UKHSA National Mycobacterium Reference Service for information on culture confirmation and drug-susceptibility testing. Further thanks are due to the UKHSA National TB Unit for providing the cleaned matched data set, the Regions data science team for developing the report, Yorkshire and Humber Health Protection Team and the Field Service team for their work supporting TB surveillance.