Tuberculosis (TB) notifications reported to enhanced TB surveillance systems: UK, 2000 to 2022
Updated 22 February 2024
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Corrections
This report was corrected on 4 December 2023 after an error was discovered in Table 2, where numbers and rates for East Midlands were incorrectly reported as numbers and rates for East of England and vice versa. Table 2 of the supplementary data set was also affected, which has also now been corrected.
Table 4 of the supplementary dataset was corrected on 22 February 2024 after an error was identified in which numbers and proportions of notifications in Scotland identified as being isoniazid or multi-drug resistant, prior to 2020 were incorrectly reported as being zero. The main messages of the report were unaffected by this issue.
Main messages
The UK has remained a low TB incidence country with a TB notification rate of 7.0 per 100,000 population in 2022, below the World Health Organization (WHO) threshold of 10 per 100,000 population.
TB notification rates in the UK have decreased since a peak rate in 2009 of 14.2 per 100,000 population, but the rate of decline has recently slowed; the large decrease in notification rates in 2020 (12.9%) has been followed by an increase in 2021 and rates remaining stable in 2022.
TB notification rates were higher in England than the devolved administrations. In 2022, the TB notification rate in England was 7.7 per 100,000 population compared with 3.7 per 100,000 in Scotland, 2.2 per 100,000 in Wales and 3.5 per 100,000 in Northern Ireland.
Significant variation in notification rates has continued between regions and local authority areas in England in 2022.
Notification rates were highest in London (17.9 per 100,000) and lowest in the North East and South West of England (both 2.8 per 100,000).
The 3-year average TB notification rate has remained at more than 40 per 100,000 people in one lower tier local authority (LTLA) in England (Newham, London) and between 30 to 39 per 100,000 population in a further 5 local authorities; 3 in London (Brent, Ealing and Harrow), Leicester and Slough.
Resistance to antibiotics used to treat TB remained stable in the UK, with 1.6% of individuals having rifampicin resistant (RR) or multidrug resistant TB (MDR-TB) and 5.9% mono-resistant to isoniazid.
TB treatment completion in the UK at 12 months for individuals expected to complete within this period was 83.5% in 2022, consistent with previous years.
TB notification rates in the UK and by country over time, 2000 to 2022
From the peak number of people notified with TB in 2011 to 2022, a 47.1% reduction in TB notifications has been observed (Table 1). In 2019 a small increase in TB notifications occurred, the first since 2011. This was followed by a large decrease in 2020 (12.9% decrease compared with 2018) at the same time as the COVID-19 pandemic.
Table 1: Number of people notified with TB, TB notification rates and annual percentage change, UK, 2000 to 2022
| Year | Number of notifications | Notification rate per 100,000 (95% confidence interval (CI)) | Annual change in notification numbers (%) | Annual change in rate (%) |
|---|---|---|---|---|
| 2000 | 6,686 | 11.4 (11.1 to 11.6) | - | - |
| 2001 | 6,761 | 11.4 (11.2 to 11.7) | 1.1 | 0.0 |
| 2002 | 7,290 | 12.3 (12.0 to 12.6) | 7.8 | 7.9 |
| 2003 | 7,219 | 12.1 (11.8 to 12.4) | -1.0 | -1.6 |
| 2004 | 7,590 | 12.7 (12.4 to 12.9) | 5.1 | 5.0 |
| 2005 | 8,283 | 13.8 (13.5 to 14.1) | 9.1 | 8.7 |
| 2006 | 8,307 | 13.9 (13.6 to 14.2) | 0.3 | 0.7 |
| 2007 | 8,259 | 13.5 (13.2 to 13.8) | -0.6 | -2.9 |
| 2008 | 8,489 | 13.7 (13.4 to 14.0) | 2.8 | 1.5 |
| 2009 | 8,870 | 14.2 (14.0 to 14.5) | 4.5 | 3.6 |
| 2010 | 8,395 | 13.4 (13.1 to 13.7) | -5.4 | -5.6 |
| 2011 | 8,920 | 14.1 (13.8 to 14.4) | 6.3 | 5.2 |
| 2012 | 8,715 | 13.7 (13.4 to 14.0) | -2.3 | -2.8 |
| 2013 | 7,871 | 12.3 (12.0 to 12.6) | -9.7 | -10.2 |
| 2014 | 7,030 | 10.9 (10.6 to 11.1) | -10.7 | -11.4 |
| 2015 | 6,228 | 9.6 (9.3 to 9.8) | -11.4 | -11.9 |
| 2016 | 6,118 | 9.3 (9.1 to 9.6) | -1.8 | -3.1 |
| 2017 | 5,532 | 8.4 (8.2 to 8.6) | -9.6 | -9.7 |
| 2018 | 5,029 | 7.6 (7.4 to 7.8) | -9.1 | -9.5 |
| 2019 | 5,115 | 7.7 (7.4 to 7.9) | 1.7 | 1.3 |
| 2020 | 4,470 | 6.7 (6.5 to 6.9) | -12.6 | -13.0 |
| 2021 | 4,779 | 7.1 (6.9 to 7.3) | 6.9 | 6.0 |
| 2022 | 4,718 | 7.0 (6.8 to 7.2) | -1.3 | -1.4 |
The supplementary data set Table 1 shows the number of TB notifications and TB notification rates for England, Scotland, Wales and Northern Ireland from 2000 to 2022. Most TB notifications in the UK were in England with correspondingly higher TB notification rates compared with the devolved administrations. In 2022, there were 4,380 individuals with TB in England giving a rate of 7.7 per 100,000 (95% CI 7.5 to 8.0 per 100,000), very similar to 2021. Scotland and Wales both had a decrease in numbers and rate compared with 2021; 201 notifications, rate of 3.7 per 100,000 (95% CI 3.2 to 4.2 per 100,000) and 70 notifications, rate of 2.2 per 100,000 (95% CI 1.7 to 2.8 per 100,000) respectively. In Northern Ireland there were 67 notifications giving a rate of 3.5 per 100,000 (95% CI 2.7 to 4.5 per 100,000) in 2022, a small increase compared with 2021.
TB notification rates by geography in England
In 2022 the UK Health Security Agency (UKHSA) region with the highest TB notification rate was London at 17.9 notifications per 100,000 population, approximately 6 times higher than the rate in the North East and South West with the lowest TB notification rates (both 2.8 per 100,000 population) (Table 2).
TB notification rates are calculated down to LTLA level by calculating the average TB notification rate over the 3 years up to and including 2022. This is done due to small numbers of annual notifications in some areas (supplementary data set Table 2). This data demonstrates that there is a large amount of variability within regions and between LTLAs within the same area.
Table 2: Number of TB notifications and TB notification rates by UKHSA region, England, 2022
| UKHSA region | Number of notifications | Case rate per 100,000 (95% CI) |
|---|---|---|
| East Midlands | 385 | 7.9 (7.1 to 8.7) |
| East of England | 368 | 5.5 (5.0 to 6.1) |
| London | 1,575 | 17.9 (17.0 to 18.8) |
| North East | 74 | 2.8 (2.2 to 3.5) |
| South East | 496 | 6.7 (6.1 to 7.3) |
| North West | 479 | 5.3 (4.9 to 5.8) |
| South West | 161 | 2.8 (2.4 to 3.3) |
| West Midlands | 537 | 9.0 (8.3 to 9.8) |
| Yorkshire and the Humber | 305 | 5.6 (5.0 to 6.2) |
Note: Table 2 was revised on 4 December to correct an error where values for East Midlands were incorrectly reported as values for East of England and vice versa.
Culture confirmation in people notified with pulmonary and all notifications of TB by country over time
The supplementary data set Table 3 shows the proportion of all TB notifications and proportion of pulmonary TB notifications that were confirmed by culture, by country and over time from 2011 to 2022. As expected, culture confirmation rates have been consistently higher for pulmonary compared with non-pulmonary TB. Culture confirmation rates for both have consistently increased in recent years in Scotland but remained static in England and variable in Wales and Northern Ireland. In 2022, culture confirmation rates (proportions) for all TB notifications were:
- England: 63%
- Scotland: 80%
- Wales: 71%
- Northern Ireland: 76%
Drug resistance by country over time
The supplementary data set Table 4 shows the number and proportion of people whose TB was culture confirmed and confirmed as having TB resistant to isoniazid alone (isoniazid mono-resistance, INH-R) or with MDR-TB, defined as resistant to rifampicin and isoniazid or rifampicin resistant (RR-TB), with or without evidence of resistance to isoniazid, reported combined with MDR-TB. Drug resistant TB in all countries in the UK remains low with no consistent changes over time indicated. Observed fluctuations likely represent small numbers of notifications each year. In 2022 MDR or RR TB rates (proportions) of all culture confirmed TB notifications were:
- England: 1.6%
- Scotland: 1.1%
- Wales: 2.0%
- Northern Ireland: 5.9%
Note that Northern Ireland has often (including 2021 and 2020) reported no cases of MDR or RR TB and this apparent increased rate is most likely due to small numbers.
TB treatment outcomes
Table 3 shows TB treatment outcomes for individuals notified in the UK excluding notifications with culture confirmed or suspected MDR or RR TB notified in 2021 and excluding notifications with an expected treatment duration of less than 12 months. In 2022 treatment completion at 12 months was 83.5%, with 2.9% reported as still being on treatment. These figures are consistent with previous years (supplementary data set Table 5).
The proportion of individuals who died within 12 months of diagnosis or starting treatment ranged from 0% in Northern Ireland to 7.0% in Wales and was 4.0% in England. Due to small numbers of notifications in Northern Ireland and Wales, proportions of rare outcomes like death are more variable and differences should be interpreted with caution.
Table 3: TB outcome at 12 months for people notified in 2021 with non-MDR or RR TB with expected treatment duration of less than 12 months by country, UK, 2021 [note 1] [note 2]
| Country | Number completed (%) | Number died (%) | Number lost to follow-up (%) | Number still on treatment (%) | Number stopped (%) | Number not evaluated (%) | Total |
|---|---|---|---|---|---|---|---|
| England | 3,245 (84.2%) | 154 (4%) | 101 (2.6%) | 112 (2.9%) | 69 (1.8%) | 172 (4.5%) | 3,853 |
| Wales | 45 (61.6%) | 5 (6.8%) | 3 (4.1%) | 1 (1.4%) | 1 (1.4%) | 18 (24.7%) | 73 |
| Northern Ireland | 33 (82.5%) | 0 (0%) | 0 (0%) | 2 (5%) | 0 (0%) | 5 (12.5%) | 40 |
| Scotland | 157 (78.5%) | 10 (5%) | 3 (1.5%) | 5 (2.5%) | 2 (1%) | 23 (11.5%) | 200 |
| United Kingdom | 3,479 (83.5%) | 169 (4.1%) | 107 (2.6%) | 120 (2.9%) | 72 (1.7%) | 218 (5.2%) | 4,166 |
[note 1] Excludes people with culture confirmed MDR or RR-TB at diagnosis or during treatment and people treated with an MDR-TB regimen in the absence of culture confirmation and those with CNS, spinal, miliary or cryptic disseminated TB.
[note 2] Not evaluated includes missing, unknown and transferred out.
Table 4 shows the last recorded TB treatment outcome for all individuals notified in the UK without confirmed or suspected MDR or RR-TB, who were notified in 2021. Note that this group includes those with severe disease categories that are not expected to complete treatment within 12 months and were not included in Table 3 above. As expected, an increased proportion of people are reported to have completed treatment at their last recorded outcome and lower proportion as not evaluated.
Table 4: Last recorded TB treatment outcome for people notified in 2021 with non-MDR or RR TB by country, UK, 2022 [note 2] [note 3]
| Country | Number completed (%) | Number died (%) | Number lost to follow-up (%) | Number still on treatment (%) | Number stopped (%) | Number not evaluated (%) | Total |
|---|---|---|---|---|---|---|---|
| England | 3,793 (88.1%) | 203 (4.7%) | 122 (2.8%) | 20 (0.5%) | 82 (1.9%) | 87 (2%) | 4,307 |
| Wales | 59 (67.8%) | 7 (8%) | 3 (3.4%) | 0 (0%) | 1 (1.1%) | 17 (19.5%) | 87 |
| Northern Ireland | 41 (80.4%) | 1 (2%) | 2 (3.9%) | 1 (2%) | 3 (5.9%) | 3 (5.9%) | 51 |
| Scotland | 179 (80.6%) | 12 (5.4%) | 3 (1.4%) | 0 (0%) | 2 (0.9%) | 26 (11.7%) | 222 |
| United Kingdom | 4,072 (87.3%) | 223 (4.8%) | 130 (2.8%) | 21 (0.4%) | 88 (1.9%) | 133 (2.8%) | 4,667 |
[note 3] Excludes people with culture confirmed MDR or RR-TB at diagnosis or during treatment and people treated with an MDR-TB regimen in the absence of culture confirmation.
See [note 2] as above.
Methodology and definitions
TB notifications
TB is a notifiable disease. Enhanced Tuberculosis Surveillance (ETS) was introduced across England Wales and Northern Ireland in 2000 and the equivalent scheme in Scotland, Enhanced Surveillance of Mycobacterial Infections (ESMI). From 2021 reporting of TB notifications in all countries except Scotland was through the replacement National TB Surveillance System (NTBS). Data from the surveillance systems is compiled for the purpose of UK reporting. Data includes notification details, demographic information, clinical and microbiological information.
Only individuals with disease caused by Mycobacterium tuberculosis complex (MTBC) are reported. Individuals were denotified and removed from the data set if the infective agent was identified as non-MTBC or M. bovis Bacillus Calmette-Guerin (BCG).
TB definition
All new TB notifications (including those diagnosed post-mortem) that meet one of the 2 following case definitions are reported.
Culture-confirmed case
A culture-confirmed case is defined as a culture-confirmed disease, with speciation confirming Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis, M. africanum or M. microti).
Clinically diagnosed case
In the absence of culture confirmation, it is a case that meets both of the following criteria:
- a clinician’s judgement that the patient’s clinical and/or radiological signs and/or symptoms are compatible with active TB
- a clinician’s decision to treat the patient with a full course of anti-TB therapy for active TB
Data sources and production
Data was extracted from the surveillance systems in October 2023, cleaned and validated. Data for Scotland in this report is provisional and subject to further validation, and thus may differ slightly from data presented in Scottish reports.
Data from all TB isolates identified in UK mycobacterial reference laboratories (MRLs) (excluding Scotland) is routinely imported into the national annual data and matched to case notifications using patient identifiers common to both the laboratory isolate and the case notification. In addition, external to the system, an annual probabilistic matching process based on the patient identifiers is undertaken to identify additional matches. TB isolates in Scotland are identified by the Scottish MRL and this data is not matched using this method.
The population data used is sourced from the Office for National Statistics (ONS), incorporating data from the National Records of Scotland and Northern Ireland Statistics and Research Agency.
Data cleaning to improve data quality (applies to all countries except Scotland)
Denotifications
TB notifications can be subsequently denotified if they were later found not to meet the notification criteria. This may occur when notifications were made on the basis of a clinical diagnosis that is later confirmed to be incorrect. Notifications associated with BCG-osis, chemoprophylaxis for latent TB infection or with a non-tuberculous mycobacterial infection, who were notified in error were identified using comments fields, and denotified. People with culture confirmed TB who had been denotified were queried with clinics, and lab contaminations were removed, or people were renotified if they were found to have been denotified in error. In addition, a probabilistic matching process was carried out for notifications between January 2021 and December 2022 to identify people with more than one notification within a 12-month period. Identified duplicates were denotified with any missing information transferred from the duplicate to the original notification.
Geography
The postcode field (used to map postcodes to geographic areas) was cleaned by identifying invalid postcodes based on matching to the May 2022 Postcode Directory from ONS. Where cleaning was necessary, the correct postcode was identified using the address fields. For people who were homeless or who had a residence outside the UK, but were notified in England, the postcode of the clinic or hospital at which they were treated was assigned to the notification. For people with no postcode or treatment clinic or hospital, the local authority and UKHSA centre were updated using the local authority field recorded based on the area that the notifying case manager was located in.
UKHSA centre was derived from UKHSA region of residence based on the individual’s residential postcode. If missing, UKHSA centre in which treatment occurred (most recently, as care may have been transferred) was used, for example if a person had no fixed abode.
Site of disease
The site of disease was reclassified to pulmonary if a positive sputum smear (microscopy) sample was recorded or if a positive culture was grown from a pulmonary laboratory specimen. People with laryngeal TB were included in pulmonary breakdowns, and people with miliary TB were included in both pulmonary and extra-pulmonary breakdowns. Site of disease for people with culture confirmation was reclassified based on the site in the body from which the specimen was taken. Site of disease classifications were also updated using the free text field for site of disease.
Definitions of the TB treatment cohorts
For the purposes of reporting TB treatment outcomes in this report, people with culture confirmed MDR or RR TB, or those treated with a second line regimen for MDR or RR TB are excluded as TB treatment outcomes are not expected to be comparable to those treated for drug sensitive TB on a first line regimen. TB outcomes are reported at 12 months for those with an expected duration of treatment of less than 12 months, which excludes people diagnosed with CNS disease, who have an expected duration of treatment of at least 12 months. In addition, those with spinal, cryptic, disseminated or miliary disease are excluded, as CNS involvement cannot be reliably ruled out from these groups. The last recorded outcome is reported for the entire non-MDR or RR cohort. Previously this was referred to as the drug sensitive cohort.
Public Health Scotland aligned with the WHO treatment outcome definitions in 2015, and therefore treatment outcomes in this report may differ slightly to those in their regional report.
Calculation of TB notification rates
TB notifications are reported by area of residence and by calendar year of notification.
Overall TB notification rates per 100,000 population, as well as those by area of reporting, are calculated using the mid-year population estimates provided by the ONS. For 2022, the population estimate for 2021 was used due to delay in publication of population estimates. Average annual rates per 100,000 for the 3-year period were calculated by dividing the numerator (the number of TB notifications in the 3-year period) by the denominator (the sum of the mid-year population estimates for the same 3-year period) and multiplying by 100,000. A 95% confidence interval for incidence was obtained assuming a Poisson distribution.
Statistical analysis was carried out using Stata 17 and RStudio.
Further information
Further TB data reports that are available from organisations include:
- UKHSA produces detailed public health reports with TB data for England
- Public Health Agency Northern Ireland produces TB data for Northern Ireland
- Public Health Wales produces TB data for Wales
- Health Protection Scotland produces TB data for Scotland
About these statistics
Our statistical practice is regulated by the Office for Statistics Regulation (OSR). OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to. You are welcome to contact us directly by emailing tbunit@ukhsa.gov.uk with any comments about how we meet these standards. Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.
The UKHSA is committed to ensuring that these statistics comply with the Code of Practice for Statistics. This means users can have confidence in the people who produce UKHSA statistics because our statistics are robust, reliable and accurate. Our statistics are regularly reviewed to ensure they support the needs of society for information.
UKHSA will next be conducting a formal review of these statistics in Spring 2024. Following this review, an implementation plan will be developed to continue to improve the trustworthiness, quality, and value of these statistics. Key continuous improvements made will be highlighted within future releases of these statistics for transparency.
Glossary
Acquired resistance
Resistance identified on repeat culture after one month of the first specimen date. Notifications with a change from a sensitive to resistant result following treatment start are reclassified as acquired resistance, even if this is within the one-month period.
Confidence interval
In this report, 95% confidence intervals (CIs) were used.
Initial resistance
A cultured isolate resistant to a particular drug within one month of the first specimen date
Last recorded outcome
Last known outcome, irrespective of when it occurred.
Multi-drug resistant TB (MDR-TB)
Multi-drug resistant TB is defined as resistance to at least isoniazid and rifampicin, with or without resistance to other drugs.
Multi-drug resistant or rifampicin-resistant TB (MDR or RR-TB)
Multi-drug resistant or rifampicin-resistant TB is defined as resistance to rifampicin including MDR-TB cases.