Tuberculosis (TB) notifications reported to enhanced TB surveillance systems: UK, 2000 to 2023
Published 27 September 2024
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Main points
The main messages of this report are:
- the UK has remained a low tuberculosis (TB) incidence country with a TB notification rate (the number of people notified with TB in a year) of 7.84 per 100,000 population in 2023, below the World Health Organization (WHO) threshold of 10 per 100,000 population
- TB notification rates in the UK in 2023 increased by 12.5% compared with 2022, the largest year-on-year increase in the current reporting period (2000 to 2023)
- TB notification rates increased for all UK nations, with the largest increase (41.2%) in Scotland and the lowest increase in England (11.0%)
- the 3-year average TB notification rate for lower-tier local authorities (LTLAs) was highest in Leicester at 40.9 per 100,000 people, similar to Newham in London, the only other LTLA above 40 per 100,000; 4 LTLAs had notification rates of 30 to 39 per 100,000, 3 in London (Brent, Ealing and Harrow) and 1 in Slough
- resistance to the antibiotics used to treat TB has risen in the UK, with the highest number of individuals (74) having rifampicin resistant (RR) or multidrug resistant TB (MDR-TB) since 2013; this is the highest proportion since enhanced surveillance began, at 2.3%
- TB treatment completion in the UK for individuals expected to complete at 12 months was 81.7% in 2023, which is consistent with previous years
TB notification rates in the UK and by country over time, 2000 to 2023
In 2023, the number and rate of TB notifications increased by the largest amount (12.4% increase in numbers compared with 2022) since the year 2000, giving a TB notification rate of 7.84 per 100,000 individuals. This exceeds the previous largest increase of 9.1% in 2005. However, TB notifications and rates are still below the peak observed in 2011 (40.6% reduction) (Table 1). The increase in 2023 was preceded by a decrease in 2020 (12.6% decrease compared with 2019) occurring at the same time as the coronavirus (COVID-19) pandemic. This decrease during and rebound after the pandemic is observed in many countries, as reported in the WHO Global TB report.
Table 1. Number of TB notifications, rates and annual percentage change, UK, 2000 to 2023
| Year | Number of notifications | Notification rate per 100,000 | Lower CI | Upper CI | Annual change in notification numbers (%) | Annual change in rate (%) |
|---|---|---|---|---|---|---|
| 2000 | 6,686 | 11.4 | 11.1 | 11.6 | [z] | [z] |
| 2001 | 6,761 | 11.4 | 11.2 | 11.7 | 1.1 | 0.0 |
| 2002 | 7,290 | 12.3 | 12.0 | 12.6 | 7.8 | 7.9 |
| 2003 | 7,219 | 12.1 | 11.8 | 12.4 | -1.0 | -1.6 |
| 2004 | 7,590 | 12.7 | 12.4 | 12.9 | 5.1 | 5.0 |
| 2005 | 8,283 | 13.8 | 13.5 | 14.1 | 9.1 | 8.7 |
| 2006 | 8,307 | 13.9 | 13.6 | 14.2 | 0.3 | 0.7 |
| 2007 | 8,259 | 13.5 | 13.2 | 13.8 | -0.6 | -2.9 |
| 2008 | 8,489 | 13.7 | 13.4 | 14.0 | 2.8 | 1.5 |
| 2009 | 8,870 | 14.2 | 14.0 | 14.5 | 4.5 | 3.6 |
| 2010 | 8,395 | 13.4 | 13.1 | 13.7 | -5.4 | -5.6 |
| 2011 | 8,920 | 14.1 | 13.8 | 14.4 | 6.3 | 5.2 |
| 2012 | 8,715 | 13.7 | 13.4 | 14.0 | -2.3 | -2.8 |
| 2013 | 7,872 | 12.3 | 12.0 | 12.5 | -9.7 | -10.2 |
| 2014 | 7,030 | 10.9 | 10.6 | 11.1 | -10.7 | -11.4 |
| 2015 | 6,227 | 9.6 | 9.3 | 9.8 | -11.4 | -11.9 |
| 2016 | 6,119 | 9.3 | 9.1 | 9.6 | -1.7 | -3.1 |
| 2017 | 5,531 | 8.4 | 8.2 | 8.6 | -9.6 | -9.7 |
| 2018 | 5,029 | 7.6 | 7.4 | 7.8 | -9.1 | -9.5 |
| 2019 | 5,115 | 7.7 | 7.5 | 7.9 | 1.7 | 1.3 |
| 2020 | 4,469 | 6.7 | 6.5 | 6.9 | -12.6 | -13.0 |
| 2021 | 4,775 | 7.1 | 6.9 | 7.3 | 6.8 | 6.0 |
| 2022 | 4,713 | 7.0 | 6.8 | 7.2 | -1.3 | -1.4 |
| 2023 | 5,298 | 7.8 | 7.6 | 8.1 | 12.4 | 11.4 |
Supplementary Table 1 of the accompanying data set shows the number of TB notifications and TB notification rates for England, Scotland, Wales and Northern Ireland from 2000 to 2023.
Increases in TB notifications and rates were observed for all UK nations in 2023 compared with 2022:
- Scotland (41.2%, 281 notifications, 5.2 per 100,000, 95% CI 4.6 to 5.8)
- Wales (21.4%, 85 notifications, 2.7 per 100,000, 95% CI 2.2 to 3.4)
- Northern Ireland (11.6%, 77 notifications, 4.0 per 100,000, 95% CI 3.2 to 5.0)
- England (11.0%, 4,855 notifications, 8.5 per 100,000, 95% CI 8.3 to 8.7)
TB notification rates by geography in England
The UK Health Security Agency (UKHSA) region with the highest TB notification rate was London at 18.9 notifications per 100,000 population. This is approximately 5 times higher than the South West (3.7 per 100,000 population), which had the lowest TB notification rate (Table 2).
Table 2. Number of TB notifications and rates by UKHSA Region, England, 2023
| UKHSA Region | Number of notifications | Case rate per 100,000 | Lower CI | Upper CI |
|---|---|---|---|---|
| East Midlands | 397 | 8.0 | 7.3 | 8.9 |
| East of England | 410 | 6.1 | 5.5 | 6.8 |
| London | 1,662 | 18.7 | 17.9 | 19.7 |
| North East | 112 | 4.2 | 3.4 | 5.0 |
| West Midlands | 580 | 9.6 | 8.9 | 10.4 |
| North West | 586 | 7.8 | 7.2 | 8.5 |
| South West | 212 | 3.7 | 3.2 | 4.2 |
| South East | 539 | 5.9 | 5.4 | 6.5 |
| Yorkshire and the Humber | 357 | 6.4 | 5.8 | 7.1 |
Note 1: CI stands for confidence interval.
TB notification rates are calculated down to lower tier local authority level by calculating the average TB notification rate over the 3 years up to and including 2023. This is done due to small numbers of annual notifications in some areas (Supplementary Table 2 of the accompanying data set). This data demonstrates that there is a large amount of variability within regions and even between lower-tier local authorities within the same area. For example, the 3-year average notification rates within the London UKHSA region in 2023 varied from 5.3 in Richmond upon Thames to 27.5 in the adjacent local authority, Hounslow, and 40.7 notifications per 100,000 in Newham. In the East Midlands, Leicester had the highest rate of any local authority at 40.9 per 100,000, while most of the lower tier local authorities in the region had rates fewer than 5 per 100,000.
Culture confirmation in people notified with pulmonary TB, and all TB notifications by country over time
Supplementary Table 3 of the accompanying data set shows the proportion of all TB notifications that were confirmed by a culture test. It also specifies the site of disease (pulmonary and non-pulmonary) by country and over time, from 2011 to 2023. Culture confirmation was higher in individuals with pulmonary TB, with 75.3% of cultures confirmed as TB, as pulmonary sites are easier to sample. This was compared with a confirmation rate of 61.8% for all TB notifications (pulmonary and non-pulmonary) in the UK in 2023.
In 2023, culture confirmation proportions for all TB notifications by country were:
- England: 61.2%
- Wales: 71.7%
- Scotland: 74.0%
- Northern Ireland: 63.6%
Drug resistance by country over time
Supplementary Table 4 in the accompanying data set shows the number and proportion of people notified with TB who were culture confirmed as having some form of TB resistance. For instance, some were resistant to isoniazid alone (isoniazid mono-resistance, INH-R) or had multi-drug resistant TB (MDR-TB), defined as resistant to rifampicin and isoniazid or rifampicin resistant (RR-TB). This was with or without evidence of resistance to isoniazid, which is reported together with MDR-TB. Drug-resistant TB in all countries in the UK remains low, although the rate of MDR or RR-TB in 2023 in England is the highest observed so far. This increase may still be due to fluctuations resulting from the small numbers of notifications each year.
MDR or RR TB rates (proportions) of all culture-confirmed TB notifications by country were:
- England: 2.4%
- Wales: 0.0%
- Scotland: 1.4%
- Northern Ireland: 0.0%
- UK: 2.3%
TB treatment outcomes
Treatment completion at 12 months varied by country for individuals in the UK treated for drug-sensitive TB and notified in 2022, with an expected treatment duration of fewer than 12 months (Table 3). The highest proportion was in England at nearly 83%, with the lowest observed in Scotland. It should be noted that a high proportion of TB notifications in Scotland and Northern Ireland did not have a reported outcome (‘not evaluated’ in Table 3) and likely accounts for the low proportion of notifications reported as having completed treatment.
Overall, 4.4% of individuals notified in 2022 and treated for drug-sensitive TB across the UK had died at their last recorded treatment outcome at the time of data extraction, while 3.3% were lost to follow-up.
Table 3. TB outcome at 12 months for notifications treated for drug sensitive TB notifications with expected duration of less than 12 months by country, UK, 2022
| Country | England | Wales | Scotland | Northern Ireland | United Kingdom |
|---|---|---|---|---|---|
| Number who completed | 3,125 | 46 | 113 | 43 | 3,327 |
| Percentage completed | 82.8% | 73.0% | 63.1% | 81.1% | 81.7% |
| Number who died | 142 | 1 | 6 | 1 | 150 |
| Percentage who died | 3.8% | 1.6% | 3.4% | 1.9% | 3.7% |
| Number lost to follow-up | 119 | 1 | 1 | 3 | 124 |
| Percentage lost to follow-up | 3.2% | 1.6% | 0.6% | 5.7% | 3.0% |
| Number still on treatment | 125 | 0 | 6 | 1 | 132 |
| Percentage still on treatment | 3.3% | 0.0% | 3.4% | 1.9% | 3.2% |
| Number who stopped treatment | 81 | 0 | 4 | 1 | 86 |
| Percentage who stopped treatment | 2.1% | 0.0% | 2.2% | 1.9% | 2.1% |
| Number not evaluated | 184 | 15 | 49 | 4 | 252 |
| Percentage not evaluated | 4.9% | 23.8% | 27.4% | 7.5% | 6.2% |
| Total | 3,776 | 63 | 179 | 53 | 4,071 |
Note 1: excludes people with culture-confirmed MDR or RR-TB or those treated with an MDR-TB regimen, and those diagnosed postmortem. Also excludes those with central nervous system (CNS), spinal, miliary or cryptic-disseminated TB. This is because these people are not expected to complete treatment within 12 months.
Note 2: ‘Not evaluated’ includes patients who are missing, unknown and transferred out.
Note 3: treatment completion at 12 months for this cohort by country and over time are available in Supplementary Table 5 of the accompanying data set, and show that there are no consistent improvements or otherwise over time for any of the countries.
Table 4. Last recorded TB outcome for the entire TB cohort treated for drug-sensitive TB by country, UK, 2022
| Country | England | Wales | Scotland | Northern Ireland | United Kingdom |
|---|---|---|---|---|---|
| Number who completed | 3,644 | 48 | 128 | 53 | 3,873 |
| Percentage who completed | 85.9% | 71.6% | 65.6% | 84.1% | 84.8% |
| Number who died | 192 | 3 | 6 | 2 | 203 |
| Percentage who died | 4.5% | 4.5% | 3.1% | 3.2% | 4.4% |
| Number lost to follow-up | 143 | 1 | 1 | 4 | 149 |
| Percentage lost to follow-up | 3.4% | 1.5% | 0.5% | 6.3% | 3.3% |
| Number still on treatment | 57 | 0 | 3 | 0 | 60 |
| Percentage still on treatment | 1.3% | 0.0% | 1.5% | 0.0% | 1.3% |
| Number stopped treatment | 98 | 0 | 4 | 1 | 103 |
| Percentage stopped treatment | 2.3% | 0.0% | 2.1% | 1.6% | 2.3% |
| Number not evaluated | 110 | 15 | 53 | 3 | 181 |
| Percentage not evaluated | 2.6% | 22.4% | 27.2% | 4.8% | 4.0% |
| Total | 4,244 | 67 | 195 | 63 | 4,569 |
Note 1: excludes people with culture-confirmed MDR or RR-TB or those treated with an MDR-TB regimen.
Note 2: ‘Not evaluated’ includes patients who are missing, unknown and transferred out.
Note 3: data is provisional and subject to further updates.
Data sources and methodology
Data sources
The TB data for England, Wales and Northern Ireland presented in this report is from the National TB Surveillance System (NTBS) and Enhanced TB Surveillance (ETS). The exception is London, where notifications were reported to the London TB Register (LTBR) before NTBS was implemented. Data for Scotland is from Enhanced Surveillance of Mycobacterial Infections (ESMI). Please see the background information for more detail.
Data was extracted from the surveillance systems 19 June 2024, cleaned and validated. Data for Scotland and Northern Ireland in this report is provisional and subject to further validation, and thus may differ slightly from data presented in Scottish and Northern Irish reports. Earlier Welsh reports used earlier provisional data for 2023.
Clinical teams provide information on TB notifications either directly through the web-based system entered at the clinic, or on a case report form entered onto the system at the Health Protection Team level. Data includes notification details, demographic information, clinical and microbiological information.
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
Denotifications
People with BCGosis, on 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. 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 2020 and December 2021 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.
The UKHSA region was derived from UKHSA region of residence based on the individual’s residential postcode. If missing, the UKHSA region in which treatment occurred (most recently, as care may have been transferred) was used. This may have happened if, for example, 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.
Data type and methodology
TB notifications are reported by area of residence and by calendar year of notification.
Overall TB 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. 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 and are model derived.
For the purposes of TB outcome reporting, the drug-sensitive cohort is defined as all TB notifications, excluding those with multi-drug resistant or rifampicin-resistant TB (MDR/RR-TB) (initial or acquired), and those treated with a second line regimen for MDR/RR-TB. TB outcomes are reported at 12 months for drug-sensitive notifications with an expected duration of treatment of less than 12 months. This group excludes notifications with central nervous system (CNS) disease, who have an expected duration of treatment of 12 months. In addition, those with spinal, cryptic, disseminated or miliary disease are excluded from this group, as CNS involvement cannot be reliably ruled out from these groups. The last recorded outcome is reported for the entire drug-sensitive cohort.
Public Health Scotland aligned with the World Health Organisation (WHO) treatment outcome definitions in 2015, and therefore treatment outcomes in this report may differ slightly to those in their regional report.
Statistical analysis was carried out using Stata 17 and RStudio 4.3.1.
Background information
Tuberculosis (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.
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) subspecies.
Related statistics
- 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.
Further information and contact details
Feedback and contact information
Please contact TBunit@ukhsa.gov.uk to provide any feedback or for any queries.
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