TB is often regarded as a disease of Victorian England that was eradicated a long time ago, and is now just an issue for low income countries.
Sadly this is not the case. Although the number of TB cases in England has declined year-on-year over the past 4 years; down by a third from the peak seen in 2011 to just over 5,750 in 2015, the incidence of TB in England remains among the highest in Western Europe.
Reducing the burden of tuberculosis in England is, therefore, a priority for Public Health England and the NHS.
TB is a curable and preventable infectious disease caused by a bacterium that is spread through the air in small droplets, when a person with infectious TB coughs, talks, sings or sneezes.
When someone breathes in the bacteria they may become infected with TB and develop active TB disease or latent (dormant) TB.
Active TB disease usually affects the lungs and this is known as pulmonary TB. TB can, however, develop in other organs in the body, and this is known as extra-pulmonary TB.
The symptoms of TB include a cough for over 3 weeks, fever, night sweats, loss of appetite, weight loss and extreme tiredness.
TB is curable with antibiotics and the sooner the illness is diagnosed and treated the better. If left untreated, TB can be life-threatening.
For the first time in 2015, there has been a sustained reduction in UK born as well as non UK born cases of TB, indicating reduced transmission in England. The decrease has also occurred in all regions of the country.
TB is more common in people born abroad and the rate of TB in non-UK born populations is 15 times higher than in the UK born. In 2015, about three quarters of all TB cases notified were in people born abroad.
However there has been a decline in the number of cases among new migrants. Sixty percent of non-UK born TB cases now occur among those who have lived in the UK for more than six years.
TB can be seen as a barometer of health inequalities and tackling it will play a key role in enabling local authorities, PHE and the NHS successfully reduce health inequalities across England.
We can make significant inroads into reducing TB by focusing on the groups that are disproportionately affected by TB. This under-served population with social risk factors includes:
- those with a history of or current homelessness
- those with a history or current imprisonment
- those with current or history of drug or current alcohol misuse problems
People with social risk factors were the only group where cases of TB increased in 2015. The proportion of TB cases in England with a social risk factor increased from 10% (539 cases) to 12% (579) in 2015.
This group have poorer treatment completion and are twice as likely to die.
We need to raise awareness of TB and tackle stigma among populations at high risk, so that if they become unwell with symptoms of TB they self-present to healthcare services.
We also need to build on existing achievements and address gaps in current service provision using the Collaborative TB Strategy for England to do so.
This requires the sustained and coordinated action of all key stakeholders and this edition of Health Matters outlines some recommended actions for each of the main stakeholder groups, including advice on:
- improving the awareness of TB among at-risk groups and among health professionals
- ensuring TB is diagnosed & treated early particularly under-served populations
- work to increase take up of new entrant latent TB testing and treatment
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