What is tuberculosis and what are we doing to fight it?

The man in the black cardigan is coughing with one hand on his face and the other on his chest.

Tuberculosis (TB) is a bacterial infection that is spread by inhaling small drops from an infected person’s cough or sneeze. It mainly affects the lungs, but can affect any part of the body, including the lymph nodes, bones, and the brain that causes meningitis.

Common symptoms of TB include a persistent cough lasting more than 3 weeks, unexplained weight loss, night sweats, high temperature, fatigue and tiredness, loss of appetite and depending on the location of the disease, swelling of the lymph nodes in neck or back pain. TB affects the spine.

The picture depicts a woman coughing with the words 'Think TB, not every cough is covid'

This is a potentially serious condition, but it can be cured if it is diagnosed early and treated immediately with the right combination of specific antibiotics. The minimum length of treatment for non-drug-resistant tuberculosis is a minimum of six months and more for the treatment of a person with drug-resistant tuberculosis.

What is the status of tuberculosis in England?

The story of tuberculosis prevention, detection and control in England has been successful, with the incidence of tuberculosis declining significantly since 2011, when it was the highest in Western Europe, with about 9,000 cases recorded that year.

However, in 2019 we saw the fall off and instead, the case increased by 2.4%.

By 2020, cases have dropped again, but we know that COVID-19 has disrupted epidemic services and affected diagnoses.

At the moment, the number of cases per year in England is just over 4,000 with the highest rate concentrated in large urban areas. For example, in 2020, 35.5% (1,464 out of 4,125) incidents occurred in London.

Who is most at risk?

Although almost anyone can be infected with TB, those at high risk are those who live in, come from, or spend time in a country or area with high levels of TB. About three out of every four TB cases in the UK affect people born outside the UK.

Other risk groups are:

  • Those who are in close contact with an infected person, for example, live in the same house
  • Those whose immune systems are weakened, such as diabetes and renal conditions
  • There are treatments that weaken the immune system
  • Those who are too young or too old
  • Lifestyle and social risk factors such as drug abuse, alcohol abuse or homelessness due to poor health or poor diet

One way we work to quickly identify cases, get people to the right treatment quickly and reduce the spread is pre-entry screening for those who want to migrate to England from a highly infected country. There are also free TB tests and treatments for those at risk but who may not have symptoms (known as latent TB infection) – which can be accessed through a GP.

Contact your GP if you think you may be at risk.

What are we doing to reduce tuberculosis?

To enable the UK to live up to its commitment to the World Health Organization (WHO) TB eradication strategy by 2035, the UKHSA and NHS England have launched a 5-year action plan.

It will build on the improvement of TB prevention, detection and control in England over the last 10 years and will focus on 5 key priorities for providing partners with tools to reduce TB incidence in all our communities.

The 5 priority areas are:

  1. Recovery from COVID-19

It is expected that missed and delayed diagnosis, late presentation of symptoms and delayed treatment will increase the pool of untrained and undiagnosed tuberculosis in the community, potentially leading to an increase in TB cases in the short term.

  1. Prevent and protect

Prevent and protect sensitive people in England from developing TB infection and active disease. This includes increasing the incidence of latent tuberculosis infection and giving BCG vaccine to all eligible within 4 weeks of birth.

  1. Identify TB

Improve early detection of TB by identifying, investigating, and working on factors that contribute to the patient’s delay.

  1. Control TB disease

Prepare and respond to TB transmission clusters, outbreaks and events and threats posed by drug-resistant TB. These include the rollout of the new National TB Surveillance System and routine provision of complete genome sequencing data in TB services.

  1. Workforce

Develop and maintain a healthcare workforce to ensure staff capacity in TB detection, case management and control.

Read more about the Five Year Plan here and find out more about TB here.

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