WITH 44 cases per 100,000 residents, Harrow has the second-highest tuberculosis (TB) rate in England, according to data from the National TB Surveillance System, writes Grant Williams.
The incidence of TB in other areas of northwest London is also high.
However, this appears to be levelling off, whereas in Harrow the cases “still seem to be rising”, according to the council.
Harrow’s Department of Public Health is working towards a TB action plan.
Between January 2023 and December 2025, there was an average of 105 people per year diagnosed with active TB in Harrow – which has increased year on year from the 69 people per year between January 2017 and January 2019, when incidence was at its lowest.
During this period, 95 per cent of active cases in Harrow were in people born outside the UK, with 69 per cent of those non-UK born people coming from India.
Of the total number of incidents, 58 per cent had been living in the UK for fewer than five years, according to figures from Harrow’s Department of Public Health.
At a recent Health and Social Care Scrutiny meeting on March 10, Harrow’s director of public health, Laurence Gibson, said the current cohort of residents with TB “are likely to have been infected before they travelled to the UK” and, while it is an issue across northwest London, “it does seem to be affecting Harrow more than others”.
The incidence of TB in Harrow is continuing to increase, resulting in “significant morbidity and mortality for residents”, according to council documents.
Data appears to show this is largely driven by changes in migration patterns, missed opportunities to detect and treat latent infection in new migrants and an increase in the proportion of residents with diabetes mellitus and chronic kidney disease. Harrow’s public health data shows that, of those eligible for latent TB screening, only 35 per cent were screened and of those screened only 10 per cent completed treatment.
Gibson said they “don’t know why this is”, but understanding it will form a “vital part” of creating an action plan.
There are “significant inequalities” in how TB impacts residents, according to the Public Health Department. It suggests the disease disproportionately affects those from Asian communities and from more deprived backgrounds.
TB is more common in people who live in urban areas, were born outside of the UK, live in the most deprived areas of England – among whom it is five times as common when compared to people living in the least deprived areas, and those who have diabetes, chronic kidney disease, HIV and liver disease.
There is geographical variation in the incidence of TB within Harrow, with wards in the south of the borough – particularly Edgware, Centenary, Kenton East, Kenton West, Wealdstone South, Headstone, Rayners Lane and Roxeth – having the highest incidences, according to a council report.
Harrow Council has agreed to a number of recommendations ahead of creating an action plan, which is expected to be brought forward in the early part of next year.
These include advocating for more screening, advocating for a better conversion of screens to treatment, promoting GP registrations, increasing capacity for screening and care, and improving awareness and education of the disease.
Gibson said: “It can be life threatening. It’s a shame because it’s a curable condition, but for approximately one in ten people diagnosed there is a mortality rate associated. There’s greater awareness that’s needed, unquestionably.
“The incidents in Harrow indicate that we particularly need to do work with the cohorts that are directly relevant. […] Although [Indian people] are a majority cohort of the cases, it does affect other groups and communities.”
TB is an infection that normally affects the lungs, but can also affect other parts of the body, including the brain, spine and kidneys. It has two forms: active and latent.
An Active TB patient has symptoms such as cough, tiredness, fever, and weight loss, while those with latent TB do not have symptoms despite being infected with the bacteria.
Worldwide, TB remains one of the top ten causes of death.
In England, approximately one in every 25 people diagnosed with active TB dies within 12 months of diagnosis – equating to approximately 150 deaths per year. People with active TB can infect others, while people with latent TB cannot. However, latent TB can ‘reactivate’ and become active TB for around one in every ten people.
When people with active TB sneeze or cough they produce droplets containing the bacteria and it is these droplets that lead to the spread of TB from one person to another. People with active TB normally stop being infectious after about two weeks of effective treatment.
The council report added: “Changes in migration patterns mean there is now a very large population in the borough who are at risk of having latent tuberculosis, which can subsequently reactivate to become active, infectious, tuberculosis.
“Without changes to how latent and active tuberculosis are detected and treated in the borough, it is likely the incidence of tuberculosis, and its associated harm, will continue to increase.” (Local Democracy Reporting Service)
