India, Pakistan top countries of origin for non-UK TB cases

INDIA and Pakistan have emerged as the leading countries of origin for tuberculosis (TB) cases in England among non-UK-born people in 2023, according to data released by the UK Health Security Agency (UKHSA).

The report revealed that 80 per cent of all TB cases in England last year were among people born outside the UK, with Nigeria and Romania also featuring prominently.

TB cases in England rose by 11 per cent in 2023, with 4,855 cases reported compared to 4,380 in 2022. Despite the increase, England remains classified as a low-incidence country, with a notification rate of 8.5 cases per 100,000 people.

However, TB rates continue to disproportionately affect deprived communities and urban areas, particularly London, which recorded the highest rate at 18.7 notifications per 100,000 population.

Among UK-born individuals, TB cases were more prevalent among people experiencing homelessness, substance dependency, or involvement with the criminal justice system.

Symptoms of TB include a persistent cough lasting more than three weeks, high fever, night sweats, loss of appetite, and significant weight loss.

The rise in cases was accompanied by an increase in drug-resistant TB, which requires longer and more complex treatments. Laboratory testing revealed that 2.4 per cent of cases were multi-drug resistant. UKHSA has deployed Whole Genome Sequencing technology to expedite diagnosis and ensure timely treatment for affected individuals.

Dr Esther Robinson, head of the TB Unit at UKHSA, stressed the importance of early detection and treatment. "TB is curable and preventable, but it remains a significant public health concern in England," she said. "Symptoms like a persistent cough lasting over three weeks, fever, or weight loss should not be ignored. It is vital to seek medical advice promptly."

To control TB, the country requires individuals from certain high-prevalence countries to undergo a TB screening test before obtaining a visa for stays longer than six months.

In 2023, over one million people were screened under this programme, resulting in the detection of 505 pulmonary TB cases. These people were required to complete treatment before entering the UK.

In addition to managing active TB cases, the NHS Latent TB Infection (LTBI) programme saw significant expansion. Testing in high-incidence areas of England doubled, with 34,680 people screened in 2023 compared to 17,484 in 2022. Of those tested, 15.1 per cent were diagnosed with latent TB, which can remain dormant for years before becoming active.

Globally, TB continues to be the leading cause of death from a single infectious agent, surpassing Covid-19. According to the WHO, 10.8 million people were infected with TB in 2023, marking a seven per cent increase from 2020.

The UKHSA is collaborating with partners to advance research on new therapeutics and vaccines to combat TB, aiming to improve prevention, detection, and treatment outcomes in England, a statement said.