Tuberculosis (TB) is increasing in England at its highest annual rate since the current reporting period began in 1971, according to the Government’s recent Tuberculosis in England 2024 report. The latest annual round up reports on the incidence of TB in England, based on notifications of people diagnosed with tuberculosis disease to the national TB surveillance system (NTBS) in 2023. The rising TB rates, particularly those amongst children, are cause for concern, and the report calls for a sharp and sustained reversal in the nation’s current TB trajectory if the NHS is to meet its TB Action Plan target to reduce by 90% the number of people infected with TB by 2035 in England, in accordance with World Health Organization’s (WHO) ‘End TB Strategy’. The reduction of suffering and disability from this dangerous but treatable disease will only be achieved with dramatic improvement in the control, prevention, early detection and treatment of tuberculosis. What is tuberculosis? Tuberculosis or TB is a serious, contagious infection caused by a group of bacteria known as the mycobacterium tuberculosis complex. Pulmonary TB, which affects the lungs, is the most common form of tuberculosis infection. It is spread by being coughed, sneezed or spat by the infected person and then inhaled from the air by another susceptible person. TB is not limited to the lungs, however, and extra-pulmonary TB can infect other areas of the body, such as the lymph nodes, brain, spine, bones and joints or abdomen. At first, the newly infected person’s immune system may be able to cope with the TB infection, without the infected person suffering obvious symptoms or spreading the disease to others. This dormant form of tuberculosis is known as latent TB, and is thought to affect around a quarter of the global population. Latent TB carries a risk of becoming active, particularly in people whose immune systems are weakened by existing health conditions, such as diabetes or HIV, or who live with poverty, malnutrition, poor housing and sanitation. Smoking and alcohol also increase the risk of active TB. In its early stages, active TB infection may cause only mild symptoms, such as coughing, headache and fatigue, which may be confused with other common conditions. With early diagnosis and correct treatment, tuberculosis can be treated in time to prevent permanent injury to the infected person or the spread of the disease to family members, friends and others in the infected person’s close environment. If treatment is delayed, however, TB can soon become life-threatening and cause permanent injury from severe respiratory disability and injury to the brain from tuberculous meningitis. What are the latest TB statistics for England? In 2023, 10.8 million people worldwide developed tuberculosis. The vast majority of these (87%) were from 30 countries with high rates of TB infection, and followed a global rise in active TB cases following disruption to health services during the COVID-19 pandemic. England is currently defined as a low TB incidence country, with an annual TB notification rate of 8.5 per 100,000 population. The WHO threshold is 10 or fewer notifications per 100,000 population. However, England’s TB notification rate is rising. 4,855 people were notified with TB in England in 2023, an 11% increase in England’s TB notification rate when compared with the previous year. Provisional figures for the first three quarters of 2024 suggest that England has had a further annual increase of 13.7% in the TB rate, compared with the same 9-month period in 2023, representing the largest annual increase in the entire 1971-2023 reporting period. The Tuberculosis in England 2024 report emphasises that this ongoing increase means that England is moving further off-track from WHO’s End TB Strategy targets. To meet the 2035 target, ‘a sharp reversal of the current upward trajectory is required, followed by a year-on-year decrease of 16% from 2024 onwards’. The report points out that the only year in which a decrease close to this magnitude has ever been achieved was in 1987 (15.7%). TB rates in England in 2023 were highest in urban areas, with the London NHS region having a rate five times higher than the South West. The worst affected local authority areas across the country were Leicester City, Newham, Brent, Ealing, Harrow and Slough. Almost 80% (four fifths) of all active TB notifications were for people who had been born outside the UK. The rates for non-UK-born TB notifications increased by 7.2%, and those notified within five years of entry to the UK had almost doubled compared with 2019. However, for the first time since 2012, there was also an increase in the UK-born TB rate, reversing a previous decade of continual decline. Non-UK-born people with TB were mostly aged between 25 to 34 years, whereas UK-born TB sufferers were mostly aged 65 years or older. In both UK-born and non-UK-born people with TB, 60% of those affected were male. The most frequent countries of birth for all people notified with TB in 2023 were India, UK, Pakistan, Nigeria and Romania. As with many areas of healthcare, social deprivation disproportionately increased the risk and rate of TB infection. The rate of TB notifications for people living in the most deprived 10% areas of England was 15.7 per 100,000, compared with 3.3 per 100,000 in the 10% least deprived areas. 17.2% of people aged over 15 years who were diagnosed with TB in 2023 had one or more social risk factors, such as alcohol or drug misuse, homelessness, imprisonment, mental health needs or asylum seeker status. The number of people diagnosed with TB who had two or more social risk factors had increased by 39% compared with 2018. Just over half (55%) of people notified with TB in 2023 had pulmonary TB, with or without additional extra-pulmonary TB disease. More than a quarter (25.9%) of all those with TB had at least one additional health condition or comorbidity, up from 21.2% in 2022. Diabetes (11.5%) was the most commonly reported comorbidity in 2023. Nearly a quarter (23%) had a history of smoking and 15.4% were currently smokers. Children, particularly those aged under five years, have the greatest risk of developing severe TB disease. In the 2023 year, 259 children and adolescents were notified as newly becoming ill with TB, an increase of 12.1% compared with 2022. Despite the awareness that timely and accurate detection and management of TB improves patient outcomes and reduces onward transmission or spread of the disease, the report highlighted that diagnostic delays in the time between onset of symptoms to diagnosis have not improved in England in over five years. The average (median) diagnostic delay for pulmonary TB was 75 days. Compensation claims for TB injury and disability caused by medical negligence TB medical negligence compensation claims usually arise from delays in diagnosis and treatment of tuberculosis resulting in permanent injury to the infected person. The patient’s tuberculosis symptoms may be mild when they initially seek medical advice, but often increase in severity during delays in referral, investigations, diagnosis and treatment. Where signs and symptoms of tuberculosis were ignored or treatment was negligently delayed, resulting in permanent severe or life-threatening injury, compensation can help to ease the financial hardship and meet the significant needs that arise from the injured person’s disability. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.