1. Communicable Disease Surveillance Centre, London
Country presentation United Kingdom Metropolitan and regional situation
Delphine Antoine
Communicable Disease Surveillance Centre, London
November 2003

2. United Kingdom 58 789 194 population in 2001
in England and Wales
International migration: net inflows in 2001 ( inflows and outflows)
4 states
12 regions

3. Map of the United Kingdom
SCOTLAND
N IRELAND
WALES
ENGLAND

4. Tuberculosis (all forms) TB notification and death rate,
England and Wales,

5. Tuberculosis: notifications, Mycobnet reports
Tuberculosis: notifications, Mycobnet reports* and deaths, England & Wales
*Initial isolates of M. tuberculosis complex.
Note: Notification data for 2000 are preliminary.

6. Tuberculosis notifications,
England and Wales,
Sources: Tuberculosis notifications (PHLS/CDSC-NOIDS), population figures (ONS estimates)

7. Possible explanations for the increase
of TB rate
Change in reporting system ?
Change in diagnosis practice ?
International migration form high TB incidence countries
HIV
deterioration of socio-economic status in some population groups
lack of vigilance and resources to combat a disease often considered to be almost eradicated
Failure of control

8. Methods of tuberculosis surveillance
in England & Wales, 2001
Notifications
Intermittent survey (until 1998)
Enhanced tuberculosis surveillance
reporting system implemented in 1999
Treatment outcome monitoring implemented in 2002 on TB cases reported in 2001
Reference laboratory reports (MycobNet since 1993)
Mortality

9. Main elements of tuberculosis surveillance in England & Wales, 2002
CDSC Colindale
Patient with TB
Clinician
CCDC
specimen
result
identification + drug sensitivity result (Mycobnet)
Mycobacterial isolate
Local hospital laboratory
Mycobacterial reference laboratory
Identification + drug sensitivity result

10. Methods of tuberculosis surveillance
in England & Wales, 2001
Some examples of specific studies
Strain typing studies on TB cases reported in 1998
HIV infection among TB cases 1993 and 1998,
London TB nurses caseload profile (2003)
TB in children (2004)

11. Enhanced surveillance of tuberculosis in England, Wales and Northern Ireland case definition
Culture confirmed cases: Culture confirmed disease, due to Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis or M. africanum).
Other than culture confirmed cases: in the absence of culture confirmation, a case that meets the following criteria: a clinician’s judgment that the patient’s clinical and/or radiological signs and/or symptoms are compatible with tuberculosis and a clinician’s decision to treat the patient with a full course of anti tuberculosis treatment

12. Tuberculosis cases reported in the UK, 2001
No. Cases Rate
United Kingdom
England & Wales *
Northern Ireland*
Scotland
* Source : Enhanced TB surveillance

13. Tuberculosis cases reported in England and Wales and Northern Ireland, 2001
Total number of cases:
Of which :
males / females % / 45%
cases in persons born abroad 63%
Pulmonary / extra pulm. cases 60% / 40%
pulmonary SS+ cases 21%
culture positive cases 57%
Reported in London 41%
Number of cases with DST results 3389
MDR %

14. TB rates by age group, sex, and geographic origin
, England and Wales
Male foreigners
Female foreigners
Male nationals
Female nationals

16. Tuberculosis case report rate (/100 000) by geographic origin and ethnic group,
England and Wales,
White
Indian, Pakistani, Bangladeshi
Black African
Other
Total
Born in UK
3.4
41.0
35.8
13.9
4.4
Born abroad
9.2
175.3
280.5
58.9
73.4
England and Wales = 11.2

17. Metropolitan and sub-regional information
Availability in surveillance data on national level
Region of reporting
Local authority of residence of patient
Town/city
Primary care trust (from 2003)
Post code

18. Tuberculosis case report rates, by region,
England and Wales, 2001

19. Tuberculosis case report rates, by region,
England and Wales, 2001

20. Tuberculosis rate in cities, England and Wales, 2001 (preliminary results)

21. Tuberculosis case report rate by local authority in London, 2001

22. Spatial analysis of tuberculosis rates by postal district – 2001
Defined by Triangulated Network Analysis (TIN)
cell size 0.1km
Legend
Source: London Hostels
Directory 2003; RIS
Source: Notifying centre
Enhanced TB Surveillance
CDSC
GIS mapping by Chris Lane CDSC 2003

23. London in 2001 Population 7.1 million (14% total England)
300 different spoken languages
27% born outside UK
17% households overcrowded
13 of the 20 most deprived areas in England
HIV/AIDS infected population (41,200)
> 100,000 homeless people
Est. 70,000 ‘problem’ drug users
3.5% IDU’s HIV+ (0.3% outside London)
> 6,000 prisoners

24. Tuberculosis case reports, England & Wales
London England & Wales
(without London)
TB cases reported in 2001
No. of TB cases
TB rate/
Median age
cases born abroad 80% 51%
MDR at start of tt 5.2% %
TB cases reported
HIV infection 5.3% 2.4%

25. Metropolitan and sub-regional information
Limitations
Completeness of information on geographical area
Definition of area
Availability of denominator (overall and for higher TB risk population groups)
Completeness of information on TB cases vary
Change of administrative health organisation
Interpretation of trends ?

26. Questions
How to monitor TB in higher TB risk subgroups or areas in a low incidence countries ?
Specific surveys ?