HPR volume 15 issues 11 and 12: news (13 July 2021)
Updated 19 January 2022
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TB action plan for England, 2021 to 2026
A new long-term action plan for prevention, detection and control of tuberculosis (TB) in England, launched this month, aims to build on the achievements of the Collaborative Strategy 2015 to 2020 and the recommendations of the related TB strategy end of programme report.
In 2019, the steady decline in TB incidence in England that had been seen in previous years was reversed, with cases increasing year on year by 2.4% (from 4,615 in 2018 to 4,725 in 2019). While recorded incidence fell again in 2020 (to 4,138), the coronavirus (COVID-19) pandemic has likely had an impact on diagnoses.
It is expected that missed and delayed diagnoses, late presentation of symptoms and delayed treatment will have increased the pool of undetected and unreported TB in the community, potentially leading to an increase in TB cases in the short term, post-pandemic.
Nevertheless, the new action plan seeks to build on lessons learned during the pandemic response. This will include utilising the expansion of the UK’s whole-genome sequencing (WGS) capabilities and increased use of technology in healthcare.
WGS was already in universal use for TB surveillance in England before the pandemic, being used to detect clusters and outbreaks and support prevention of TB transmission. The increased engagement between the local authority public health function and PHE health protection teams on COVID-19 contact tracing will support future public health interventions to prevent TB.
The new action plan, prepared by PHE’s TB unit in conjunction with NHS England, was published by the UK Health Security Agency (UKHSA) – formally established in April – which takes over full responsibility for PHE’s health protection activities with effect from 1 October 2021.
The strategic remit and priorities of the new agency, for its initial period of operation, has also recently been published.
NCSP to focus on screening and retesting for young women, and partner notification
Following an evidence review and a public consultation, England’s National Chlamydia Screening Programme (NCSP) is being re-configured so as to put greater emphasis on reducing the harm of untreated infections in young women rather than offering screening to all sexually active males and females under 25 years of age.
Whereas screening has in the past been offered to all sexually active young adults as part of their primary care (or sexual health) consultations, in future the programme will primarily focus on sexually active young women and the expansion of testing in community settings, and more rapid treatment. The strategy is also to prevent re-infection through improved ‘partner notification’ and retesting following treatment.
Young men will still be offered a chlamydia test: if they have symptoms, if their partner has chlamydia, or as part of care offered by specialist sexual health services. Young men may also request a test at a sexual health service.
The change comes after a comprehensive review of the programme by an international group of experts in sexually transmitted infection (STI) control, who found that focusing on harm reduction will lead to better health outcomes.
Chlamydia is the most commonly diagnosed STI in England, the prevalence of infection being highest in young sexually active women (15 to 24 year olds). If left untreated, the infection can have serious health complications in women including pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility (TFI). Complications in men are much rarer and an infection will often resolve without treatment in those who are asymptomatic.
Infection reports in this issue
Laboratory confirmed cases of invasive meningococcal infection England: January to March 2021.
Laboratory confirmed cases of pertussis in England: January to March 2021.
Laboratory confirmed cases of hepatitis A in England and Wales, April to June 2020.
Laboratory reports of hepatitis C in England and Wales, April to June 2020.