Official Statistics

National quarterly report of tuberculosis in England: quarter 1, 2025, provisional data

Updated 24 April 2025

Applies to England

Main points

In January to March (quarter 1) of 2025:

• there were 1,266 people notified with tuberculosis (TB), an increase of 2.1% compared with the same period in 2024
• the regions with the biggest increases compared with the same period in 2024 were the North East (21.2%), London (9.6%), South West (9.3%) and East Midlands (8.7%)
• the proportion of people with TB who were born outside the UK was 81.6%, similar to January to March (quarter 1) of 2024
• the proportion of people with social risk factors was also similar to January to March (quarter 1) of 2024, at 15.4%

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Overall numbers and geographical distribution

The number of TB notifications per quarter for England are shown in Figure 1a and the cumulative number of notifications by month from 2019, in Figure 1b. The number of notifications per quarter by UKHSA region are shown in Figures 2a and 2b. Exact numbers per quarter by UKHSA region and in total are shown in Table 1 of the supplementary dataset. Due to the seasonality of TB notifications, the most recent quarter is compared with the same quarter in the previous year rather than with the previous quarter. Numbers are generally lower in January to March (quarter 1) than the other quarters.

In January to March (quarter 1) of 2025, 1,266 people were notified with TB in England. This is 2.1% higher by than in January to March (quarter 1) of 2024 (1,240).

Figure 1a. Number of TB notifications in England, between January to March (quarter 1) of 2022 and January to March (quarter 1) of 2025

For data behind this graph see Table 1 of the supplementary data set.

The cumulative number of cases by month are shown in Figure 1b. The pre-pandemic year of 2019 is included for reference and the COVID-19 pandemic years of 2020 and 2021 are excluded to allow comparison with the years since.

The cumulative total of notifications in 2025, compared with the same period in the pre-pandemic year of 2019, has increased by 135 (11.9%).

Figure 1b. Monthly cumulative number of TB notifications, England. Data from pre-pandemic year, 2019, and between January 2023 and January to March (quarter 1) of 2025

For data behind this graph see Table 2 of the supplementary data set.

The number of people notified with TB in January to March (quarter 1) of 2025 (compared with January to March (quarter 1) of 2024, and analysed by UKHSA region):

• increased in the East Midlands (8.7% increase), London (9.6% increase), North East (21.2% increase) and South West (9.3% increase)
• remained similar in the North West (0.7% increase)
• decreased in the East of England (6.5% decrease), South East (7.7% decrease), West Midlands (6.8% decrease) and Yorkshire and the Humber (5.1% decrease)

Figure 2a. Number of TB notifications in London, England between January to March (quarter 1) of 2022 and January to March (quarter 1) of 2025

For data behind this graph see Table 1 of the supplementary data set.

Figure 2b. Number of TB notifications in UKHSA region, England between January to March (quarter 1) of 2022 and January to March (quarter 1) of 2025

For data behind this graph see Table 1 of the supplementary data set.

Note 1: the axes on the London figure are different to that of the other regions due to the higher number of TB notifications in London.

Note 2: figures are ordered by decreasing total number of people with TB in January to March (quarter 1) of 2025.

Demographic and clinical characteristics

The number of TB notifications by place of birth (where known) is shown in Figure 3, sub-divided by whether the site of disease is pulmonary or non-pulmonary. Pulmonary disease is defined here as disease affecting the lungs and non-pulmonary disease notifications are those without any pulmonary involvement. Note that those with pulmonary disease may also have other sites of disease outside of the lungs.

Figure 3. Number of TB notifications by place of birth and site of disease, England, over the last 2 years or 8 quarters

For data behind this graph see Table 3 of the supplementary data set.

In January to March (quarter 1) of 2025:

• people born outside of the UK accounted for 81.6% of notifications (1,031 out of 1,264), a small change in proportion compared with January to March (quarter 1) of 2024 (80.0% (991 out of 1,238)
• people with pulmonary TB accounted for 52.9% (670 of 1,266) of all people with TB, consistent with 53.6% in January to March (quarter 1) of 2024 (665 of 1,240)
• Pulmonary TB was more common in people born in the UK, accounting for 72.1% (168 of 233) compared with 48.6% (501 of 1,031) in people born outside of the UK; consistent with previous years

Note 1: numbers do not correspond to the total number of notifications due to missing data.

Note 2: place of birth was unknown for 2 notifications in January to March (quarter 1) of 2025 and 2 notifications in January to March (quarter 1) of 2024. Missing data may reflect difficulties in obtaining data (for example, if the patient died or there were language barriers).

Note 3: there was no missing data for pulmonary versus non-pulmonary disease January to March (quarter 1) of 2025 or January to March (quarter 1) of 2024.

Culture confirmation

The TB action plan 2021 to 2026 Priority 3 workplan (Action 3.3) aims to increase culture confirmation rates by 5% per year with a specific target within the workplan (3.3.2a) to reach the European standard of 80% culture confirmation for pulmonary disease. In January to March (quarter 1) of 2025 , the number of culture-confirmed TB notifications will increase as laboratory results become available. This is because it can take up to 12 weeks for a culture sample to turn positive. Therefore, further comparisons are made between October to December (quarter 4) of 2024, and October to December (quarter 4) of 2023.  

Figure 4 shows the proportion of culture confirmed notifications by disease site (pulmonary or non-pulmonary) by quarter.

In January to March (quarter 1) of 2025, 48.4% (613 of 1,266) of notifications were culture confirmed. This increased to 60.1% (403 of 670), in those with pulmonary disease. In October to December (quarter 4) of 2024, 72.7% of pulmonary notifications were culture confirmed compared with 71.5% in October to December (quarter 4) of 2023. The 80% target of culture confirmation for pulmonary TB disease was reached in none of the last 2 years or 8 quarters.

Figure 4. Proportion of culture confirmation among TB notifications by site of disease, England, over the last 2 years or 8 quarters

For data behind this graph see Table 4 of the supplementary data set.

Figures 5a and 5b show the proportions of culture confirmation for pulmonary and non-pulmonary TB disease notifications by UKHSA regions. No UKHSA region consistently achieved the 80% target of culture confirmation for pulmonary disease notifications. The highest proportions of culture confirmation for both pulmonary and non-pulmonary disease notifications were in the North East.

For pulmonary TB, the largest changes in culture confirmation between October to December (quarter 4) of 2024 compared with October to December (quarter 4) of 2023 were seen in:

• East of England and West Midlands where both decreased
• East Midlands, North East, South West and Yorkshire and the Humber where all increased

For non-pulmonary TB the largest changes in culture confirmation between October to December (quarter 4) of 2024 and October to December (quarter 4) of 2023 were seen in:

• North East and West Midlands where both decreased
• East of England, North West, South West and Yorkshire and the Humber where all increased

Figure 5a. Proportion of culture confirmation among TB notifications in London by site of disease, over the last 2 years or 8 quarters

For data behind this graph see Table 5 of the supplementary data set.

Figure 5b. Proportion of culture confirmation among TB notifications by site of disease and UKHSA region, over the last 2 years or 8 quarters

For data behind this graph see Table 5 of the supplementary data set.

Multidrug-resistant or rifampicin-resistant TB

Resistance to antimicrobial therapy is a major concern for treatment of TB, historically requiring extended therapy of between 12 to 24 months. New 6-month regimens have now been recommended by the World Health Organization (WHO) and commissioned by NHS England. All notifications with a positive culture are tested for antimicrobial susceptibility using whole genome sequencing. If a notification does not have a positive culture, no resistance results are available.

This report uses the WHO classification of multidrug or rifampicin resistance (MDR or RR). Multidrug resistance is classified as resistance to at least isoniazid and rifampicin. Figure 6 shows the number of culture-confirmed notifications that are MDR or RR by quarter.

Figure 6. Number of culture confirmed TB notifications with MDR or RR TB at diagnosis, England, over the last 2 years or 8 quarters

For data behind this graph see Table 6 of the supplementary data set.

Note: this figure displays numbers rather than proportions due to the low number of MDR or RR TB notifications.

In January to March (quarter 1) of 2025, there were 11 people notified with culture confirmed MDR or RR, but this may increase as laboratory results are finalized. For example, we now report 14 MDR or RR notifications in October to December (quarter 4) of 2024, 2 more than previously reported for this quarter. The number of people notified with MDR or RR TB in 2024 was 77. This is an increase of 8.5% compared with 2023 (71 people).

Treatment delays

Treatment delay is the time between the reported symptom onset date and treatment start date. It reflects either delays in individuals seeking or accessing healthcare or delays in diagnosis after presentation, or both. Treatment delays are reported only for pulmonary TB (Figure 7) due to the risk that extended treatment delays may increase transmission within communities. Analysis excludes notifications with a diagnosis made after death (post-mortem).

The joint UKHSA-NHS England 2021 to 2026 TB Action Plan has a target of a 5% reduction per year in the proportion of people with a treatment delay of 4 months or more compared with that in 2021 and 2022 (Action plan 3.1 and 3.2).

Data was missing for a considerable proportion of people due to the missing date of onset of symptoms or treatment start date. In January to March (quarter 1) of 2025 this was missing for 181 people (27.3%) compared with 125 (18.9%) in January to March (quarter 1) of 2024. In October to December (quarter 4) of 2024 it was missing for 196 (28.7%) compared with 183 (27.8%) in October to December (quarter 4) of 2023.

In January to March (quarter 1) of 2025, 71.8% of people with pulmonary TB started treatment within 4 months of symptom onset, compared with 71.1% in January to March (quarter 1) of 2024. This proportion may change due to incomplete data in October to December (quarter 4). Thus, further comparisons are made for the previous quarter compared with the same quarter in the previous year.

Figure 7. Proportion of pulmonary TB notifications starting treatment within 4 months (symptom onset to treatment start), England, over the last 2 years or 8 quarters

For data behind this graph see Table 7 of the supplementary data set.

Figures 8a and 8b show the proportion of people starting treatment within 4 months by UKHSA region and quarter. In October to December (quarter 4) of 2024 compared with October to December (quarter 4) of 2023, the proportion of people with TB who started treatment within 4 months of symptom onset is:

• higher for the North West, South East and West Midlands
• lower for the East of England and North East
• similar for the East Midlands, London, South West and Yorkshire and the Humber

Figure 8a. Proportion of pulmonary TB notifications in London starting treatment within 4 months (symptom onset to treatment start), over the last 2 years or 8 quarters

For data behind this graph see Table 8 of the supplementary data set.

Figure 8b. Proportion of pulmonary TB notifications starting treatment within 4 months (symptom onset to treatment start) by UKHSA region, between April to June (quarter 2) of 2023 and January to March (quarter 1) of 2025

For data behind this graph see Table 8 of the supplementary data set.

Treatment outcomes

Treatment outcomes at or before 12 months from start of treatment are reported for people notified up to January to March (quarter 1) of 2024 with known or assumed drug-sensitive TB, the majority of whom should have completed treatment within 12 months of starting. Data is not presented for those notified after January to March (quarter 1) of 2024 as many are not expected to have completed treatment. The data excludes people in the drug-resistant group and those with central nervous system (CNS), spinal, miliary or cryptic disseminated TB as treatment time for these groups usually exceeds 12 months.

The joint UKHSA-NHS England 2021 to 2026 TB action plan has a target of 90% treatment completion at 12 months by 2026 (Action plan 4.1) in those treated for drug-sensitive TB and expected to complete within 12 months.

Where treatment outcome is reported as not known or transferred to a different country, data is included in the not evaluated group. Figure 9a shows outcomes for notifications where treatment is complete, not evaluated or other. The category ‘other’ includes those who either died, were lost to follow-up, are still on treatment (treatment period may be extended beyond 12 months in some cases) or where the treatment was stopped. The proportion of each of these is shown in Figure 9b.

The proportion of people with drug sensitive TB (with an expected treatment duration of less than 12 months) who completed treatment at 12 months was 71.5% for people notified in January to March (quarter 1) of 2024 compared with 80.5% in January to March (quarter 1) of 2023.

Note that in the last 12 months, there was a high proportion of people with treatment outcomes recorded as “not evaluated”, despite these people having started treatment at least 12 months previously. This demonstrates that there was a delay in reporting the final outcome of the treatment process. The proportion not evaluated is expected to decrease with time. For those notified between April to June 2022 and January to March (quarter 1) of 2024, the highest proportion of treatment completed was observed in July to September 2023 at 80.5%.

Figures 9a and 9b. Outcomes at 12 months for people treated for drug-sensitive TB with expected treatment duration under 12 months, England, between January to March (quarter 1) of 2022 and January to March (quarter 1) of 2024

Figure 9a

Figure 9b

For data behind these graphs see Table 9 of the supplementary data set.

Note 1: this excludes people in the drug resistant group and those with CNS, spinal, miliary or cryptic disseminated TB. People included here as drug-sensitive TB notifications include those with known drug sensitivities and those with no information on drug sensitivity or not known to be high-risk for MDR or RR TB and who were therefore not treated as MDR or RR notifications.

Note 2: not evaluated includes unknown and transferred out.

Social risk factors

Social risk factors (SRFs) are reported as categorical yes or no variables with current or past history recorded as yes. Information on these social risk factors is collected through the routine surveillance system via interviews by the clinical team. Social risk factors that are recorded include current or history of prison, drug and alcohol misuse, homelessness, mental health needs and asylum seeker status. Data reported is only for people aged over 15 years due to low numbers in young children.

Figure 10a. Proportion of TB notifications (15 years or older) with at least one social risk factor (SRF), England, over the last 2 years or 8 quarters

For data behind this graph see Table 11 of the supplementary data set.

Note: the axes on the figure for people with at least one SRF (Figure 10a) are different to that for individual SRFs (Figure 10b) due to the higher proportion of people with at least one SRF.

In January to March (quarter 1) of 2025, 15.4% of people with TB aged 15 years and older had at least one SRF reported. This is similar to January to March (quarter 1) of 2024 (15.8%).

For single risk factors, shown in Figure 10b, the proportion of people with TB in January to March (quarter 1) of 2025 with:

• alcohol misuse was similar to January to March (quarter 1) of 2024
• asylum seeker status was higher than January to March (quarter 1) of 2024
• current or a history of drug misuse was similar to January to March (quarter 1) of 2024
• current or a history of homelessness was lower than January to March (quarter 1) of 2024
• mental health needs was lower than January to March (quarter 1) of 2024
• current or a history of imprisonment was lower than January to March (quarter 1) of 2024

Figure 10b. Proportion of TB notifications (15 years or older) by social risk factor, England, over the last 2 years or 8 quarters

For data behind this graph see Table 11 of the supplementary data set.

Data sources and methodology

Data sources and comprehensive methodological information can be found in the Quality and Methodology Information (QMI) report

Background information

This report aims to provide timely and up-to-date figures of important epidemiological indicators to inform ongoing TB control efforts in England.

Note that data for 2024 and 2025 is provisional and subject to validation and should be interpreted with caution. The data used for this report was extracted on 7 April 2025.

This report presents quarterly data on people with tuberculosis (TB) disease notified to the National TB surveillance system (NTBS) in England. Notifications include patients with culture confirmed TB or if a patient has started treatment for TB based on their clinical presentation. It is mandatory to notify cases of TB in the UK within 3 working days of making or suspecting a diagnosis of TB. Find out more about the notification of TB). Most health protection functions are devolved to the other UK nations’ public health teams in the UK, so this report only covers TB notifications and data from England.

Detailed results for data up to the end of 2023 are published in the annual report.

This report aims to provide timely and up-to-date figures of important epidemiological indicators to inform ongoing TB control efforts in England.

TB notifications

People who are diagnosed with TB in England, Wales and Northern Ireland must be notified through the NTBS. This report only includes data for individuals with TB who are resident in England or are treated in England (including individuals who are homeless or visiting from abroad). Individuals with TB are reported by area of residence and by calendar year quarter of notification. UKHSA region was derived from UKHSA region of residence based on individual’s residential postcode. If missing, UKHSA region in which treatment occurred was used, for example if a person had no fixed abode. Data from January to March (quarter 1) 2025 onwards is provisional and are provisional for treatment outcomes for those notified from January to March (quarter 1) of 2024 onwards. Verification and data cleaning and recoding, as conducted for the annual TB report dataset is not yet complete for provisional data.

Culture confirmation

Microbiological culture from biological specimens from persons with suspected disease confirms diagnosis and provides valuable information on antimicrobial susceptibility of TB and possible transmission events between persons notified with TB. It is noted that suitable specimens from children and from non-pulmonary sites are harder to obtain and culture from lower numbers of viable bacteria.

Site of disease

Site of disease is classified as pulmonary and therefore potentially infectious through airborne transmission if disease was recorded in the lungs, larynx or was recorded as miliary (i.e. disseminated TB). If none of these sites were recorded, disease is classified as non-pulmonary disease. People can have multiple sites of disease and have pulmonary and non-pulmonary disease sites.

Social risk factors including prison and asylum status

People with TB are reported as having at least one Social Risk Factor (SRF) (‘yes’) if any of the 6 SRFs has ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual SRFs were a ‘no’ and may result in under-estimation. The 6 SRFs are:

• current alcohol misuse
• current or a history of homelessness
• current or a history of imprisonment
• current drug misuse
• asylum seeker status
• mental health needs

Data for individual social risk factors reported is limited to those with recorded data, for example a ‘yes’ or a ‘no’. As a result, the denominators for these are smaller than all notifications due to missing data. If there is significant under-reporting of SRFs in those with missing data, this should result in a better estimate of the true proportion of the people with each SRF. However, if data is more likely to be recorded if the response is a ‘yes’ this could result in an over-estimates. This may be the case for the asylum seeker SRF.

Mental health needs are recorded by TB case managers and is based on their judgement if mental health concerns are likely to affect the person’s ability to complete treatment.

Alcohol misuse is as recorded by case managers and is based on their judgement if current alcohol misuse is likely to affect treatment.

History of drug misuse, homelessness and prison are self-reported by individuals and are first asked as a ‘yes’ or ‘no’ response, and then asked for additional information on the duration. This is then recorded as either current, within the last 5 years, or more than 5 years ago. Unless indicated otherwise, analyses here present these SRFs as ‘yes’ if a history was recorded, including any duration value (current, within the last 5 years, or more than 5 years ago).

Data for SRFS are reported only for people aged over 15 years due to low numbers in young children.

Treatment delay

Treatment delay is calculated as the days difference between self-reported date of symptom onset and the date treatment started. People with either a missing symptom onset date or treatment start date have no value calculated for treatment delay and are not included in the denominator for the proportion of people with treatment delay.

Treatment outcome

For people expected to complete treatment in 12 months, if no treatment outcome at 12 months was recorded this was recoded as ‘not evaluated’. Hence, the denominator for the proportion of people completing treatment in 12 months includes all people in this group.

Further information and contact details

Feedback

To provide feedback and for all queries relating to this document, please contact tbunit@ukhsa.gov.uk

Official statistics

Our statistical practice is regulated by the Office for Statistics Regulation (OSR). OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to. You are welcome to contact us directly by emailing tbunit@ukhsa.gov.uk with any comments about how we meet these standards. Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.  

UKHSA is committed to ensuring that these statistics comply with the Code of Practice for Statistics. This means users can have confidence in the people who produce UKHSA statistics because our statistics are robust, reliable and accurate. Our statistics are regularly reviewed to ensure they support the needs of society for information. They were last formally reviewed internally in spring 2023. Actions following this review have continued to improve the trustworthiness, quality and value of the statistics, including:

• the automation of data processing to improve the accuracy of the statistics
• improved transparency of assessment of data, methods and quality assurance via publication of the accompanying quality and methodology information report
• simplified commentary to better enable users to understand the key messages
• clearer advice on appropriate use of the statistics, including consideration of seasonal trends in the data