Official Statistics

National quarterly report of tuberculosis in England: quarter 3, 2024, provisional data

Updated 31 October 2024

Applies to England

Main points

• tuberculosis (TB) notifications were 21% higher in quarter 3 (Q3) of 2024 compared with the same period in 2023 and exceeded the normal seasonal peak in Q2
• in the first 3 quarters of 2024, there was a 13.7% increase in notifications (4,155) compared with the same period in 2023 (3,657)
• the proportion of notifications in people born outside the UK remains consistent with previous quarters at 83.1%
• the number of individuals with culture-confirmed rifampicin-resistant (RR) or multidrug-resistant (MDR) TB rose in the first 3 quarters of 2024 compared with the same period in 2023 (53 versus 49 individuals)
• notifications were higher for every English region except the East Midlands and South East for the first 3 quarters of 2024 compared with the same period in 2023; the largest numerical increase was in London (1,417 compared with 1,263 individuals, 12.2% rise) and the largest percentage rise in the West Midlands (556 compared with 430 individuals, 29.3% rise)
• the proportion of people with pulmonary TB who started treatment within 4 months of symptom onset was lower in Q3 2024 than in the preceding quarter (65.1% compared with 73.8%), but similar to Q3 2023 (68.5%)

Overall numbers and geographical distribution

The number of 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 UK Health Security Agency (UKHSA) regions 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 data set. 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.

For England in Q3 2024, 1,461 people were notified with TB. This is higher by 21% compared with Q3 2023 (1,207).

Figure 1a. Number of TB notifications in England, Q1 (January to March) 2021 to Q3 (July to September) 2024 (Table 1 of the supplementary data set)

When comparing the cumulative number of cases by month (Figure 1b), the pre-pandemic year of 2019 is included for reference and the peak COVID-19 pandemic year of 2020 excluded to allow comparison with the years since (Figure 1b).

In 2024, there have been 4,155 notifications, which is 534 more (14.7%) than the same time period in the pre-pandemic year of 2019.

Figure 1b. Monthly cumulative number of TB notifications, England. Data from pre-pandemic year, 2019, and between January 2022 to Q3 (July to September) 2024 (Table 2 of the supplementary data set)

The number of people notified with TB in Q3 2024 compared with Q3 2023 (analysed by UKHSA region):

• increased in the East Midlands (38.3% increase), East of England (15.7% increase), London (22.9% increase), North East (26.9% increase), North West (24.6% increase), South West (47.9% increase) and West Midlands (32.2% increase)
• remained similar in the South East (0.0% decrease)
• decreased in the Yorkshire and the Humber (6.9% decrease)

When comparing the first 3 quarters of 2024 with the same period in 2023, there has been a rise in notifications in every region except the East Midlands and South East, where numbers have remained similar.

Figure 2a. Number of TB notifications in London, England, Q1 (January to March) 2021 to Q3 (July to September) 2024 (Table 1 of the supplementary data set)

Figure 2b. Number of TB notifications in UKHSA region, England, Q1 (January to March) 2021 to Q3 (July to September) 2024 (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 Q3 2024.

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 disease is pulmonary or non-pulmonary (site of disease). 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 8 quarters (Table 3 of the supplementary data set)

Place of birth was not known for 7 notifications in Q3 2024 and 2 notifications in Q3 2023. Missing data may reflect difficulties in obtaining data (for example, if the patient died or there were language barriers). In Q3 2024, people born outside of the UK accounted for 83.1% of notifications (1,209 out of 1,454), a small change in proportion compared with Q3 2023 (81.2% (979 out of 1,205)). Note that the numbers do not correspond to the total number of notifications due to missing data.

There was no missing data for pulmonary versus non-pulmonary disease. In Q3 2024, the number of people with pulmonary TB accounted for 51.3% (749 of 1,461) of all people with TB, consistent with 53.2% in Q3 2023 (642 of 1,207). For those born outside the UK, pulmonary disease accounted for 47.6% (576 of 1,209) of all notifications in Q3 2024 compared with 69.4% (170 of 245) for those born in the UK. This pattern of pulmonary disease being more common in UK-born people is seen for all quarters.

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 the current quarter, the number of notifications with culture confirmation will increase as laboratory results become available. Thus, further comparisons are made for the previous quarter compared with the same quarter in the previous year.

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

In Q3 2024, 49.8% (728 of 1,461) of notifications were culture confirmed. This increased to 57.7% (432 of 749), in those with pulmonary disease. In Q2 2024, 73.4% of pulmonary notifications were culture confirmed compared with 76.3% in the same quarter in 2023. The 80% target of culture confirmation for pulmonary TB disease was reached in none of the last 8 quarters.

Figure 4. Proportion of culture confirmation among TB notifications by site of disease, England, over the last 8 quarters (Table 4 of the supplementary data set)

Figure 5 shows the proportions of culture confirmation for pulmonary and non-pulmonary TB disease notifications by UKSHA regions. No UKSHA regions were consistent in achieving the 80% target of culture confirmation for pulmonary disease notifications. The North East consistently achieved the highest proportions for both pulmonary and non-pulmonary disease notifications.

For pulmonary TB, the largest changes in culture confirmation between Q2 2024 compared with the same quarter in 2023 were seen in:

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

For non-pulmonary TB the largest changes in culture confirmation between Q2 2024 and the same quarter in 2023 were seen in:

• East of England and London, which decreased
• North East, North West, South West and Yorkshire and the Humber, which all increased

Figure 5a. Proportion of culture confirmation among TB notifications in London by site of disease, over the last 8 quarters (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 8 quarters (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 guidance of 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 resistant by quarter.

Figure 6. Number of culture confirmed TB notifications with MDR or RR TB at diagnosis, England, over the last 8 quarters (Table 6 of the supplementary data set)

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

Numbers of TB notifications with culture-confirmed MDR or RR in Q3 2024 were slightly lower than the same quarter in 2023 but may increase as laboratory results are finalised. For example, there were 22 MDR or RR notifications in Q2 2024, more than previously reported for this quarter. A higher number of people were notified with MDR or RR TB (74 people) in the most recent 4 quarters (starting from Q3 2023) compared with the previous 4 quarters (57 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 missing date of onset of symptoms or treatment start date. In Q3 of 2024 this was missing for 201 people (27.2%) compared with 121 (18.9%) for Q3 in 2023. In Q2 of 2024 it was missing for 202 (26.4%) compared with 138 (18.8%) for Q2 in 2023.

In Q3 2024, 65.1% of people with pulmonary TB started treatment within 4 months of symptom onset, compared with 68.5% in Q3 2023. This proportion may change due to incomplete data in the latest quarter. 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 8 quarters (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 Q2 2024 compared with Q2 2023, the proportion of people with TB who started treatment within 4 months of symptom onset is:

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

Figure 8a. Proportion of pulmonary TB notifications in London starting treatment within 4 months (symptom onset to treatment start), over the last 8 quarters (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, Q4 (October to December) 2022 to Q3 (July to September) 2024 (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 Q3 2023 with known or assumed drug-sensitive TB, the majority of whom should have completed treatment within 12 months of treatment start. Data is not presented for those notified after Q3 2023 as many are not expected to have completed treatment. The data excludes people in the drug resistant cohort 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 (proportion shown in bars). The category ‘other’ comprises those who 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 72.7% for people notified in Q3 2023 compared with 78.8% in quarter 3 2022.

Please note: the latest 4 quarters evaluated tend to show a high proportion of people with treatment outcomes recorded as ‘not evaluated’ despite having started at least 12 months previously. This reflects a delay in reporting the final outcome. The proportion not evaluated is expected to decrease with time. For those notified between Q4 2021 and Q3 2023 the highest proportion of treatment completed was observed in Q1 2022 at 80.6%.

Figures 9a and 9b. Outcomes at 12 months for people treated for drug-sensitive TB with expected treatment duration under 12 months, England, Q1 (January to March) 2021 to Q3 (July to September) 2023 (Table 9 of the supplementary data set)

Figure 9a

Figure 9b

Note 1: excludes people in the drug-resistant cohort 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. It also includes those 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 8 quarters (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 Q3 2024, 13.4% of people with TB aged 15 years and older had at least one SRF reported. This is similar compared with Q3 2023 (17.1%).

For single risk factors, shown in Figure 10b, the proportion of people with TB in Q3 2024 with:

• alcohol misuse was lower than Q3 2023
• asylum seeker status was similar to Q3 2023
• current or a history of drug misuse was lower than Q3 2023
• current or a history of homelessness was lower than Q3 2023
• mental health needs was lower than Q3 2023
• current of history of imprisonment was lower than Q3 2023

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

TB notifications

People who are diagnosed with TB in England, Wales and Northern Ireland must be notified through 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 the calendar year quarter of notification. The UKHSA region was derived from UKHSA region of residence based on individual’s residential postcode. If missing, the UKHSA region in which treatment occurred was used, for example if a person had no fixed abode. Data from Q1, 2022 onwards is provisional and is provisional for treatment outcomes for those notified from Q1, of 2021 onwards. Verification and data cleaning and recoding, as conducted for the annual TB report data set, 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 due to 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 (such as disseminated TB). If none of these sites was 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 were 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 adhere to treatment.

Alcohol misuse is as recorded by case managers and is based on their judgement if current alcohol misuse is likely to affect adherence to 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 with additional information on duration: as current, within last 5 years or more than 5 years ago. Unless indicated otherwise, analyses here present these SRFs as ‘yes’ if either history of, or a duration value, was recorded.

Data for SRFS is 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 in the cohort 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 cohort.

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.

Please note that data for 2023 and 2024 is provisional and subject to validation and should be interpreted with caution. The data used for this report was extracted on 3 July 2024.

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. You can find more details about notification of TB online (PDF, 174KB). 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 2022 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.

Further information and contact details

Feedback and contact information

For any feedback and enquiries, 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:    

• 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