NHS England and Public Health England are investing £11.5 million in a new initiative aimed at eliminating tuberculosis from England by 2020.

The UK currently has the second-highest rate of TB in western Europe, and rates are nearly five times higher than in the US. If current trends continue, England alone - which had 13.5 cases 100,000 population in 2013, with 7,290 cases reported - will have more TB cases than the whole of the US within two years, say the agencies. 

Working with key stakeholders, NHS England and PHE have developed a 10-point evidence-based action strategy for England, which aims to: improve access to services and ensuring early diagnosis; provide universal access to high-quality diagnostics; improve treatment and care services; ensure comprehensive contact tracing; improve BCG vaccination uptake; reduce drug-resistant TB; tackle the disease in under-served populations; systematically implement new entrant latent TB (LTBI) screening; strengthen surveillance and monitoring; and ensure an appropriate workforce to deliver TB control.

In England, TB is concentrated in large urban areas, with hot spots concentrated in London, Leicester, Birmingham, Luton, Manchester and Coventry, while TB clinics in London manage more cases a year than those in all other western European capital cities put together. Drug-resistant disease is also an increasing problem in England, with cases of multi-drug-resistant TB increasing from 28 cases reported in 2000 to 68 in 2013.

England’s poor showing is in marked contrast to the US, Germany and the Netherlands, which have all seen consistent reductions by using concerted approaches to TB prevention, treatment and control. 

“TB should be consigned to the past and yet it is occurring in England at higher rates than most of western Europe,” said Professor Paul Cosford, director for health protection and medical director at PHE.

“While many local areas in England have taken major steps to tackle TB, there is still unacceptable variation in the quality of clinical and public health measures across England,” he added.

- Across the UK, TB continues to disproportionately affect the most deprived communities in England, with 70% of all cases coming from the 40% most deprived areas. The majority of cases occur among specific risk groups, such as people with close links to countries with a high TB burden (often settled migrants from such countries, who experience reactivation of LTBI acquired many years previously), people with social risk factors such as homelessness, a history of imprisonment or problem drug or alcohol use, and older people.