Tuberculosis in the UK—time to regain controlBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4281 (Published 31 July 2011) Cite this as: BMJ 2011;343:d4281
- Ibrahim Abubakar, consultant epidemiologist12,
- Marc Lipman, consultant physician3,
- Charlotte Anderson, senior scientist4,
- Peter Davies, consultant respiratory physician 5,
- Alimuddin Zumla, professor of infectious diseases and international health6
- 1Tuberculosis Section, Health Protection Services—Colindale, Health Protection Agency, London NW9 5EQ, UK
- 2Norwich Medical School, University of East Anglia, Norwich, UK
- 3Centre for Respiratory Medicine, Royal Free Hospital, University College London Medical School, London, UK
- 4London Regional Epidemiology Unit, Health Protection Agency
- 5TB Unit, Liverpool Heart and Chest Hospital, Liverpool, UK
- 6Division of Infection and Immunity, University College London Medical School
- Correspondence to: I Abubakar, Tuberculosis Section, Health Protection Services—Colindale, Health Protection Agency, London
- Accepted 28 June 2011
Easy travel and migration have allowed tuberculosis to re-emerge as a public health problem in many European countries.1 In the United Kingdom the number of reported cases is now at its highest since the 1970s. In 2009, 9040 cases of active tuberculosis were notified, which represents roughly a 75% increase over the past 20 years.2 Most cases occur in large towns and cities (fig 1⇓). We present an analysis of the size of the problem, factors driving the epidemic, weakness of our current control strategies, lessons to be learnt from other tuberculosis control programmes, and the actions required to achieve tuberculosis control in the UK.
Who has tuberculosis in the UK?
Most cases of tuberculosis (73% in 2009) in the UK occur in people born outside the country (fig 2⇓, table 1⇓).3 The majority develop active symptomatic disease several years after arrival (in 2009, almost four fifths had lived in the UK for two or more years). DNA fingerprinting studies suggest that most cases arose from latent Mycobacterium tuberculosis infection acquired outside the UK.4 This forms a reservoir of latent M tuberculosis infection from which future cases may arise.
M tuberculosis is spread by aerosol transmission and disproportionately …