Intended for healthcare professionals


Tuberculosis in the UK—time to regain control

BMJ 2011; 343 doi: (Published 31 July 2011) Cite this as: BMJ 2011;343:d4281
  1. Ibrahim Abubakar, consultant epidemiologist12,
  2. Marc Lipman, consultant physician3,
  3. Charlotte Anderson, senior scientist4,
  4. Peter Davies, consultant respiratory physician 5,
  5. Alimuddin Zumla, professor of infectious diseases and international health6
  1. 1Tuberculosis Section, Health Protection Services—Colindale, Health Protection Agency, London NW9 5EQ, UK
  2. 2Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3Centre for Respiratory Medicine, Royal Free Hospital, University College London Medical School, London, UK
  4. 4London Regional Epidemiology Unit, Health Protection Agency
  5. 5TB Unit, Liverpool Heart and Chest Hospital, Liverpool, UK
  6. 6Division of Infection and Immunity, University College London Medical School
  1. Correspondence to: I Abubakar, Tuberculosis Section, Health Protection Services—Colindale, Health Protection Agency, London ibrahim.abubakar{at}
  • Accepted 28 June 2011

Tuberculosis is increasing in incidence in many large cities in the UK. This contrasts with stable or declining rates in most western European countries. Ibrahim Abubakar and colleagues explain why and describe what needs to be done to regain control

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.

Fig 1 Three year average tuberculosis case rates per 100 000 by primary care trust, 2007-9 (rates calculated using Office for National Statistics mid-year population estimates for 2008)

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.

Fig 2 Tuberculosis case reports and rates per 100 000 by place of birth, England, 2000-93

View this table:
Table 1

Region of origin of non-UK born people reported with tuberculosis in UK, 20093

M tuberculosis is spread by aerosol transmission and disproportionately …

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