Intended for healthcare professionals


Tuberculosis cases in England will outnumber US in two years unless trends are reversed

BMJ 2015; 350 doi: (Published 20 January 2015) Cite this as: BMJ 2015;350:h355
  1. Ingrid Torjesen
  1. 1London

Public Health England and NHS England have launched a joint strategy that aims to eliminate tuberculosis as a public health problem in England.

The five year £11.5m (€15m; $17.4m) strategy, launched on Monday 19 January, is expected to achieve year on year decreases in tuberculosis incidence and a reduction in health inequalities, to eventually end the transmission of tuberculosis in England’s communities.1 A 10 point plan for accomplishing this is outlined in the strategy.

The plan includes improving access and early diagnosis; better treatment; improving contact tracing; tackling tuberculosis in under-served groups, such as homeless people and prisoners; and improving new migrants’ screening and treatment for latent tuberculosis infection. The plan will target urban centres that have the highest incidence of tuberculosis, including London, Leicester, Birmingham, Luton, Manchester, and Coventry.

Paul Cosford, director for health protection and medical director at Public Health England, said, “TB [tuberculosis] should be consigned to the past, and yet it is occurring in England at higher rates than most of western Europe. This situation must be reversed.”

In 2013, 7290 cases of tuberculosis were reported in England—an incidence of 13.5 in 100 000 and a rate more than four times higher than that in the United States. Unless trends are reversed England is expected to have more cases of tuberculosis than the whole of the US within two years. Drug resistant tuberculosis is also an increasing problem in England, as cases of multi-drug resistant tuberculosis increased from 28 in the year 2000 to 68 in 2013.

Of the £11.5m investment, £1.5m will fund nine tuberculosis control boards, and the remaining £10m will fund testing for and treating infection. The plan also aims to nationally expand London’s outreach “Find and Treat” service, which takes diagnostic services directly to under-served populations.

The Find and Treat service is run by University College London (UCL) Hospitals. For several years it has been run using a single mobile x ray unit that visits under-served groups at homeless hospitals, drug units, and prisons, but this week UCL launched its new “TB” bus. People who use the new bus will fill in a questionnaire to help collect information on possible symptoms and risk factors for tuberculosis, and they will then have a chest x ray. As well as x ray equipment the bus will have a rapid polymerase chain reaction (PCR) testing machine so that sputum samples from people with suspicious x ray results can be tested immediately for tuberculosis.

Andrew Hayward, professor of infectious disease epidemiology and inclusion health research at UCL, told The BMJ that some of the groups targeted by the mobile unit needed to be persuaded to use the service. The service “uses people who have had experience of homelessness and often tuberculosis [as well as outreach workers], so that they can talk to the client in a language that resonates with them, and that certainly seems to help.”

As well as screening for tuberculosis the TB bus has been commissioned to provide influenza and pneumococcus vaccinations, and in the future it will also aim to offer screening for hepatitis B, hepatitis C, and HIV.

Mobile units screening for tuberculosis were a common sight in the 1950s and ’60s but were disinvested when tuberculosis was no longer considered a problem. Jonathan Fielden, medical director of UCL Hospitals, said, “Some other countries, [such as] our colleagues in the Netherlands, kept their crews going, kept their vans out and about. They now have the lowest rates of TB and some of the lowest rates of resistant TB as well.”


Cite this as: BMJ 2015;350:h355


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