The 24th March is World TB Day, the date that Dr. Robert Koch discovered the bacillus in 1882, and today used as a worldwide event to raise awareness, and highlight the importance of prevention, early diagnosis and treatment in the fight against TB.
For those who have studied the history of infectious diseases, you will have come across The White Death by Thomas Dormandy. With its tales of the social, artistic and human impact of TB and the transparent ghostlike aged photographs and paintings. If you haven’t read it, it’s one we would recommend. However, both the historical narrative and the artistic representation of TB can lead many to consider TB as either a disease of the past or one that is easily treated with minimal impact.
Tuberculosis, a curable and preventable disease has returned to being the world’s leading cause of death from a single infectious agent, following three years in which coronavirus took the top spot. The World Health Organisation (WHO) estimated that 10.8 million people were diagnosed with TB in 2023, an increase from 10.7 million in 2022 and 10.4 million in 2021.
In 2023, TB in England increased by 11% compared with 2022 – this is the largest year-to-year increase since 1971. Wales saw an increase of 18% and Scotland had the largest increase with a 41% rise compared to 2022. Provisional data for England in 2024 reports a further increase of 13% in notifications compared with 2023 from 4,850 to 5,480 people.
Unfortunately, we are moving further away from achieving the WHO End TB Strategy goal of a 90% reduction in people with TB by 2035 and England is close to losing its status as a low incidence country.
There are many contributing factors to the increasing rates of TB. The COVID-19 pandemic resulted in the disruption of local TB services and partnerships, leading to more undiagnosed and untreated TB cases, and we are still experiencing the impact of this. It is not uncommon for early symptoms of TB to be confused with flu or COVID-19, causing delays in early diagnosis, treatment and preventing onward transmission.
TB in the UK is more common in people born in countries with high TB rates and in those from vulnerable communities who may have co-infections and concurrent non-communicable diseases. We know that health-seeking behaviour and barriers, such as awareness, stigma, language and cultural factors contribute to delayed presentation and access to healthcare services. People with TB may also experience difficulties self-administering treatment and attending follow-up appointments.
For these reasons we must work collaboratively, with a wide range of stakeholders across all health and social care systems, to raise awareness of TB, reduce avoidable inequalities, improve health outcomes, to head towards our TB elimination targets again.
But this isn’t just about the patients we support and treat – TB has a big impact on the health and social care workforce too. We are seeing increasing numbers of health and social care workers (HSCW) being diagnosed with tuberculosis, with a high proportion having infectious pulmonary TB. It is really important that HSCW remain aware of the signs and symptoms of TB and know what to do if they do experience them. Staff who have recently arrived in England from a country where TB is more common should be encouraged and supported to accept the offer of latent TB screening if eligible and if positive start and continue to take preventative treatment – this not only supports their own health and wellbeing but helps to protect patients in vulnerable settings. It is also important that HSCW are aware of how to protect themselves when caring for patients with TB, following guidance in the National infection prevention and control manual for-england.
TB is curable and preventable, if it is diagnosed early and treated promptly with the right combination of antibiotics and the person completes the full course of treatment. However, without effective and timely treatment, TB causes significant mortality and morbidity worldwide.
All healthcare professionals and the wider public must remain aware and report symptoms of active TB. United Kingdom Health Security Agency (UKHSA) has produced a TB stakeholder communications toolkit to support awareness raising.
It is our view that IPC teams are well placed to support organisations in increasing awareness of TB symptoms and prompt referral to specialist services. The TB and IPC teams at UKHSA are working closely together to identify gaps and produce guidance to support the management and control of TB in other settings, for example, updating guidelines for TB in secure settings e.g. prisons. With complementing skill sets, we can work much more effectively together. What will be your commitment on WTBD to reducing the impact from this curable disease? Let’s help achieve the WHO Global Ambition for TB reduction and reduce the incidence of TB and associated deaths.
Blog post written by:
Esther Taborn
Senior Infection Prevention and Control Specialist Nurse, National Infection Prevention Team, UKHSA
Tracey Langham
Lead Nurse, National TB Unit
