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Country presentation United Kingdom Metropolitan and regional situation

This presentation provides an overview of the tuberculosis (TB) situation in the United Kingdom, with a focus on England and Wales. It discusses the notification and death rates of TB, possible explanations for the increase in TB cases, methods of TB surveillance, specific studies conducted, demographic information, and the spatial analysis of TB rates. It also highlights the challenges faced in TB control and prevention.

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Country presentation United Kingdom Metropolitan and regional situation

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  1. Country presentationUnited KingdomMetropolitan and regional situation Delphine Antoine Communicable Disease Surveillance Centre, London November 2003

  2. United Kingdom • 58 789 194 population in 2001 • 52 084 500 in England and Wales • International migration: 172 000 net inflows in 2001 (480 000 inflows and 308 000 outflows) • 4 states • 12 regions

  3. Map of the United Kingdom SCOTLAND N IRELAND WALES ENGLAND

  4. Tuberculosis (all forms) TB notification and death rate, England and Wales, 1913 - 2000

  5. Tuberculosis: notifications, Mycobnet reports* and deaths, England & Wales 1981-2000 *Initial isolates of M. tuberculosis complex. Note: Notification data for 2000 are preliminary.

  6. Tuberculosis notifications, England and Wales, 1982-2001 Sources: Tuberculosis notifications (PHLS/CDSC-NOIDS), population figures (ONS estimates)

  7. Possible explanations for the increase of TB rate • Change in reporting system ? • Change in diagnosis practice ? • International migration form high TB incidence countries • HIV • deterioration of socio-economic status in some population groups • lack of vigilance and resources to combat a disease often considered to be almost eradicated • Failure of control

  8. Methods of tuberculosissurveillance in England & Wales,2001 • Notifications • Intermittent survey (until 1998) • Enhanced tuberculosissurveillance • reporting system implemented in 1999 • Treatment outcome monitoring implemented in 2002 on TB cases reported in 2001 • Reference laboratory reports (MycobNet since 1993) • Mortality

  9. Main elements of tuberculosis surveillance in England & Wales, 2002 CDSC Colindale Patient with TB Clinician CCDC specimen result identification + drug sensitivity result (Mycobnet) Mycobacterial isolate Local hospital laboratory Mycobacterial reference laboratory Identification + drug sensitivity result

  10. Methods of tuberculosissurveillance in England & Wales,2001 • Some examples of specific studies • Strain typing studies on TB cases reported in 1998 • HIV infection among TB cases 1993 and 1998, 1998-2000 • London TB nurses caseload profile (2003) • TB in children (2004)

  11. Enhanced surveillance of tuberculosis in England, Wales and Northern Irelandcase definition Culture confirmed cases: Culture confirmed disease, due to Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis or M. africanum). Other than culture confirmed cases: in the absence of culture confirmation, a case that meets the following criteria: a clinician’s judgment that the patient’s clinical and/or radiological signs and/or symptoms are compatible with tuberculosis and a clinician’s decision to treat the patient with a full course of anti tuberculosis treatment

  12. Tuberculosis cases reported in the UK, 2001 No. Cases Rate United Kingdom 7004 11.9 • England & Wales * 6597 12.7 • Northern Ireland* 55 3.3 • Scotland 352 6.9 * Source : Enhanced TB surveillance

  13. Tuberculosis cases reported inEngland and Wales and Northern Ireland, 2001 Total number of cases: 6652 Of which : males / females 55% / 45% cases in persons born abroad 63% Pulmonary / extra pulm. cases 60% / 40% pulmonary SS+ cases 21% culture positive cases 57% Reported in London 41% Number of cases with DST results 3389 MDR 2.6%

  14. TB rates by age group, sex, and geographic origin 1998-2000, England and Wales Male foreigners Female foreigners Male nationals Female nationals

  15. Tuberculosis case report rate (/100 000) by geographic origin and ethnic group, England and Wales, 1998 - 2000 England and Wales = 11.2

  16. Metropolitan and sub-regional information Availability in surveillance data on national level • Region of reporting • Local authority of residence of patient • Town/city • Primary care trust (from 2003) • Post code

  17. Tuberculosis case report rates, by region, England and Wales, 2001

  18. Tuberculosis case report rates, by region, England and Wales, 2001

  19. Tuberculosis rate in cities, England and Wales, 2001 (preliminary results)

  20. Tuberculosis case report rate by local authority in London, 2001

  21. Spatial analysis of tuberculosis rates by postal district – 2001 Defined by Triangulated Network Analysis (TIN) cell size 0.1km Legend Source: London Hostels Directory 2003; RIS Source: Notifying centre Enhanced TB Surveillance CDSC GIS mapping by Chris Lane CDSC 2003

  22. London in 2001 Population 7.1 million (14% total England) 300 different spoken languages 27% born outside UK 17% households overcrowded 13 of the 20 most deprived areas in England HIV/AIDS infected population (41,200) > 100,000 homeless people Est. 70,000 ‘problem’ drug users 3.5% IDU’s HIV+ (0.3% outside London) > 6,000 prisoners

  23. Tuberculosis case reports, England & Wales • London England & Wales • (without London) • TB cases reported in 2001 • No. of TB cases 2717 3880 • TB rate/100 000 37.8 8.4 • Median age 34 43 • cases born abroad 80% 51% • MDR at start of tt 5.2% 0.7% • TB cases reported 1998-2000 • HIV infection 5.3% 2.4%

  24. Metropolitan and sub-regional information Limitations • Completeness of information on geographical area • Definition of area • Availability of denominator (overall and for higher TB risk population groups) • Completeness of information on TB cases vary • Change of administrative health organisation • Interpretation of trends ?

  25. Questions • How to monitor TB in higher TB risk subgroups or areas in a low incidence countries ? • Specific surveys ?

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