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Tuberculosis

Introduction 

Rates of tuberculosis in Reading have been consistently higher than the England rate since 2000 and in 2013-2015 Reading had the 12th highest rate of all Local Authority areas in England (PHOF). Reading has a diverse population and attracts a high level of international migration, including from countries where risk of contracting TB is high, but recent guidance highlights the importance of targeting awareness campaigns and screening on underserved populations made vulnerable to TB by social risk factors such as homelessness, drug and alcohol misuse, offending and imprisonment. 

What do we know?

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of a person with TB of the lungs. TB can affect many parts of the body but mainly affects the lungs. TB is less contagious than colds and flu and is usually spread between family members who live together (NHS Choices). Only the TB of lungs and throat (pulmonary TB) is infectious and not infectious after 2 weeks of starting medication. If left untreated, TB is a life-threatening illness. However, it is curable with the right antibiotics.

There are two types of TB conditions: Active TB disease and Latent TB condition.

Active TB disease: People with active TB disease are unwell and infectious. A person with untreated infectious TB can pass on the infection on to 10-15 people a year through close contact. The general symptoms of active TB include unexplained weight loss, loss of appetite, night sweats, fever, fatigue and chills. Symptoms may vary depending on the part of the body affected.

Latent TB condition: In some cases the bacteria that cause TB infect the body but don't cause any symptoms.  This condition is known as latent or dormant TB and carries a risk that the TB can become active, causing illness and allowing the infection to spread. Latent TB is not infectious and can only be detected through a skin test or a blood test. There are screening services and treatment available for latent TB.

Those at greatest risk of TB, including latent TB, are those:

  • born or who have lived in a high risk country for more than 6 months; 
  • who came to the UK from one of these high risk countries within the past 5 years; 
  • in prolonged close contact with someone infected with TB;
  • with a weakened immune system (this could be because of a condition such as HIV, or because they are having certain medical treatments such as chemotherapy, or because they are very young or much older, or in very poor health related to lifestyle factors such as dependent drug or alcohol use or being homeless). (NHS Choices). 

Nationally, the rate of Tuberculosis (TB) infections reached a peak of 8,280 cases in 2011, a rate of 15.6 per 100,000. The number and rate of TB cases have declined year-on-year and in 2015 had fallen to 5,758 cases and a rate of 10.5 per 100,000 population (PHE, 2016). 

The incidence of TB in England is higher than most other Western European countries, and more than four times as high as in the USA (PHE, WHO estimates of TB incidence by country). 

In 2015, 72.5% of TB cases where place of birth was known, affected people born outside of the UK and the rate of infection was 15 times higher than the rate in the UK born population.  The ten most frequent countries of birth for non-UK born cases were India, Pakistan, Bangladesh, Somalia, Nepal, Nigeria, Romania, Philippines, Zimbabwe and Eritrea. Most TB cases amongst those born in the UK are amongst those aged 80 years or older (most cases in those born outside of the UK are aged 25-29 years). 

In Reading, between 2013 and 2015 there was an average of 56 new cases of TB each year, with an incidence rate of 34.7 per 100,000 population. This is significantly higher than the national average of 12 cases per 100,000 averaged over the same three-year period (Public Health Outcomes Framework). Three year incidence of TB in Reading has been consistently higher than the England rate since 2000 and in 2013-2015 Reading had the 12th highest rate of all Local Authority areas in England (PHOF). 

National and Local Strategies

In 2016, Public Health England published guidance for Local Authorities, Clinical Commissioning Groups, TB Control Boards and Clinical Teams and third sector organisations (PHE, 2016). The guidance notes that, while rates of TB had declined in populations who had lived in or had links with countries with higher prevalence of TB, the number of cases amongst those with social risk factors (such as homelessness, drug use, recent migrants, offenders and prisoners) had increased. National strategy focuses on raising awareness amongst health professionals and targeting awareness campaigns and testing for active and dormant TB to underserved populations (individuals whose social circumstances, language, culture or lifestyle (or those of their parents or carers) make it difficult to recognise the clinical onset of TB) (PHE, 2017)

Reducing the number of people with tuberculosis is a key priority in Reading Health and Wellbeing Board's Health and Wellbeing Strategy. Planned action includes:

  • Promoting awareness of the symptoms of TB and encouraging people to seek advice and receive treatment as soon as possible.
  • Using more targeted approaches to reach communities at greater risk of having the disease or of failing to take up treatment effectively. 

What is this telling us?

Reducing the rates of TB is a priority in Reading and raising awareness and targeting screening on key communities, including underserved populations with social risk factors, will be key to achieving this.

What are the key inequalities?

As described above those who were born or who have lived in a high risk country for more than 6 months; who came to the UK from one of these high risk countries within the past 5 years; has been in prolonged close contact with someone infected with TB; or who may have weakened immune system are at greater risk of contracting TB. 

Although rates have declined in both the UK born and non-UK born populations in recent years, cases amongst those with a social risk factor (such as homelessness, drug use, offending) have increased. 

What are the unmet needs or gaps in service?

In Berkshire, TB services are of high quality with good treatment completion rates; however, referral of new entrants for screening needs to be improved. The Collaborative Tuberculosis Strategy for England was launched in 2015 and aims to achieve a year on year reduction in TB incidence and associated health inequalities and eventually to eliminate TB as a public health problem.

THOSE AT RISK OF TB, INCLUDING LATENT TB SHOULD BE ENCOURAGED TO REQUEST A FREE SAMPLE BLOOD OR SKIN TEST FROM THEIR LOCAL TB SERVICE

Reading, Newbury or Wokingham residents should call 0118 322 6882 to book your test at our New Entrant Screening Clinic (Royal Berkshire Hospital, Craven Road, Reading RG1 5AN).

Information about latent TB and the new entrant screening is available at http://www.royalberkshire.nhs.uk/wards-and-services/tuberculosis.htm

This section links to the following sections in the JSNA

Communicable Diseases

Migration

Deprivation by Ward and Lower Super Output Area

Poverty

References 

Public Health England (PHE) (2016). Tuberculosis in England: 2016 Report (presenting data to end of 2015). Public Health England, London.

PHE (2016). Health Matters: reducing the burden of Tuberculosis. PHE, London. 

PHE (2017). Tackling tuberculosis in Under-Served Populations: A resource for TB Control Boards and their partners. PHE, London. 

 

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