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. 2001 Mar;56(3):173–179. doi: 10.1136/thorax.56.3.173

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998

A Rose 1, J Watson 1, C Graham 1, A Nunn 1, F Drobniewski 1, L Ormerod 1, J Darbyshire 1, J Leese 1
PMCID: PMC1758771  PMID: 11182007

Abstract

BACKGROUND—A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis.
METHODS—Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis.
RESULTS—A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV.
CONCLUSIONS—The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.



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Selected References

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  1. Bhatti N., Law M. R., Morris J. K., Halliday R., Moore-Gillon J. Increasing incidence of tuberculosis in England and Wales: a study of the likely causes. BMJ. 1995 Apr 15;310(6985):967–969. doi: 10.1136/bmj.310.6985.967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Binkin N. J., Vernon A. A., Simone P. M., McCray E., Miller B. I., Schieffelbein C. W., Castro K. G. Tuberculosis prevention and control activities in the United States: an overview of the organization of tuberculosis services. Int J Tuberc Lung Dis. 1999 Aug;3(8):663–674. [PubMed] [Google Scholar]
  3. Churchill D., Hannan M., Miller R., Williams I., Nelson M., Kupek E., Coker R. HIV associated culture proved tuberculosis has increased in north central London from 1990 to 1996. Sex Transm Infect. 2000 Feb;76(1):43–45. doi: 10.1136/sti.76.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Davies P. D., Darbyshire J., Nunn A. J., Byfield S. P., Fox W., Citron K. M., Raynes R. H. Ambiguities and inaccuracies in the notification system for tuberculosis in England and Wales. Community Med. 1981 May;3(2):108–118. [PubMed] [Google Scholar]
  5. Kumar D., Watson J. M., Charlett A., Nicholas S., Darbyshire J. H. Tuberculosis in England and Wales in 1993: results of a national survey. Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group. Thorax. 1997 Dec;52(12):1060–1067. doi: 10.1136/thx.52.12.1060. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ormerod L. P., Charlett A., Gilham C., Darbyshire J. H., Watson J. M. Geographical distribution of tuberculosis notifications in national surveys of England and Wales in 1988 and 1993: report of the Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group. Thorax. 1998 Mar;53(3):176–181. doi: 10.1136/thx.53.3.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ormerod L. P. Is new immigrant screening for tuberculosis still worthwhile? J Infect. 1998 Jul;37(1):39–40. doi: 10.1016/s0163-4453(98)90432-7. [DOI] [PubMed] [Google Scholar]
  8. Ormerod L. P., Watson J. M., Pozniak A., Kumar D., McManus T. Notification of tuberculosis: an updated code of practice for England and Wales. J R Coll Physicians Lond. 1997 May-Jun;31(3):299–303. [PMC free article] [PubMed] [Google Scholar]
  9. Raviglione M. C., Dye C., Schmidt S., Kochi A. Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project. Lancet. 1997 Aug 30;350(9078):624–629. doi: 10.1016/s0140-6736(97)04146-9. [DOI] [PubMed] [Google Scholar]
  10. Springett V. H. Tuberculosis notification rates in the elderly. CDR (Lond Engl Rev) 1991 Dec 6;1(13):R149–R150. [PubMed] [Google Scholar]
  11. Stead W. W., Dutt A. K. Tuberculosis in elderly persons. Annu Rev Med. 1991;42:267–276. doi: 10.1146/annurev.me.42.020191.001411. [DOI] [PubMed] [Google Scholar]
  12. Tocque K., Doherty M. J., Bellis M. A., Spence D. P., Williams C. S., Davies P. D. Tuberculosis notifications in England: the relative effects of deprivation and immigration. Int J Tuberc Lung Dis. 1998 Mar;2(3):213–218. [PubMed] [Google Scholar]
  13. Van den Bosch C. A., Roberts J. A. Tuberculosis screening of new entrants; how can it be made more effective? J Public Health Med. 2000 Jun;22(2):220–223. doi: 10.1093/pubmed/22.2.220. [DOI] [PubMed] [Google Scholar]
  14. Van den Bosch C. A., Roberts J. A. Tuberculosis screening of new entrants; how can it be made more effective? J Public Health Med. 2000 Jun;22(2):220–223. doi: 10.1093/pubmed/22.2.220. [DOI] [PubMed] [Google Scholar]
  15. Watson J. M., Meredith S. K., Whitmore-Overton E., Bannister B., Darbyshire J. H. Tuberculosis and HIV: estimates of the overlap in England and Wales. Thorax. 1993 Mar;48(3):199–203. doi: 10.1136/thx.48.3.199. [DOI] [PMC free article] [PubMed] [Google Scholar]

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