tuberculosis in the uk 2013 report tables and figures slide-set

Tuberculosis in the UK 2013 report

Tables and figures slide-set

1. Tuberculosis case reports, UK, 2000-2012

2 Tuberculosis in the UK: 2013 report

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

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e (p

er 1

00,

000)

Nu

mb

er o

f ca

ses

Year

Number of cases Rate per 100,000

Figure 1.1: Tuberculosis case reports and rates, UK, 2000-2012

Source: Enhanced Tuberculosis Surveillance (ETS), Enhanced Surveillance of Mycobacterial Infections (ESMI), Office for National Statistics (ONS)

Data as at July 2013

Prepared by: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England


Figure 1.2: Tuberculosis case reports and rates by country, UK, 2012





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England Northern Ireland Wales Scotland Total

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e (p

er 1

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000)

Nu

mb

er o

f ca

ses

Country



Figure 1.3. Three-year average tuberculosis case rates by local area*, UK, 2010-2012 *England – Local authorities, Wales and Scotland – Health Boards, NI – data not available

Source: Enhanced Tuberculosis Surveillance (ETS), Enhanced Surveillance of Mycobacterial Infections (ESMI), Office for National Statistics (ONS)Data as at July 2013


© Crown copyright and database rights 2013 Ordnance Survey 100016969

London

41.9

19.4

9.311.3 11.5 10.8

7.85.8 6.4

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Region

Number of cases Rate (per100,000) and 95% CI


Figure 1.4: Tuberculosis case reports and rates by region*, England, 2012

* HPA regionCI – 95% confidence intervals Source: Enhanced Tuberculosis Surveillance (ETS), Office for National Statistics (ONS) Data as at July 2013 Prepared by: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England

Figure 1.5: Tuberculosis case reports and rates by PHE Centre, England, 2012


6.37.8

4.7

11.0

3.9

10.7

17.3

7.4

41.8

6.4

11.914.5

6.5

19.3

11.4

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PHE Centre


CI - confidence intervals Source: Enhanced Tuberculosis Surveillance (ETS), Office for National Statistics (ONS) Data as at July 2013 Prepared by: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England

Figure 1.6: Tuberculosis case reports by place of birth and country, UK, 2012

Source: Enhanced Tuberculosis Surveillance (ETS), Enhanced Surveillance of Mycobacterial Infections (ESMI)




5,819

48 185 73

2,020

39 142 56

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Per

cen

tag

e o

f ca

ses

Country (% where place of birth known)

Non UK-born UK-born

Figure 1.7: Tuberculosis case reports by place of birth and PHE Centre, England, 2012

92101

352326

73298

701 168227

2,807

192

221 120

35

58100

192130

37101

340 8079

566

115

73 45

43

0%

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40%

50%

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70%

80%

90%

100%

Per

cen

tag

e o

f ca

ses

PHE Centre (% where place of birth known)

Non UK-born UK-born





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ses

Years since entry to diagnosis

Figure 1.8: Non UK-born tuberculosis case reports by time since entry to the UK to tuberculosis diagnosis, UK, 2012





Table 1.1: Most frequent countries of birth for non UK-born tuberculosis cases, UK, 2012

* Where country of birth was known; **Years





Country of birthNumber of

casesPercentage

of cases*Median time since

entry UK (IQR)**

India 1,858 30.7 4 (2 - 13)

Pakistan 1,091 18.0 7 (2 - 21)

Somalia 380 6.3 8 (3 - 12)

Bangladesh 276 4.6 7 (2 - 23)

Nepal 216 3.6 2 (1 - 5)

Nigeria 184 3.0 5 (1 - 10)

Philippines 136 2.3 5 (2 - 9)

Zimbabwe 132 2.2 9 (7 - 11)

Kenya 98 1.6 13 (6 - 40)

Sri Lanka 98 1.6 7 (2 - 15)

Eritrea 87 1.4 4 (2 - 5)

Romania 78 1.3 2 (0 - 4)

Afghanistan 75 1.2 5 (2 - 10)

Poland 71 1.2 5 (2 - 7)

Others (each <1%) 1,265 21.1 5 (1 - 13)

Total* 6,045 100 6 (2 -13)

Figure 1.9: Tuberculosis case reports and rates by ethnic group and place of birth, England, Wales and Northern Ireland, 2012

3

2836

1231 39

187 6 9

30

178

53

243

215

123

27

68

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Whi

te

Bla

ck-C

arib

bea

n

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ck-A

fric

an

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ck-O

ther

Ind

ian

Pak

ista

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Ban

gla

des

hi

Chi

nese

Mix

ed /

Oth

er

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ther

Ind

ian

Pak

ista

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Ban

gla

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Mix

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Oth

er

UK-born Non UK-born

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00)

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f ca

ses

Place of birth/Ethnic group

Number of cases

Rate (per 100,000)

Source: Enhanced Tuberculosis Surveillance (ETS), Rates by place of birth calculated using Labour Force Survey population estimates.




Figure 1.10: Tuberculosis case reports and rates by age group and place of birth, UK, 2012




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Age group (years)

UK-born Non UK-born

Rate in UK-born Rate in non UK-born


Figure 1.11: Tuberculosis case reports and rates by age group and sex, UK, 2012

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Age group (years)

Male cases Female cases

Rate in males Rate in females





Figure 1.12: Tuberculosis case reports and rates by place of birth, UK, 2000-2012

4 4 4 4 4 4 4 4 4 4 4 4 4

76 77

88 8993

9891

85 86 8682 84

80

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Year

UK-born Non UK-born

Rate UK-born Rate Non UK-born





Figure 1.13: Proportion of tuberculosis case reports by site of disease (pulmonary/extra-pulmonary), UK, 2000-2012





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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Per

cen

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(%)

Year

Pulmonary Extra-pulmonary

Table 1.2: Tuberculosis case reports by site of disease, UK, 2012

Site of disease* Number of cases Percentage**

Pulmonary 4,563 52.1

Extra-thoracic lymph nodes 1,872 21.4

Intra-thoracic lymph nodes 946 10.8

Other extra-pulmonary 619 7.1

Pleural 651 7.4

Gastrointestinal 471 5.4

Bone – spine 394 4.5

Cryptic± 46 0.5

Miliary± 197 2.3

Bone – other 218 2.5

CNS – meningitis 187 2.1

Genitourinary 137 1.6

CNS – other 80 0.9

Laryngeal 16 0.2

Unknown extra-pulmonary 15 0.2





*With or without disease at another site **Percentage of cases with known sites of disease (8751)±For Scotland cases, this includes both cryptic and miliary site

CNS - Central Nervous System Total percentage exceeds 100% due to infections at more than one site

Figure 1.14: Child to adult ratio in notifications rate, UK, 2000-2012

The child-to-adult ratio is the ratio of the case notification rate in children under 15 years of age, to that in adults. A declining trend in the ratio suggests a decrease in ongoing transmission (European Centre for Disease Prevention and Control).

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/ad

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2. Microscopy, culture confirmation, speciation and drug susceptibility



Figure 2.1: Proportion of cases with first line drug resistance or MDR-TB, UK, 2000-2012

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pro

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es (

%)

Year

Isoniazid Resistant Multi-drug Resistant





Table 2.1: Number and proportion of tuberculosis cases with drug resistance by age group, UK, 2012

n % n % n %

0-14 10 9.7 10 9.7 7 6.8 103

15-44 240 7.2 264 7.9 65 2.0 3,333

45-65 77 7.6 78 7.7 8 0.8 1012

65+ 24 3.4 27 3.8 1 0.1 703

Age Group

Isoniazid Resistant to any Multi-drug

Total**resistant first line drug* resistant

*First line drugs - isoniazid, rifampicin, ethambutol and pyrazinamide**First line drugs – isoniazid, rifampicin, ethambutol and pyrazinamide**Culture confirmed cases with drug susceptibility results for at least isoniazid and rifampicin





Table 2.2: Proportion of tuberculosis cases with drug resistance by previous history of tuberculosis, UK, 2012*

* Cases with unknown previous history of tuberculosis are excluded** First line drugs - isoniazid, rifampicin, ethambutol and pyrazinamide$ Culture confirmed cases with drug susceptibility results for at least isoniazid and rifampicin




n % n % n %

Yes 28 11.5 31 12.7 14 5.7 244

No 304 6.7 329 7.2 62 1.4 4570

Previous history of TB

Isoniazid Multi-drugTotal$resistant resistant

Resistant to any first line drug**


Table 2.3: Number and proportion of tuberculosis cases with drug resistance by place of birth, UK, 2012*

* Cases with unknown previous history of tuberculosis are excluded** First line drugs - isoniazid, rifampicin, ethambutol and pyrazinamide$ Culture confirmed cases with drug susceptibility results for at least isoniazid and rifampicin

n % n % n %

UK born 64 5.3 70 5.8 9 0.7 1,216

Non-UK born 274 7.4 296 8.0 71 1.9 3,709

Central Europe 6 4.3 6 4.3 5 3.6 139

East Europe 19 35.2 20 37.0 13 24.1 54

West Europe 10 10.4 10 10.4 5 5.2 96

East Mediterranean 2 4.9 3 7.3 0 0.0 41

East Asia 4 6.5 4 6.5 0 0.0 62

South Asia 151 7.0 163 7.6 31 1.4 2,144

South East Asia 19 10.1 23 12.2 2 1.1 189

North Africa 0 0.0 0 0.0 0 0.0 35

Sub-Saharan Africa 51 6.2 54 6.6 13 1.6 819

North America and Oceania 0 0.0 0 0.0 0 0.0 5

South and Central America and the Caribbean 7 10.3 8 11.8 0 0.0 68

Total$Place of birthIsoniazid

resistant

Resistant to any

first line drug**

Multi-drug

resistant





54

243

7

54

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14

UK-born Non UK-born UK-born Non UK-born

Isoniazid resistant Multi-drug resistant

Pro

po

rtio

n o

f ca

ses

(%)

No previous history of TB





* Cases with unknown place of birth and unknown previous history of TB are not includedCulture confirmed cases with drug susceptibility results for at least isoniazid and rifampicin

Figure 2.2: Proportion of tuberculosis cases isoniazid and multi-drug resistance by place of birth and previous history of tuberculosis, UK, 2012*





*Proportion were calculated out of those who were tested

Figure 2.3: Proportion* of multi-drug resistance cases from Eastern Europe, South Asia and Sub-Saharan Africa with additional resistance, UK, 2012

4

8 8

2 25

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32

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100

Resistant to all 1stline drugs (H, R, E

and Z)

Resistant to at leastone second line drug

Resistant to at leastone injectable drug

Resistant to at leastone Fluoroquinolone

Extensively drugresistant tuberculosis

(XDR)

Pro

po

rtio

n o

f M

DR

cas

es (

%)

Eastern Europe

South Asia

Sub-Saharan Africa

3. Strain typing, 2010-2012


Table 3.1: Number and proportion of culture confirmed cases typed or with 23 loci typed by year and country


Culture confirmed

cases

Cases with a strain type*

Number of cases

clustered**

Number of clusters

Estimated proportion of cases likely due to

recent transmission$

n n (%) n n % 2-4 5-9 10+

England, Wales and Northern Ireland‡ 14,692 11,745 (79.9) 6,113 1,401 40 1,110 198 93

England§ 14,248 11,491 (80.6) 5,973 1,371 40 1,084 198 89

Wales 296 167 (56.4) 26 12 8 12 0 0

Northern Ireland# 148 87 (58.8) 21 9 14 9 0 0

Number of clusters by cluster

size

Source: Enhanced Tuberculosis Surveillance (ETS)



* Culture confirmed cases with a MIRU-VNTR profile with at least 23 complete loci** Clustered cases are clustered within geographical area$ Calculated using the n-1 method (number of cases in a cluster-number of clusters/number of cases with a strain type)‡ The number of clusters in England, Wales and Northern Ireland is higher than the sum of all clusters in the three countries because it includes clusters that span more than one country§ The number of clusters in England is higher than the sum of all PHEC clusters because it includes clusters that span more than PHEC# The number of culture confirmed cases in Northern Ireland reported here is less than the 157 culture confirmed cases known about locally

Table 3.2: Number of tuberculosis cases and proportion of clustering stratified by place of birth, 2010-2012

Source: Enhanced Tuberculosis Surveillance (ETS)



Culture confirmed

cases

Cases with a strain type*

Number of cases

clustered

Number of clusters

Estimated proportion of cases likely due to

recent transmission**

Proportion of cases with a unique strain

n n (%) n n % %

England, Wales and

Northern Ireland$ 14,692 11,745 (80) 6,113 1,401 40 48.0

UK-born‡ 3,327 2,756 (82.8) 1,779 669 40 35.4

Non UK-born§ 10,782 8,549 (79.3) 4,111 1,229 34 51.9

* Culture confirmed cases with a MIRU-VNTR profile with at least 23 complete loci** Calculated using the n-1 method (number of cases in a cluster-number of clusters/number of cases with a strain type)$ The number of cases in England, Wales and Northern Ireland is higher than the sum UK-born and non UK-born as 583 cases have unknown UK-born information‡ Number of clusters with at least one UK-born person in the cluster§ Number of clusters with at least one non UK-born person in the cluster


4. TB treatment outcomes, UK, 2001-2011



Table 4.1: Treatment outcome at 12 months for tuberculosis cases, UK, 2011*

* Excludes MDR-TB and RMP-resistant TB cases. Not evaluated includes missing, unknown and transferred out




Treatment outcome n %

Completed 7,302 82.9

Died 434 4.9

Lost to follow-up 435 4.9

Still on treatment 289 3.3

Stopped 88 1.0

Not evaluated 257 2.9

Total 8,805 100


Figure 4.1: Trends in tuberculosis treatment outcomes at 12 months post start of treatment, UK*

*Cases who developed MDR or rifampicin resistance while on treatment were not available for years prior to 2010 and will remain in the 12 month treatment outcome cohort for these years. These data were also not available for Scotland.




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Completed Died Lost to follow-up

Still on treatment

Stopped Not completed, reason

unknown

Not evaluated

Pro

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ses

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Outcome

2007

2008

2009

2010

2011


Figure 4.2: Proportion of cases completing treatment by Country and PHE Centre, UK, 2011

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100P

erce

nta

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of

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s

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Table 4.1: Relationship between tuberculosis diagnosis and cause of death at 12 months, UK, 2011

Relationship between TB and death n %

TB caused death 63 14.5

TB contributed to death 123 28.3

TB incidental to death 109 25.1

Unknown 139 32.0

Total 434 100




34 Annual report on tuberculosis surveillance in the UK 2013

Figure 4.3: Treatment outcomes at 12 months for tuberculosis cases by place of birth, UK, 2011




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Completed Died Lost to follow-up Still on treatment

Stopped Not evaluated

Pro

po

rtio

n o

f ca

ses

(%)

Outcome

Non UK-born

UK-born


Figure 4.4: Treatment outcomes at 12 months for tuberculosis cases with at least one social risk factor, UK, 2011

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Completed Died Lost to follow-up Still on treatment Stopped Not evaluated

Per

cen

tag

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Outcome

No known social risk factor

Known social risk factor




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90


Pro

po

rtio

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f ca

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(%)

Outcome

No known social risk factor

Known social risk factor


Figure 4.5: Treatment outcomes at 12 months for tuberculosis cases with previous history of TB, UK, 2011

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Pro

po

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No previous history of TB






Table 4.3: Treatment outcome at 24 months for MDR and rifampicin resistant tuberculosis cases, UK, 2010

Treatment outcome n %

Completed 49 72.1

Died 0 0.0

Lost to follow-up 6 8.8

Still on treatment 7 10.3

Stopped 4 5.9

Not completed, no reason 1 1.5

Not evaluated 1 1.5

Total 68 100




tuberculosis in the uk 2013 report tables and figures slide-set

Documents

tuberculosis case reports

tuberculosis diagnosis

public health england

report figure

tb section

phe centre

national statistics

london slide