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BMJ. 2007 March 31; 334(7595): 658.
PMCID: PMC1839180

UK government fails to stem rise in tuberculosis cases

The number of cases of tuberculosis in the United Kingdom continues to rise year on year, with a 2% increase from 2005 to 2006, provisional figures from the Health Protection Agency show.

Tuberculosis experts have predicted that the incidence of the disease will continue to rise for at least the next five years as many trusts fail to implement the government's plan to control tuberculosis. The plan recommended, among other things, that multidisciplinary tuberculosis networks should be established around the country and that patients suspected of having the disease should be seen by someone from such a team within two weeks of presenting to a doctor.

Results of a survey by the British Thoracic Society among 54 tuberculosis specialists show that more than three quarters have no more resources, and 10% have fewer resources, to tackle tuberculosis now than they did before 2004, when the government published its plan.

John Macfarlane, chairman of the society, said, “This Victorian disease is on the march. Doctors up and down the country are warning us tuberculosis is in danger of staging a serious comeback.”

The number of tuberculosis cases provisionally reported in England, Wales, and Northern Ireland in 2006 reached 8171, up from 8008 cases in 2005. This is a 29% increase in cases since 2000, when 6323 diagnoses were recorded.

London continues to count for the highest proportion of cases (42%), followed by the West Midlands, Yorkshire and Humberside, and the north west.

John Watson, head of the respiratory diseases department at the agency, said that it was too early to tell whether the provisional results for 2006 show a slowing in the overall trend of increase in cases.

Peter Borriello, director of the centre for infections, said, “The fact that we are still seeing more new cases diagnosed each year means we need to continue heightened efforts with those most affected by tuberculosis.

“Worldwide, tuberculosis is the leading cause of death in terms of curable infectious diseases, but fortunately it remains very low in most parts of the UK. We need to emphasise to everyone that tuberculosis is a preventable and treatable condition. The key to reducing levels of tuberculosis is early diagnosis and appropriate treatment of the infection. This is where we must put our effort. Work on improving tuberculosis vaccines is also critical.”

The survey among tuberculosis specialists indicates that many measures in the chief medical officer's action plan in October 2004, Stopping Tuberculosis in England, are not being implemented (BMJ 2004;329:877, doi: 10.1136/bmj.329.7471.877-a).

More than a fifth (21%) of the specialists reported that patients suspected of having tuberculosis were not being seen by someone from a tuberculosis team within two weeks of presenting to a doctor, as envisioned in the plan. In addition, nearly half (46%) the respondents to the survey said they did not have a local multidisciplinary tuberculosis network in their area, with a similar proportion (43%) having no access to a designated tuberculosis microbiologist—contrarily to two other recommendations of the plan.

Research done in January this year by the charity TB Alert shows that five of the 11 areas in the UK with a high incidence of tuberculosis have fewer than one specialist tuberculosis nurse for every 50 patients, the minimum number recommended by the National Institute for Health and Clinical Excellence. A third of tuberculosis specialists also said that tuberculosis nurse specialists remain under threat of review.

Keith Prowse, chairman of the British Lung Foundation, criticised the government's “all plan and no action.”

“We urgently need the resources to deliver the specialist doctors, nurses, and multidisciplinary teams that were promised in the plan. Tuberculosis is a preventable and treatable condition, and the key to tackling it in the UK is in early diagnosis and treatment by specialists,” he said.

Professor Macfarlane added that the government would fail to meet its own measures of success for tuberculosis if the targets in the action plan were not urgently prioritised. The aim was to reduce tuberculosis cases among the population born in the UK by at least 2% a year within three years of the launch of the plan and to reduce cases among new UK residents within five years.


Reports from the Health Protection Agency are available at

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