TB cases are on the rise – the worst hit regions, mapped ...Middle East

Tuberculosis (TB) cases shot up by 13 per cent in England last year, driven by rising poverty rates, government figures show.

There were 5,480 reported cases of TB in 2024, up from 4,850 the year before and 25 per cent higher than in 2022, according to the UK Health Security Agency (UKHSA) – a number that remains relatively low but is the highest since 2016 and shows concerning signs of increasing, experts say.

TB is a highly debilitating bacterial infection that usually affects the lungs and can be fatal. It is mostly spread by coughing, sneezing and talking.

The number of cases reported last year amounts to 9.5 people per 100,000 of the population – compared to 8.5 a year earlier.

That increase brings the rate close to 10 – the level at which the World Health Organisation (WHO) classifies a disease as being “low incidence”, a significant milestone for a virus even if cases are still very low.

Hitting this level wouldn’t trigger any additional requirements from the health service although experts said it would put a further spotlight on this growing problem that may lead to increased surveillance, contact tracing and monitoring to identify and address the drivers of the increase.

Where were the biggest increases?

The biggest increases were seen in the West Midlands, which saw a 22.2 per cent rise in reported cases to 709 in 2024, followed by London, where there was a 13.3 per cent increase, taking cases to 1,877 – the highest number in the country.

Large urban centres are the major hotspots for TB because they have can have high levels of poverty, are densely populated and have more people born outside the UK, who are at higher risk.

Although the data relates to England, experts said TB rates have been going up across the UK.

They said growing poverty rates as a result of the cost of living crisis are likely to have played a significant role in rising TB cases – although there are many factors involved.

According to the UKHSA “tuberculosis continues to be associated with deprivation and is more common in large urban areas”.

And separate figures show that the number of people living in poverty in the UK has risen by 18 per cent in three years, increasing from 13.6 million in 2020 to 16 million in 2023, according to a report by the Social Metrics Commission published in November.

Tuberculosis

Symptoms of TB usually come on gradually.

Common symptoms include:

Children may also have difficulty gaining weight or growing.

If TB has spread to another part of your body such as your glands (lymph nodes), bones or brain, you may also have other symptoms, including:

Experts say that poor living conditions, like overcrowded and poorly ventilated housing, often found in deprived areas, significantly increase the risk of TB transmission, while factors like malnutrition and weakened immune systems – which are often linked to poverty – also make people more susceptible to developing the disease.

“I think that increasing levels of poverty and the cost of living crisis will be among the factors contributing towards increasing TB cases,” Tom Wingfield, of the Liverpool School of Tropical Medicine, told The i Paper – adding that its not possible to prove a definitive link.

“But it is clear that poorer people have higher risk of being exposed to TB, developing TB infection and disease. Poverty is the leading driver of TB with the poorest 10 per cent having five-times higher rates of TB than the richest 10,” he said.

“TB is associated with poverty through many intersecting elements including malnutrition, stress, other illnesses, unemployment, and overcrowded or inadequate housing.”

Dr Wingfield added: “TB is the single leading cause of death from an infectious disease globally and although rates in England and the UK are low, they have increased year on year and we are far from WHO targets of achieving TB elimination. We should be concerned by any rise in TB cases be it in England or globally.”

As in previous years, the vast majority of cases were reported in people who were born outside the UK, who accounted for 81.5 per cent of reported TB infections.

That group saw collective infections increase by 15.2 per cent in 2024, compared to a 3.9 per cent rise in the UK born population.

China, India, Nigeria and South Africa are among the countries with high levels of TB.

The rates among people born outside the UK are higher because those coming from areas with high TB rates are more likely to carry a latent infection that was caught in their home country but remained dormant, sometimes for many years.

This can be activated upon arrival in a new country – or some time after – triggered by factors such as proverty, stress, or weakened immune system, coupled with potential barriers to accessing healthcare in their new environment.

Simon Williams, a behavioural scientist and public health expert at Swansea University, told The i Paper: “The rise in TB rates is concerning, both because it can be a very serious disease, with harmful consequences including potentially death and because it is a preventable disease”.

“TB rates tend to be higher in urban areas – when large numbers of people live and mix within close quarters, infections spread more easily. London and Birmingham also have areas of high poverty and high concentrations of ethnic minority groups who are at higher risk of TB,” he added.

Professor Paul Hunter, of the University of East Anglia, said: “Any increase in TB is a matter of serious concern. It’s a nasty disease that can take months to treat with anti-tuberculous drugs. Untreated TB can be fatal or leave people with significant disability, while drug resistance is a problem and can lead to treatment failure.”

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Professor Steve Griffin added that the rising number of TB cases strengthens the case for broadening the number of children who have a TB jab.

TB vaccines are now targeted at infants classed as at “high risk” after the national schools vaccination and testing programme ended in 2005.

Professor Griffin explains that the vaccine prevents severe forms of TB and contributed significantly to the reduction in prevalence since its introduction in the 1950s.

“Whilst various debates around cost-effectiveness and some rare adverse reactions to this vaccine exist, there certainly seems to be a growing case for reassessing the remit for its use as infections continue to increase,” he said.

“TB is incredibly infectious – literally a handful of the bacteria can establish infection – and spreads via airborne aerosols when present in an infected persons’ lungs. So measures that improve indoor air quality including ventilation and filtration as well as well-fitted respirator masks will reduce transmission,” Professor Griffin added.

Dr Esther Robinson, head of the TB unit at UKHSA, said: “TB remains a serious public health issue in England”.

“The infection is preventable and curable. If you have moved to England from a country where TB is more common, please be aware of the symptoms of TB so you can get promptly tested and treated through your GP surgery.

“Not every persistent cough, along with a fever, is caused by flu or Covid. A cough that usually has mucus and lasts longer than three weeks can be caused by a range of other issues, including TB. Please speak to your GP if you think you could be at risk,” she says.

To help tackle TB cases the UKHSA and NHS England launched a five-year action plan in July 2021.

This included plans for a new National TB Surveillance System and the routine provision of whole genome sequencing data to TB services and to improve early detection of TB by identifying, investigating and acting on the components that contribute to patient delay.

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