Tuberculosis in London a decade and a half of no decline - TB epidemiology and control

Sarah R Anderson ^1*, Helen Maguire ² and Jacqui Carless ²

¹ North West London Health Protection Unit, United Kingdom
² HPA London, United Kingdom

^* To whom correspondence should be addressed. E-mail: sarah.a{at}virgin.net.

Accepted 5 October 2006

Abstract

Background: London accounts for nearly half of the national burden of tuberculosis. The incidence of tuberculosis has more than doubled in London in the last 15 years.

Methods: Data from enhanced tuberculosis surveillance 1999-2003, the national TB surveys of 1993 and 1998, and TB notifications were compared and analysed.

Results: In 2003, 3048 patients with tuberculosis were reported in London; 45% of the national total. This represents an incidence of 41.3 per 100,000, five times higher than the rest of England and Wales, and in parts of London TB incidence is nine times the national average. Seventy-five percent of people with TB in London are born abroad; nearly half have lived in the UK for less than five years but a third for over ten years. Eighty-six percent are from an ethnic minority group and incidence is highest in black Africans at 283 per 100,000 compared to 141, 141 and 8 for Pakistanis, Indians and whites respectively. In absolute terms a third of London TB patients are from Africa and nearly a third from the Indian subcontinent. Specific groups affected also include the homeless, prisoners, and hard drug and alcohol users, as well as the immunosuppressed.

Conclusions: London reflects the worldwide rise in TB with increasing incidence in ethnic minorities. Work has been done to combat this rise but more is needed. TB control and prevention strategies should be mindful of the changing epidemiology of TB in London and provide information, diagnosis and treatment tailored to the specific needs of the capital and its at risk groups.

Keywords: Epidemiology, London, Tuberculosis

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