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Evidence for a national problem: continued rise in tuberculosis case numbers in urban areas outside London
  1. Michelle E Kruijshaar1,
  2. Ibrahim Abubakar1,2,
  3. Martin Dedicoat3,
  4. Graham H Bothamley4,
  5. Helen Maguire5,6,
  6. Jonathan Moore1,
  7. Jonathan Crofts1,
  8. Marc Lipman7
  1. 1TB Section, Respiratory Diseases Department, Health Protection Agency, Health Protection Services Colindale, London, UK
  2. 2Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3Heart of England Foundation Trust, Birmingham, UK
  4. 4Homerton University Hospital, London, UK
  5. 5Health Protection Agency, Health Protection Services Victoria, London, UK
  6. 6European Centre for Disease Control, Stockholm, Sweden
  7. 7Centre for Respiratory Medicine, Royal Free Hospital, UCL, London, UK
  1. Correspondence to Dr M E Kruijshaar, Health Protection Services Colindale, 61 Colindale Avenue, London NW9 5EQ, UK; michelle.kruijshaar{at}


WHO standards for tuberculosis (TB) control require monitoring and evaluation of TB control programmes. In London, TB rates have stabilised at 44 per 100 000 since 2005. In 38 urban areas outside London with TB rates above the national average, these continued to rise after 2004, to 28 per 100 000 in 2008 (15% increase). London has the highest proportion of TB cases in certain risk groups, but these are increasing rapidly outside London. Many TB control efforts focus on the capital, but with rates rising elsewhere in the country, this strategy is likely to fail in the long term.

  • Tuberculosis
  • England
  • urban
  • incidence
  • control
  • clinical epidemiology
  • tuberculosis
  • atypical mycobacterial infection
  • respiratory infection
  • cytokine biology
  • infection control
  • innate immunity
  • ARDS
  • aspergillus lung disease
  • bacterial infection
  • infection control
  • opportunist lung infections
  • paediatric lung disaese
  • viral infection
  • immunodeficiency

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  • Competing interests None.

  • Ethical approval This study was carried out with national surveillance data. The Health Protection Agency has Patient Information Advisory Group approval to hold and analyse national surveillance data for public health purposes under Section 60 of the Health and Social Care Act 2001.

  • Provenance and peer review Not commissioned; externally peer reviewed.