UK could lose low TB status amid rising cases, officials warn

The UK is at risk of losing its status for having low levels of tuberculosis (TB) circulating in the community following a rise in cases in recent years, officials have warned.

It comes as the UK Health Security Agency (UKHSA) published its first annual report detailing the infectious diseases impacting England, with data spanning from 2023 to early 2025.

It said the return of social mixing and international travel following the Covid-19 pandemic, as well as changing migration patterns, has led to the “reemergence, reestablishment and resurgence” of a number of illnesses.

Countries with a threshold of 10 TB cases per 100,000 people are classed as low-incidence by the World Health Organisation (WHO).

However, UKHSA figures show notifications of the bacterial infection rose by 11% – or almost 500 additional cases – in 2023, with provisional data for 2024 showing a further 13% increase, or more than 600 additional cases.

According to the UKHSA, these trends could result in the UK losing its WHO low incidence status – which it has held since 2017 – if not reversed.

Dame Jenny Harries, chief executive of UKHSA, warned that TB “remains a serious public health issue in England”.

Speaking at the UKHSA conference in Manchester on Tuesday, she said: “Data shows reported notifications having increased by 11% in 2023, and a further 13% increase in provisional data for 2024.

“This current rate of increase will soon see the UK lose its WHO low incidence status of 10 per 100,000 population.”

The UKHSA highlighted a “strong association” between the rise in TB cases in England and migration from “high or very high incidence countries”.

Some 80% of reported cases in 2023 were people born outside of the UK, it added, despite the number of people being screened for infection before entry doubling between 2021 and 2023.

A test for TB in the lungs is part of the visa requirement for people coming to the UK for six months or more from countries where the disease is common.

However, the bacteria that causes the illness can sometimes lie dormant for years, which is known as latent TB.

A testing and treatment programme is in place for people in areas of England with higher rates, or those coming from high-risk countries.

The universal BCG vaccine programme for school-aged children was stopped in 2005 and replaced by a targeted programme for babies and children at risk of exposure to the disease.

Officials also raised concerns over declining vaccine uptake in England, particularly for childhood illnesses like measles and whooping cough.

In September it emerged that childhood vaccination coverage fell in 2023/24, with no vaccines meeting the 95% target.

The uptake of some doses of the jab for measles, mumps and rubella (MMR) fell to levels not seen since 2009/2010.

The MMR was introduced in 1988 and prior to this notifications for measles cases were between 160,000 to 800,000 each year, according to Dame Jenny.

“Following the introduction of MMR we saw very few cases in the UK and in 2017 the World Health Organisation declared the UK to have eliminated measles,” she said.

“Sadly, as our report shows, we are in a different place now. In 2023 there were 362 confirmed measles cases. In 2024, 2,836.

“Those numbers sit alongside other data for childhood vaccine preventable illness.

“We saw pertussis – whooping cough – cases rise from the hundreds in 2023 to over 14,000 in 2024, tragically resulting in a small number of deaths in babies.”

Dame Jenny also warned many other diseases are “out of step from the pandemic or moving in the wrong direction”, including sexually transmitted infections.

Analysis by UKHSA found infectious diseases were the reason for more than 20% of NHS hospital bed usage in 2023/2024, costing almost £6 billion.

Publication of the report comes as the health service emerges from the winter months, which saw a so-called “quad-demic” of disease; flu, Covid-19, respiratory syncytial virus (RSV) and the vomiting bug norovirus.

Richard Pebody, director of epidemic and emerging infections at UKHSA, added: “This winter has demonstrated that rises in rates of infectious diseases can cause significant strain, not only on the individuals directly affected, but also on the NHS.

“It is vital that we are not complacent about infections where we can reduce the burden of disease via interventions such as our world-class vaccination programmes.”