Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998

Background-A national survey of tuberculosis was conducted in England and W ales in 1998 to obtain detailed information on the occurrence of the diseas e and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevale nce of HIV infection in adults with tuberculosis. Methods-Clinical and demographic data for all cases diagnosed during 1998 w ere obtained, together with microbiological data where available. Annual in cidence rates in the population were estimated by age, sex, ethnic group, a nd geographical region using denominators from the 1998 Labour Force Survey . Incidence rates in different subgroups of the population were compared wi th the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult p atients with tuberculosis. Results-A total of 5658 patients with tuberculosis were included in the sur vey in England and Wales (94% of all formally notified cases during the sam e period), giving an annual rate of 10.93 per 100 000 population (95% CI 10 .87 to 10.99). This represented an increase of 11% in the number of cases s ince the survey in 1993 and 21% since 1988. In many regions case numbers ha ve remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% si nce 1993. Annual rates of tuberculosis per 100 000 population have continue d to decline among the white population (4.38) and those from the Indian su bcontinent, although the rate for the latter has remained high at 121 per 1 00 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. O ver 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. Conclusions-The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those r ecently arrived from high prevalence areas of the world. The geographical d istribution is uneven with urban centres having the highest rates. The incr ease in the number of cases in London is particularly large. Tuberculosis i n patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and contr ol measures must be based on accurate and timely information on the occurre nce of disease. A new system of continuous enhanced tuberculosis surveillan ce was introduced in 1999, based on the methodology developed in this natio nal survey.