TB – be aware of the symptoms

TB is an infectious disease that usually affects the lungs but can affect other parts of the body. One third of the world’s population are infected with TB. This is called latent TB and it is estimated that 5–10% of those with latent TB will develop active TB during their lifetime.

Globally more than nine million people developed active TB in 2009 and 1.7 million people died. It is estimated that in 2009, 3.3% of all new TB cases worldwide had multi-drug resistant TB (MDRTB). This is a much more serious form of the disease requiring prolonged inpatient treatment.

There were 9,040 cases of TB in the UK in 2009 – the highest number for nearly thirty years. Last year 68 cases of TB were reported in Northern Ireland.

Although the number of TB cases in Northern Ireland is low compared to other parts of the UK, the global threat of TB has direct implications for us here as a result of increased international travel and the increasing threat of MDRTB.

Dr Michael Devine, Consultant in Health Protection in the Public Health Agency and Chair of the Regional TB Group, said: “TB is not easily caught, as you have to be in close and lengthy contact with someone with TB, but it’s really important that people recognise the symptoms as early as possible so that they can receive the best treatment.”

The most common symptoms of TB include:

• a persistent cough that gets progressively worse over several weeks;
• loss of weight for no obvious reason;
• fever and heavy night sweats;
• a general and unusual sense of tiredness and being unwell;
• coughing up blood.

All of these may also be signs of other problems but if you have them and are worried, talk to a doctor or nurse at your local surgery or clinic.

The PHA is working with health trusts and primary care to develop a regional TB action plan to address aspects of prevention, diagnosis and management of TB.

The three key messages for TB control are:

• Early identification, diagnosis and treatment of new cases of TB are the most important measures for prevention and control.

• All suspected cases of TB should be referred for urgent assessment by the designated TB physicians within each Health and Social Care Trust.

• Prompt reporting of all confirmed or suspected cases of TB by doctors to the Public Health Agency is essential to enable appropriate public health measures to be implemented.

Notes to the editor

Global TB

TB is a disease of poverty affecting young adults in their most productive years and is an increasing world-wide problem. More than two billion – one third of the world’s total population – are infected with TB bacteria.

The World Health Organization (WHO) has estimated that globally there were 9.4 million new cases of TB in 2009, including 1.1 million cases among people infected with HIV. Most of the new TB cases in 2009 occurred in South-East Asia, African and Western Pacific regions. It is estimated that in 2009, 3.3% of all new TB cases had MDRTB.

HIV infection is the most important factor contributing to the increased incidence of TB since 1990. In 2009, an estimated 11–13% of new cases of TB were HIV positive. Globally, 1.7 million people died from TB in 2009, including 380,000 women. The vast majority of TB related deaths are in the developing world.

TB in the UK

There were 9,040 cases of TB in the UK in 2009 – the highest number in the UK for nearly 30 years, giving an overall rate of 15 cases per 100,000 population in the UK. Most of the cases occurred in England (92%), followed by Scotland with 5%, Wales with 2% and Northern Ireland 1%.

The rate of TB was highest in London which had 38% of all UK cases. The number of new drug resistant TB cases has nearly doubled in the past 10 years from 206 cases in 2000 to 389 cases in 2009. Most of the cases were young adults aged 15–44 years (60%) and non-UK born (73%).

The rates of TB in the non-UK born are twenty- fold higher (around 86 per 100,000) than those born in the UK (around 4 per 100,000). The majority of non-UK born cases were diagnosed two or more years after arrival in the UK.

Approximately 1 in 10 cases had at least one social risk factor (homelessness, drug or alcohol misuse or imprisonment), with a quarter reporting more than one risk factor.

TB in Northern Ireland

There were 69 cases of TB reported in Northern Ireland in 2007, giving a rate of 3.9 per 100 000 population. TB rates in Northern Ireland are approximately three times lower than for England and Wales, and significantly lower than in the Republic of Ireland.

The distribution of TB cases across the former Health and Social Care Board areas in 2007 was as follows: Eastern had 29 cases, Southern had 18 cases, Northern had 11 cases and Western had 11 cases.

TB surveillance information in 2010 indicates an increasing proportion of cases occurring in the Southern Trust area which had 34% of all TB cases in 2010 compared with 26% in 2007.

In Northern Ireland the highest proportion of cases occurred in the 25–34 year age group for men, and 35–44 year age-group for women.

Since 2004, there have been 10 cases of drug resistant tuberculosis in Northern Ireland. Most of the cases appear to have acquired the infection outside of Northern Ireland but there is also evidence of transmission of drug resistant tuberculosis within the community here.

While the incidence rates of tuberculosis in Northern Ireland remain substantially lower than those reported from the rest of the UK and the Republic of Ireland, the apparent transmission of drug resistant tuberculosis underlines the need for vigilance and prompt action when required.

The proportion of TB cases in Northern Ireland who were born outside the UK or Ireland has continued to increase in recent years. An estimated 53% of total cases notified in 2007 were born outside of the UK or Ireland compared with 38% of cases in 2006.

The ages of TB cases born outside the UK or Ireland are significantly lower than those born within UK or Ireland.

Further information

Contact the PHA Press Office on 028 9031 1611.