A new five-year action plan to reduce cases of tuberculosis (TB) in England has been launched by the UK Health Security Agency, working with NHS England.
The TB action plan will last from 2021 to 2026 and aims to improve prevention, detection, and control of TB in England, enabling the UK to meet its commitment to the World Health Organization (WHO) End TB Strategy and eliminate TB in England by 2035.
Detecting and treating TB earlier increases the likelihood of recovery and reduces the chances of disease spread.
The impact of COVID-19
Incidences of TB have been falling significantly in the UK since 2011, when it was one of the highest in western Europe with a total of 8,963 cases recorded. In 2019 the rate of decline reversed, with cases increasing by 2.4%. While recorded incidence of TB fell again in 2020 (to 4,138), the COVID-19 pandemic has had an impact on diagnoses.
Due to this, renewed efforts and focus are required to ensure that England is able to eliminate TB.
The UKHSA and NHSE TB action plan will build on the improvements in the prevention, detection, and control of TB in England over the past ten years and focus on five key priority areas to provide partners with the tools to reduce cases in all communities.
The five key areas include:
- Recovery from COVID-19
It is expected that missed and delayed diagnoses, late presentation of symptoms, and delayed treatment will have increased the pool of undetected and unreported TB in the community, potentially leading to an increase in cases in the short term.
- Prevent TB
Prevent and protect susceptible people in England from acquiring TB infection and developing active disease. This will include increasing latent tuberculosis infection testing (where groups at risk of TB are screened to see if they are carrying the bacteria without displaying symptoms) and offering the BCG vaccine to all those eligible within four weeks of birth.
- Detect TB
Improve early detection of TB by identifying, investigating, and acting on the components that contribute to patient delay.
- Control TB disease
Prepare and respond to emerging threats from TB transmission clusters, outbreaks and incidents, and drug resistant TB. This will include the rollout of the new National TB Surveillance System and the routine provision of whole genome sequencing data to TB services to allow them to better understand how the infection is being transmitted in the local community.
- Workforce
Develop and maintain the healthcare workforce to ensure workforce capacity to detect, case manage, and control TB.
Dr Jenny Harries, Chief Executive, UK Health Security Agency (UKHSA) said: “Tuberculosis affects some of the most vulnerable people in our society and ensuring that everyone has access to a timely diagnosis and effective treatment is critical.
“The elimination of TB in our communities is firmly within our grasp and this action plan presents a solid plan to creating a healthier future. Working with partners we will recover and build on learnings from the pandemic, injecting renewed focus into TB elimination.”
NHS England’s National Medical Director, Professor Stephen Powis, said: “Thanks to the hard work of NHS staff, rates of TB are significantly lower in England than they once were – but there is more work to be done to eradicate this disease completely.
“We know that there are groups who have disproportionately higher risks of contracting TB, and this action plan sets out how we’ll work with national and local partners to provide targeted support to tackle those inequalities, prevent missed or delayed diagnosis, and keep people safe and well.”
Genome sequencing
The plan will also utilise the expansion of the UK’s whole-genome sequencing (WGS) capabilities and increased use of technology in healthcare.
Before the COVID-19 pandemic, WGS was already in use for TB in England – being used to detect clusters and outbreaks, as well as to support the prevention of TB transmission. The engagement between local authority public health and health protection teams on contact tracing during the pandemic will support future public health interventions to prevent TB.
Innovative approaches across England to reach under-served populations will be built on, including schemes such as ‘Car in the Community’ in Lincolnshire — a team of nurses, who deliver care and tailored support to vulnerable groups direct from their car, to increase engagement and ease of access to healthcare in rural settings.
