Despite a reduction in the number of TB cases in the past three years, England is still the country with the highest number of cases in Western Europe¹.

Anyone can catch TB by breathing in the bacteria that causes it.  It is infectious but worsened by poor lifestyle. Rates in England are almost seven times higher in deprived areas¹ compared to the least deprived. Homelessness, drug use and general poverty are all risk factors.

There were 6,523 TB cases in England in 2014. London reported over 39% (2,572) of the country’s total, with a rate of around 30 TB cases per 100,000 people^1,2.

TB is treatable and curable, but taking the wrong dose or combination of medicines, or taking medication irregularly or for too short a time is ineffective and can lead to drug resistance. If left untreated, one person with active pulmonary TB could potentially infect as many as 15 people in a year.

Effective management of TB is dependent on close working between hospital, community and voluntary organisations. To recognise this, the new NICE guidance combines clinical advice and public health guidance for the first time.

Professor Andrew Hayward, NICE Guideline Development Group Co-Chair, Infectious Disease Epidemiology and Inclusion Health Research at UCL said: “We know what needs to be done to address the problem of TB in England; identify cases earlier, support patients through prolonged treatment and invest in co-ordinated services which are resourced to engage with socially complex cases.

“If rigorously applied the recommendations in this guidance will help to minimise the spread of infection, prevent the development of drug resistant disease and reduce the numbers of TB cases in the UK.”

The new NICE guideline focuses on prevention and education. It highlights the need to search out active cases in the communities most at risk. It also recommends that the treatment of latent TB (when the patient is infected with TB but does not show symptoms and is not yet infectious) be extended from people aged 35 years-and-under to 65 years-and-under. A course of medication for latent TB is shorter, easier to stick to and cheaper than the subsequent treatment required should the disease become active and infectious.

Professor Mark Baker, Director for the Centre of Clinical Practice at NICE, said: “TB is a disease that is treatable and curable, but it preys on the vulnerable. Those with compromised health and people suffering poor living conditions are at increased risk.

“The new NICE guidance sets out the systematic and robust approach we need to reduce the current impact of TB, effectively treat those infected and reduce its spread. This guideline, together with Public Health England’s TB strategy will undoubtedly contribute to the goal of eliminating TB from England.”   

Recommendations to support health professionals, public health workers and the voluntary sector to reach those at risk of TB are included in the guideline. Education and awareness is a key priority, and those with TB should be supported in their treatment to avoid drug resistance and limit the spread of the disease.

Professor Ibrahim Abubakar, Guideline Development Group Co-Chair and Director of Centre for Infectious Disease Epidemiology at UCL said: “In keeping with international goals to end the TB epidemic, this evidence-based guideline provides a framework that will support the implementation of the collaborative TB strategy for England and consign this killer disease back to history.”

Ends

¹Public Health England (2015) ‘Tuberculosis in England: 2015 report (presenting data to end of 2014)’ Accessed online.

²Public Health England (2015) ‘Tuberculosis in London: Annual review (2014 data)’ Accessed online.

Notes to Editors

1. Tuberculosis (TB) is a curable infectious disease caused by a bacterium called Mycobacterium tuberculosis (M. tuberculosis). Initial infection is cleared in over 80% of people, but in a small number of cases a defensive barrier is built round the infection and the TB bacteria lie dormant. This is called latent tuberculosis; the person is not ill and is not infectious. If the immune system fails to build the defensive barrier, or the barrier fails later, latent tuberculosis can spread within the lung (pulmonary tuberculosis) or develop in the other part(s) of the body it has spread to (extrapulmonary tuberculosis). Only some of those with latent tuberculosis will develop symptoms (‘active tuberculosis’).

2.  Active pulmonary TB

If you are diagnosed with active pulmonary TB (TB that affects your lungs and causes symptoms), you will be given a six-month course of a combination of antibiotics. The usual course of treatment is:

• two antibiotics (isoniazid and rifampicin) every day for six months
• two additional antibiotics (pyrazinamide and ethambutol) every day for the first two months

It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB.

After taking the medicine for two weeks, most people are no longer infectious and feel better. However, it is important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics.

3.  Latent TB

Latent TB is when you have been infected with the TB bacteria but do not have any symptoms of active disease. Treatment for latent TB is recommended for:

• people aged 65 years or under  (was previously 35 years or under)
• people with HIV, regardless of their age
• healthcare workers, regardless of their age 
• people with evidence of scarring caused by TB, as shown on a chest X-ray, but who never received treatment 

For children with suspected TB we recommend a test for hepatitis B and C should be considered before starting treatment for latent TB.