Tuberculosis in Wales Annual Report 2016 · Public Health Wales Tuberculosis in Wales Annual Report 2016: Data to the end of 2015 Author: CDSC Date: 03/11/2016 Status: Final Version:

Public Health Wales Tuberculosis in Wales Annual Report 2016: Data to the end of 2015

Author: CDSC Date: 03/11/2016 Status: Final

Version: 1 Page: 1 of 33 Intended Audience: Health Professionals

Tuberculosis in Wales Annual Report 2016

Data to the end of 2015 Author: Communicable Disease Surveillance Centre

Date: 03/11/2016 Version: 1

Status: Final

Intended Audience: Health Professionals

Purpose and Summary of Document:

This annual report summarises trends in the epidemiology of tuberculosis in Wales.

Publication/Distribution:

Director of Integrated Health Protection, Public Health Wales

Public Health Wales TB Programme Group

Public Health Wales Intranet and Internet

Public Health England TB Section




Acknowledgements

Public Health Wales Communicable Disease Surveillance Centre would like to thank

the microbiologists, clinicians, respiratory nurses and Health Protection Teams for

their contributions to the running of the Enhanced Tuberculosis Surveillance

Scheme in Wales. Public Health Wales greatly appreciates the support received

from Public Health England in conducting tuberculosis surveillance and for

coordinating the Enhanced Tuberculosis Surveillance scheme in England, Wales and

Northern Ireland.

Background

The Enhanced Tuberculosis Surveillance Scheme commenced on the 1st January

1999 with the aim of providing detailed and comparable information on the

epidemiology of tuberculosis. The scheme is coordinated in England, Wales and

Northern Ireland by Public Health England. In Wales, the scheme is administered

by Public Health Wales in collaboration with Local Health Boards.

This report summarises the latest annual trends in the epidemiology of tuberculosis

in Wales, using data reported through the Enhanced Tuberculosis Surveillance

Scheme. Wales’ data for the last ten years are summarised in a series of tables

and graphs by demographic, geographical, clinical and microbiological

characteristics.

Suggested Citation:

Tuberculosis in Wales Annual Report, October 2016. Public Health Wales Communicable

Disease Surveillance Centre.

Note:

The data used in this report were derived from the Enhanced Tuberculosis Surveillance

scheme. Figures for recent years should be considered provisional.




Key Points

The rate of tuberculosis in Wales has continued to decline steadily since 2009.

In 2015, 116 cases of tuberculosis were reported in Wales (3.7 per 100,000 population), stable compared to last year.

Notification rates vary geographically, with Newport and Cardiff having

the highest rates.

The notification rate was highest in those aged 35-44 years (6.7 per 100,000 population). Between 2014 and 2015 the notification rate

remained stable in most age groups apart from those aged 15-24 years where the rate decreased by 1.7 per 100,000 population, and those aged

35-44 years where the rate increased by 1.7 per 100,000 population.

Of the 116 cases reported in 2015, 54% were male and 46% female (rates of 4.1 and 3.4 per 100,000, respectively).

In 2015, 46% of tuberculosis cases were reported in the White ethnic

group, 52% were in the non-White population and 3% were of an unknown ethnic group. Forty-six percent of tuberculosis cases reported in

Wales were born in the UK, 53% of cases were born abroad and 2% of

cases had unknown place of birth.

Completeness of recording of social risk factors varied from 88% to 96% in 2015. Of those reported, 7% of cases reported a history of, or current

drug abuse; 5% reported a history of, or current alcohol misuse or abuse; 4% reported they had been, or are currently, homeless; and 5%

reported they had been, or are currently, in prison.

The rate of tuberculosis in those who reside in the most deprived areas of Wales was 6.7 (95% CI 4.8–9.1) per 100,000 population compared to 1.6

(95% CI 0.8–2.4) per 100,000 population in the least deprived areas.

Over half of the cases in 2015 (56%, 65/116) had pulmonary

tuberculosis (with or without extra-pulmonary disease); of these, 12 (18%) also had extra pulmonary disease.

In 2015 there was one case of MDR-TB reported in culture confirmed

tuberculosis in Wales. There was a decrease in both isoniazid and

rifampicin resistance in culture confirmed cases of tuberculosis in 2015 compared to 2014, from 12% to 8% and 4% to 1% respectively.




Outcome data are available for cases newly diagnosed in 2014. The proportion of drug sensitive cases with expected treatment duration of

less than 12 months who had completed treatment by 12 months increased in 2014 to 84%, compared to 83% in 2013. Treatment

completion was lowest in those aged 65 years and older (57%, 8/14). Treatment completion was over 80% in all other age groups.

The proportion of deaths in drug sensitive cases has increased from 5% (7/139) in 2013 to 10% (11/111) in 2014, a similar proportion to 2012.




Contents

1. Geographical Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2. Demographic Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3. Social Determinants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4. Deprivation . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .13

5. Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

6. Bacteriology, Speciation and Drug Susceptibility . . . . . . . . . . . 15

7. Tuberculosis case outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

8. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Notes on methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21




1. Geographical Distribution TB Rates in Wales and the UK

In Wales, 116 cases of tuberculosis were reported in 2015 to the Enhanced

Tuberculosis Surveillance (ETS) scheme, equivalent to a rate of 3.7 per 100,000

population (95% confidence interval (CI) 3.1-4.5 per 100,000 population). There has

been a sustained downward trend in TB since 2009, the 2015 rate remained stable

compared to 2014 (Figure 1.1).

Public Health England [1], reports the UK rate of tuberculosis as 9.6 (95% CI 9.3–9.8)

per 100,000 population in 2015. England continues to have the highest rate of

tuberculosis in the UK, with a rate of 10.5 (95% CI 10.2–10.8) per 100,000 population,

followed by Scotland (5.7 (95% CI 5.1-6.4) per 100,000 population), Wales (3.7 per

100,000 population), and Northern Ireland (3.2 (95% CI 2.5-4.2) per 100,000

population). Between 2014 and 2015, the rate of tuberculosis per 100,000 population

decreased in England, Northern Ireland and Scotland and remained the same in Wales.

Area of Residence

In 2015, the highest tuberculosis rate was observed in Cardiff and Vale University

Health Board (5.8 per 100,000 population) and the lowest rate was in Cwm Taf

University Health Board (1.3 per 100,000 population). Between 2014 and 2015, the rate

of tuberculosis increased in Betsi Cadwaladr University (3.5 per 100,000 population

compared to 2.0 per 100,000 population) and Powys Teaching Health Boards (5.3 per

100,000 population compared to 1.5 per 100,000 population), remained stable in Cardiff

and Vale, Abertawe Bro Morgannwg and Hywel Dda University Health Boards and

decreased in Aneurin Bevan (3.8 per 100,000 population compared to 5.3 per 100,000

population) and Cwm Taf University (1.3 per 100,000 population compared to 2.7 per

100,000 population) Health Boards (Table A1).

Between 2014 and 2015 the rate of tuberculosis increased in seven of the 22 Local

Authorities in Wales, remained stable in nine and decreased in six (Table A1). The rate

of tuberculosis ranged from 0 per 100,000 in Monmouthshire and Blaenau Gwent to

12.2 per 100,000 population in Newport (Figure 1.3a). Figure 1.3b shows the five year

average rate of tuberculosis per 100,000 population by Local Authority for the period

2011 to 2015. Tuberculosis rates continue to be highest in Cardiff and Newport. By

comparing 2015 with the average in the five years 2011 to 2015, the rate in 2015 was

higher in five Local Authorities, remained stable in seven Local Authorities and was

lower in nine Local Authorities (Figure 1.3).




Figure 1.1 Number of Cases and Rate of TB per 100,000 population in Wales, 2006-2015

Figure 1.2 Rate of TB per 100,000 population in the UK, 2015

183

204

169

213

152

131 136 142

114 116

6.1

6.8

5.6

7

5

4.3 4.4 4.6

3.7 3.7

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Number of cases Rate per 100 000

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

Rate per 100,000

England

Scotland

Wales

Northern Ireland

95% CI




Figure 1.3 Rate of TB by Local Authority a. 2015 b. 2011-2015

© Crown Copyright and database right 2014. Ordnance Survey 100044810




2. Demographic Characteristics

Age and Sex

In 2015, just over half of newly diagnosed tuberculosis cases were male (54%, 63/116),

a rate of 4.1 (95% CI 3.2-5.3) per 100,000 male population, with a lower rate of 3.4

(95% CI 2.5-4.4) per 100,000 females (Table A2). The highest incidence was seen in

people aged 35-44 (6.7 per 100,000; 21% of cases). The median age at diagnosis

remained stable between 2014 and 2015 at 43 years of age. During 2015 there was

only one reported case of tuberculosis in a child aged under 15 years, the same as in

2014 (Table A3). Changes in the rate of tuberculosis amongst different age groups from

2006-2015 are presented in Figure 2.1.

Ethnicity

Information on ethnic group was known for 97.4% (113/116) of cases notified in 2015.

The largest proportions of cases were from White (45.7%, 53/116) and Pakistani

(16.4%, 19/116) ethnic groups. The five year (2011 to 2015) average annual rate was

highest in the Black-African ethnic group; 134.6 per 100,000 population (95% CI 76.9-

218.6) and lowest in the White ethnic group, a rate of 1.7 per 100,000 population (95%

CI 1.3-2.3) (Figure 2.2, Table A4). Using 2011 census population estimates, since 2006

the rate of TB has decreased or remained stable in all ethnic groups. The rate of TB has

decreased by 54% in the Black African ethnic group (201.9 per 100,000 population in

2006 compared to 92.5 per 100,000 population in 2015), 35% in the Indian ethnic group

(115.9 per 100,000 population in 2006 compared to 75.3 per 100,000 population in

2015) ethnic group, 35% in the White ethnic group (2.8 per 100,000 population in 2006

compared to 1.8 per 100,000 population in 2015) and 5% in the Pakistani ethnic group

(163.5 per 100,000 population in 2006 compared to 155.4 per 100,000 population in

2015). Annual TB rates by ethnicity should be interpreted with caution as reliable annual

denominator data are not available by ethnicity.

Place of Birth

Information on place of birth was known for 98.3% (114/116) of tuberculosis cases

notified in Wales in 2015. Fifty-three percent of cases (61/116) were known to have

been born outside of the UK whilst 45.7% of cases (53/1165) were known to have been

born in the UK (Figure 2.3, Table A5).

As in previous years, in 2015 the majority of cases known to be born outside the UK

originated from South Asia (55.7%, 34/61) and Sub-Saharan Africa (16.4%, 10/61)

(Table A6). Information on region of birth was known for all cases born outside of the

UK.




Time between Entry into the UK and Diagnosis

The time between entry to the UK and tuberculosis diagnosis was known for 75.4%

(46/61) of non-UK born cases diagnosed in 2015 (Table A7). Where time since entry

was known, the highest proportion of cases were diagnosed over ten years since UK

entry (41.3%, 19/46) followed by less than two years since UK entry (23.9%, 11/46).

Figure 2.1 Rate of TB per 100,000 population by Age Group and Year in Wales, 2006-2015

Figure 2.2 Average Annual Number of TB Cases and Rate per 100,000 population in Wales by Ethnic Group, 2011-2015

0

2

4

6

8

10

12

14

16

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate

per

100,0

00 p

op

ula

tio

n 0-4

5-14

15-24

25-34

35-44

45-54

55-64

65+

51

161

2114 4 3 12

1.7 0.0

134.6

31.0

122.9117.8

35.6

19.1 19.3

Average Number of Cases Rate




0

50

100

150

200

250

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

er o

f T

B c

ase

sNumber of non-UK born TB cases Total number of TB cases

Figure 2.3 Number of non-UK born TB Cases in Wales, 2006-20151

1During 2006-2015 between 3-8% of cases were reported with an unknown origin for place of birth.




0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Drug use Alcohol misuse Homelessness Imprisonment Any risk factor

2009 2010 2011 2012 2013 2014 2015

3. Social Determinants

The collection of information on social risk factors for tuberculosis was introduced to the

Enhanced Tuberculosis Surveillance Scheme in 2009. In 2015, information on social

risk factors was documented for between 91.4% and 95.7% of cases in Wales,

depending on the risk factor investigated (Table 3.1). The completeness of recording

social risk factors increased between 2014 and 2015 for all risk factors.

The proportion of cases for which at least one social risk factor was recorded decreased between 2014 and 2015 from 17.2% to 11.8%. In 2015, 11.8% of cases reported at least one social risk factor. Seven percent of cases reported a history of, or current, drug use; 5.4% reported a history of, or current, alcohol misuse; 3.7% reported a history of, or current, homelessness; and 4.7% reported a history of, or current, imprisonment (Figure 3.1).

Figure 3.1 History of or current social risk factors among TB patients in Wales, 2009-2015

Table 3.1 Completeness of social risk factors among TB patients in Wales, 2009-2015

2009 2010 2011 2012 2013 2014 2015

Drug use 77.0% 72.4% 86.3% 83.1% 84.5% 85.1% 92.2%

Alcohol misuse 74.2% 79.6% 91.6% 90.4% 92.3% 87.7% 95.7%

Homelessness 79.3% 82.9% 90.1% 89.7% 93.7% 90.4% 92.2%

Imprisonment 62.9% 70.4% 85.5% 80.1% 85.9% 77.2% 91.4%

Any risk factor 62.4% 69.7% 80.2% 73.5% 79.6% 76.3% 87.9%




4. Deprivation

The Welsh Index of Multiple Deprivation (WIMD) developed for Welsh Government assigns an estimated rank of deprivation to each Lower Super Output Area (LSOA) [2]. Cases have been assigned to LSOA using postcode of residence as reported on ETS, postcode was available for all cases in 2015.

There were 40 cases that reported living in LSOAs comprising the most deprived fifth of Wales, 27 in the second most deprived fifth, 20 in the middle fifth, 19 in the forth fifth and 10 in the least deprived fifth.

The highest rate of tuberculosis was in the most deprived quintile at 6.7 (95% CI 4.8–9.1) per 100,000 population compared to 1.6 (95% CI 0.8–2.4) per 100,000 population in the least deprived quintile (Figure 4.1).

Figure 4.1 Rate of TB in Wales per 100,000 population by deprivation quintile, 2015

0

1

2

3

4

5

6

7

8

9

10

Most deprived Quintile 2 Quintile 3 Quintile 4 Least deprived

Rate

per

100,0

00 p

op

ula

tio

n

1Bars refer to 95% confidence intervals

95% CI




5. Clinical Characteristics

Site of Disease

Information on site of disease was known for 98.3% (114/116) of cases notified in 2015.

Over half of tuberculosis cases with a known site of disease had pulmonary disease

(with or without extra-pulmonary disease) (56.1%, 65/114). Eighteen percent (12/65) of

pulmonary cases were reported to also have extra pulmonary disease in at least one

additional site.

Many cases reported disease at multiple sites. For those where site of disease was

known, the extra thoracic lymph nodes were the most common extra-pulmonary site of

infection (19.3%, 22/114) (Table A8).

Planned Course of Treatment

In 2015, planned course of treatment was known for 95.7% (111/116) of cases. Of

these 111 cases, 91.9% (102) were assigned to a standard six month course of

treatment. It was known whether a patient was assigned to directly observed therapy

(DOT) treatment in 94.0% of cases (109/116). Sixteen percent of these cases (17/109)

were assigned DOT treatment.

In 2015, 66.7% (8/12) of cases reporting at least one social risk factor were known to be

assigned DOT.

Vaccination Status

The collection of data on Bacillus Calmette-Guérin (BCG) vaccination was introduced to

the Enhanced Tuberculosis Surveillance Scheme in 2009. In 2015, BCG vaccination

status was known for 58.6% (68/116) of tuberculosis cases, slightly higher

completeness compared to 2014 (50.0%, 57/114). Of the 68 cases with known BCG

vaccination status, 76.5% (52) were vaccinated, stable compared to 2014 (77.2%,

44/57). Coverage was highest in those aged 45-54 and 55-64, being 90.0% (9/10) in

both age groups, and lowest in those aged 5-24 where coverage was 50.0% (5/10)

(Table A9).

Previous Diagnosis

Information on previous tuberculosis diagnosis was known for 96.6% (112/116) of

cases, of which two had a previous diagnosis of tuberculosis (Table A10).




6. Bacteriology, Speciation and Drug Susceptibility

Bacteriology

Sixty nine percent (80/116) of all cases in 2015 were culture confirmed, and 90.8%

(59/65) of pulmonary cases (with or without extra pulmonary disease) were culture

confirmed. This is higher than the 73.4% UK average reported by Public Health England

as well as compared to other UK counterparts [1] and 11% above the European Centre

for Disease Prevention and Control (ECDC) target of 80% for culture confirmation of

pulmonary tuberculosis [3]. For 61.5% (40/65) of pulmonary cases in 2015 a sputum

smear result was recorded, of which 65.0% (26/40) were positive (Table A11). Forty

percent (20/50) of cases which reported extra pulmonary disease only were culture

confirmed.

Among 80 culture-confirmed cases reported through the Enhanced Tuberculosis

Surveillance scheme in 2015, 95.0% (76) of cases were due to infection by

Mycobacterium tuberculosis, 3.8% (3) were due to Mycobacterium bovis and 1.3% (1)

Mycobacterium africanum (Table A12).

Mycobacterium bovis

During 2015 there were three confirmed cases of M. bovis in Wales, more cases than

seen in the previous two years. All were UK born and aged between 25 and 54. An

additional questionnaire is completed when an isolate is identified as Mycobacterium

bovis, this questionnaire collects information on work and travel history, contact with

animals and consumption of unpasteurised milk. All cases had history of occupational

risk factors; two were part of a cluster.

Antimicrobial Resistance

Drug susceptibility results for the first line drugs isoniazid and rifampicin were reported for 100% (80/80) of culture confirmed tuberculosis cases. As with previous years, surveillance data continues to show that resistance to first line antimicrobials is low. Compared to 2014 there was a decrease in both isoniazid resistance and rifampicin resistance from 12.3% (10/81) to 7.5% (6/80) and 3.7% (3/81) to 1.3% (1/80), respectively. These resistance levels are similar to those reported elsewhere in the UK [4]. In 2015, there was one case of multidrug resistant (MDR) TB. These are TB strains that are resistant to both isoniazid and rifampicin. There were no cases of extensively drug resistant TB (XDR-TB). XDR-TB is resistant to at least one fluoroquinolone and at least one second line injectable drug (amikacin, capreomycin or kanamycin) [3].




Table 6.1: Number and proportion of TB cases with first line drug resistance1, Wales,

2006-2015

1 Includes culture confirmed cases with drug susceptibility results for at least isoniazid and rifampicin 2 Excludes M. bovis cases

7. Tuberculosis case outcomes

Drug sensitive cohort, 2005 – 2014

In accordance with the revised World Health Organization (WHO) TB outcome definitions, the drug sensitive cohort is defined as all TB cases excluding those with rifampicin resistant TB or MDR-TB (initial or amplified), or non-culture confirmed cases treated as MDR-TB [3].

In this report, treatment outcomes at 12 months for drug sensitive TB cases are reported for cases with an expected duration of treatment less than 12 months. This group excludes cases with central nervous system (CNS) disease who have an expected treatment duration of 12 months. Cases with spinal, cryptic disseminated or miliary disease are also excluded from this group, as CNS involvement cannot be reliably ruled out for the purposes of reporting.

TB outcomes, loss to follow up and deaths in the entire drug sensitive cohort (including cases with CNS, spinal, cryptic disseminated or miliary TB disease) are presented by last recorded outcome.

TB outcomes reported using these new cohort definitions will not be directly comparable with outcome data presented in previous reports. Treatment outcomes for all cases notified from 2005-2014 have been calculated using these new definitions, so that trends can be monitored.

TB outcomes at 12 months for drug sensitive cohort with expected duration of treatment less than 12 months

Information on the outcome of treatment, 12 months after treatment commenced, was reported for 98.9% (91/92) of cases in this cohort notified in 2014 (Table A13).

Year

n % n % n % n % n %

2006 6 4.7 1 0.8 0 0.0 0 0.0 6 4.7

2007 13 10.2 4 3.1 2 1.6 3 2.4 15 11.7

2008 5 4.9 3 2.9 2 2.0 0 0.0 6 5.9

2009 7 5.9 1 0.8 0 0.0 2 1.7 9 7.6

2010 6 5.6 0 0.0 1 0.9 2 1.9 8 7.5

2011 2 2.1 2 2.1 1 1.1 0 0.0 4 4.3

2012 10 9.5 1 1.0 1 1.0 0 0.0 10 9.5

2012 8 9.2 2 2.3 0 0.0 1 1.1 8 9.2

2014 10 12.3 3 3.7 1 1.2 0 0.0 10 12.3

2015 6 7.5 1 1.3 1 1.3 2 2.6 7 8.8

Ethambutol

resistant

Pyrazinamide

resistant2

Any resistance to

one or more first

line drug

Isoniazid

resistant

Rifampicin

resistant




Eighty-four percent (77/92) of cases completed treatment within 12 months within this cohort notified in 2014, compared to 82.6% (100/121) in 2013 (Table A13, Figure 7.1).

The proportion of cases who completed treatment within 12 months varied with age (Table A14). Treatment completion was highest in 55-64 year olds (90.9%, 10/11) and 25-34 year olds (90.0%, 18/20), and lowest in those aged 65 years and older (57.1%, 8/14). The proportion of cases that completed treatment was higher in females (93.9%, 31/33) compared to males (78.0%, 46/59, Table A15). The proportion of cases with a known site of disease and who completed treatment within 12 months was higher in those with extra-pulmonary disease only (94.4%, 34/36) compared to those with pulmonary disease only (79.5%, 35/44, Table A16).

In 2014, treatment completion at 12 months varied by Health Board ranging from 64.3% (Hywel Dda UHB) to 100.0% (Cwm Taf UHB and Powys THB) (Table A17).

TB outcomes at last reported outcome

Information on the outcome of treatment based on the last reported outcome was reported for 99.1% (110/111) of cases in this cohort notified in 2014 (Table A18).

The proportion of cases in this cohort notified in 2014 who completed treatment was 82.0% (91/111) (Table A18, Figure 7.1).

In 2014, treatment completion in the entire drug sensitive cohort varied by Health Board from 70.6% (Hywel Dda UHB) to 100.0% (Powys THB) (Table A19).

Deaths at last reported outcome

In 2014, the proportion of cases who were reported to have died at the last reported outcome among all drug sensitive TB cases was 9.9% (11/111), an increase from the proportion of deaths in cases reported in 2013 (5.0%, 7/139) (Table A20).

Of the 11 deaths in 2014, tuberculosis caused or contributed to death in 27.3% (3), was incidental in 18.2% (2) and the relationship between tuberculosis and death was unknown for the remaining 54.4% (6). Among those reported to have died, 18.2% (2/11) were diagnosed post-mortem.

For cases where TB caused or contributed to death, or the relationship between TB and death was unknown, 55.6% (5/9) were aged over 65 years and 44.4% (4/9) were aged 65 years or under.

Wales had the highest proportion of deaths in drug sensitive cases notified in 2014 (9.9%) compared to other countries in the UK (Scotland: 5.9%, England: 5.5% and Northern Ireland: 5.3%) [1].

Loss to follow up at last reported outcome

In 2014, 2.7% (3/111) of all drug sensitive TB cases were lost to follow up at the last reported outcome (Table A18). For all three cases the reason for loss to follow up was leaving the UK.




Figure 7.1: TB outcome percentages at 12 months for drug sensitive cases with expected treatment duration <12 months

1, Wales, 2014

1

Excludes initial and amplified to rifampicin resistant TB and MDR-TB cases and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB. 2

Not evaluated includes missing, unknown and transferred out.

Figure 7.2: Last recorded TB outcome percentages for the entire drug sensitive cohort1, Wales

2014

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB cases and MDR-TB treated cases.

2Not evaluated includes missing, unknown and transferred out

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Completed Died Lost to

follow up

Still on

treatment

Stopped Not

evaluated

77

83 3 0 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Completed Died Lost to

follow up

Still on

treatment

Stopped Not

evaluated

91

113 5

0 1




8. Conclusions

The rate of tuberculosis in Wales continues to decline steadily and reached the lowest ever recorded incidence of 3.7 per 100,000 population in 2014. TB incidence in 2015 was identical to 2014, with the majority of cases in the urban centres of Newport and Cardiff. The age distribution of cases remains similar to last year, although there has been a decrease in the rate of tuberculosis in older teenagers and younger adults and an increase in those in the middle-aged groups. There was only one case of TB in a child. The rate of tuberculosis continues to be higher in males.

TB incidence rates remain highest in people of Black African origin followed by those of Pakistani or Indian origin. TB rates have declined in most ethnic groups, but there has been little change in rates among people of Pakistani origin. In those born outside of the UK, the majority of cases were diagnosed over ten years after they entered the country. Although there are agreed protocols in place to screen people from high risk countries who enter Wales through formal asylum seeker or refugee routes, there are many other routes by which people can relocate to reside in Wales. There is scope for developing collaborative approaches between primary care and health boards in order to raise awareness about TB in these communities.

The proportion of TB cases in the UK-born population remains slightly higher in Wales (3.7 per 100,000 population) compared to England (3.4 per 100,000 population) [4]. Contact tracing continues to be an important measure for reducing the number of TB cases in Wales. There is a need to work with cases to encourage full and honest disclosure about their contacts, to minimise any perception of stigma associated with a diagnosis of TB and to emphasise the importance of contact tracing in preventing illness in other people.

The proportion of TB cases with pulmonary disease has remained stable, and this year the proportion of cases culture confirmed was well above the ECDC target of 80% for culture confirmation of pulmonary tuberculosis [4].

The proportion of cases completing treatment by 12 months has increased for the second year in a row and is nearing the 85% target for the proportion of newly detected infectious TB cases successfully completing treatment [6]. However, compared to the other regions of the UK, Wales has the highest proportion of TB outcomes reported as death. As the number of tuberculosis cases in Wales is small, proportions can be difficult to interpret and can fluctuate over time. The highest proportion of deaths are in those aged over 65 years of age, the introduction of the annual TB death review aims to improve outcomes for patients diagnosed with TB.

Rates of MDR TB remain low in Wales, with only one case reported in 2015.




Notes on Methods

All analysis was conducted using Stata 14.0. Rates were calculated using mid-year population estimates for Wales obtained from the Office of National Statistics (ONS). Rates for ethnic groups were calculated using ONS 2011 population estimates for ethnic groups resident in Wales. The 2014 Welsh Index of Multiple Deprivation (WIMD) was used to assign cases to deprivation fifth using postcode of residence and Lower Super Output Area (LSOA). Rates by deprivation fifth were calculated using ONS 2014 population estimates for LSOAs. Deprivation scores from the 2014 index are not comparable to previous indices. The WIMD is an ecological measure and not all deprived people live in deprived areas and not all people in deprived areas are deprived. This report only includes tuberculosis cases which have been notified to ETS. All Local Health Board and Local Authority figures are based on the area of residence of tuberculosis cases. Miliary tuberculosis is classified as pulmonary tuberculosis in accordance with the WHO’s recommendation and international reporting definitions [5]. Data presented in this report are correct as at April 2016. As treatment outcomes are reported at 12 months, treatment outcomes are only available to be reported on for cases notified in the previous year, at the time data are extracted for the report.

References [1] Reports of cases of tuberculosis to enhanced tuberculosis surveillance systems: United Kingdom, 2000 to 2015. Public Health England 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555298/T

B_Official_Statistics_2016_GTW2309.pdf

[2] Welsh Index of Multiple Deprivation (WIMD). Welsh Government 2015.

http://gov.wales/statistics-and-research/welsh-index-multiple-deprivation/?lang=en

[3] European Centre for Disease Control and Prevention (ECDC), Progress towards TB

elimination, 2010.

http://ecdc.europa.eu/en/publications/Publications/101111_SPR_Progressing_towards_

TB_elimination.pdf

[4] Public Health England. (2016) Tuberculosis in England: 2016. Public Health

England, London.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555343/T

B_Annual_Report_2016_GTW2309.pdf

[5] Definitions and reporting framework for tuberculosis – 2013 revision. WHO 2013.

http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf

[6] Royal College of Nursing, 2012. Tuberculosis case management and cohort review,

guidance for health professionals.

https://www2.rcn.org.uk/__data/assets/pdf_file/0010/439129/004204.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555298/TB_Official_Statistics_2016_GTW2309.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555298/TB_Official_Statistics_2016_GTW2309.pdf

http://gov.wales/statistics-and-research/welsh-index-multiple-deprivation/?lang=en

http://ecdc.europa.eu/en/publications/Publications/101111_SPR_Progressing_towards_TB_elimination.pdf

http://ecdc.europa.eu/en/publications/Publications/101111_SPR_Progressing_towards_TB_elimination.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555343/TB_Annual_Report_2016_GTW2309.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/555343/TB_Annual_Report_2016_GTW2309.pdf

http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf

https://www2.rcn.org.uk/__data/assets/pdf_file/0010/439129/004204.pdf




Appendix

Table A1. Number of Cases and Rate1 of Tuberculosis in Wales by LHB and LA, 2006-2015

1Rate per 100,000 using ONS Mid-Year population estimates 2Average number of cases and rate calculated using the last 5 years data (2011 to 2015)

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

Abertawe Bro Morgannwg

University28 5.6 41 8.1 33 6.5 36 7.0 23 4.5 19 3.7 17 3.3 23 4.4 14 2.7 15 2.9 18 3.4

Bridgend 8 6.0 11 8.1 8 5.8 3 2.2 3 2.2 5 3.6 1 0.7 3 2.1 0 0.0 5 3.5 3 2.0

Neath Port Talbot 10 7.2 6 4.3 2 1.4 7 5.0 5 3.6 5 3.6 4 2.9 9 6.4 2 1.4 4 2.8 5 3.4

Swansea 10 4.3 24 10.3 23 9.8 26 11.0 15 6.3 9 3.8 12 5.0 11 4.6 12 5.0 6 2.5 10 4.2

Aneurin Bevan University 24 4.3 32 5.6 20 3.5 37 6.5 24 4.2 24 4.2 25 4.3 25 4.3 31 5.3 22 3.8 25 4.4

Blaenau Gwent 2 2.9 3 4.3 0 0.0 3 4.3 4 5.7 1 1.4 1 1.4 2 2.9 2 2.9 0 0.0 1 1.7

Caerphilly 2 1.2 4 2.3 4 2.3 2 1.1 3 1.7 5 2.8 5 2.8 4 2.2 2 1.1 3 1.7 4 2.1

Monmouthshire 4 4.5 5 5.6 3 3.3 0 0.0 2 2.2 5 5.5 3 3.3 3 3.3 2 2.2 0 0.0 3 2.8

Newport 15 10.7 18 12.7 13 9.1 28 19.5 15 10.4 12 8.2 15 10.3 15 10.2 24 16.3 18 12.2 17 11.5

Torfaen 1 1.1 2 2.2 0 0.0 4 4.4 0 0.0 1 1.1 1 1.1 1 1.1 1 1.1 1 1.1 1 1.1

Betsi Cadwaladr

University49 7.2 35 5.2 28 4.1 36 5.3 28 4.1 19 2.8 19 2.8 30 4.3 14 2.0 24 3.5 21 3.1

Anglesey 13 18.7 0 0.0 4 5.7 7 10.0 4 5.7 0 0.0 2 2.9 6 8.6 3 4.3 5 7.1 3 4.6

Conwy 4 3.5 7 6.2 7 6.1 6 5.2 5 4.4 2 1.7 0 0.0 4 3.5 4 3.4 3 2.6 3 2.2

Denbighshire 5 5.3 3 3.2 4 4.2 2 2.1 2 2.1 3 3.2 3 3.2 4 4.2 1 1.1 6 6.3 3 3.6

Flintshire 4 2.7 3 2.0 5 3.3 6 3.9 2 1.3 5 3.3 3 2.0 4 2.6 1 0.7 4 2.6 3 2.2

Gwynedd 10 8.4 13 10.9 2 1.7 7 5.8 10 8.3 4 3.3 7 5.7 6 4.9 3 2.5 4 3.3 5 3.9

Wrexham 13 10.0 9 6.9 6 4.5 8 6.0 5 3.7 5 3.7 4 2.9 6 4.4 2 1.5 2 1.5 4 2.8

Cardiff and Vale

University49 11.0 70 15.5 54 11.8 65 14.0 45 9.6 43 9.1 36 7.6 40 8.4 28 5.8 28 5.8 35 7.3

Cardiff 42 13.0 57 17.4 49 14.7 59 17.5 41 12.0 35 10.1 32 9.2 38 10.8 27 7.6 27 7.6 32 9.0

Vale of Glamorgan 7 5.7 13 10.4 5 4.0 6 4.8 4 3.2 8 6.3 4 3.2 2 1.6 1 0.8 1 0.8 3 2.5

Cwm Taf University 9 3.1 13 4.5 23 7.9 22 7.5 16 5.5 6 2.0 16 5.4 10 3.4 8 2.7 4 1.3 9 3.0

Merthyr Tydfil 0 0.0 2 3.5 2 3.5 3 5.2 3 5.1 2 3.4 4 6.8 3 5.1 1 1.7 1 1.7 2 3.7

Rhondda Cynon Taff 9 3.8 11 4.7 21 8.9 19 8.1 13 5.5 4 1.7 12 5.1 7 3.0 7 3.0 3 1.3 7 2.8

Hywel Dda University 19 5.1 11 2.9 7 1.8 8 2.1 12 3.2 19 5.0 20 5.2 11 2.9 17 4.4 16 4.2 17 4.3

Carmarthenshire 9 5.0 9 5.0 0 0.0 5 2.7 9 4.9 9 4.9 7 3.8 7 3.8 10 5.4 7 3.8 8 4.3

Ceredigion 3 4.0 1 1.3 1 1.3 1 1.3 1 1.3 5 6.6 2 2.6 1 1.3 1 1.3 1 1.3 2 2.6

Pembrokeshire 7 5.9 1 0.8 6 5.0 2 1.6 2 1.6 5 4.1 11 8.9 3 2.4 6 4.9 8 6.5 7 5.4

Powys Teaching 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 3 2.3 2 1.5 7 5.3 3 2.4

Powys 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 3 2.3 2 1.5 7 5.3 3 2.4

Not known 0 0 0 0 0 0 0 0 0 0 0

Total 183 6.1 204 6.8 169 5.6 213 7.0 152 5.0 131 4.3 136 4.4 142 4.6 114 3.7 116 3.7 135 4.4

20142010 2011HB and LA

5 Year Average22006 2007 2008 2009 20152012 2013




Table A2. Number of Cases and Rate1 of Tuberculosis in Wales by Sex, 2006-2015

1Rate per 100,000 using ONS Mid-Year population estimates

Table A3. Number of Cases and Rate1 of Tuberculosis in Wales by Age Group, 2006-2015

1Rate per 100,000 using ONS Mid-Year population estimates

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

Male 111 7.6 114 7.8 94 6.4 122 8.2 92 6.2 71 4.7 91 6.0 90 5.9 73 4.8 63 4.1

Female 72 4.7 90 5.9 71 4.6 86 5.5 58 3.7 57 3.7 45 2.9 52 3.3 41 2.6 53 3.4

Unknown 0 0 4 5 2 3 0 0 0 0

Total 183 204 169 213 152 131 136 142 114 116

20152011Sex

20122006 20142007 2008 2009 20132010

Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

0-4 5 3.1 11 6.7 8 4.7 11 6.4 2 1.1 2 1.1 0 0.0 2 1.1 1 0.6 0 0.0

5-14 4 1.1 3 0.8 9 2.6 3 0.9 4 1.2 6 1.8 3 0.9 3 0.9 0 0.0 1 0.3

15-24 21 5.3 25 6.2 17 4.2 29 7.1 17 4.2 21 5.1 14 3.4 26 6.3 18 4.4 11 2.7

25-34 43 12.5 53 15.4 32 9.2 44 12.5 32 9.0 29 8.0 40 11.0 37 10.0 23 6.1 24 6.4

35-44 35 8.2 36 8.4 29 6.9 33 8.0 25 6.2 27 6.9 17 4.5 16 4.3 18 4.9 24 6.7

45-54 21 5.4 28 7.1 18 4.5 32 7.8 19 4.6 11 2.6 24 5.6 19 4.4 19 4.4 17 3.9

55-64 20 5.2 9 2.3 18 4.6 17 4.3 18 4.6 9 2.3 9 2.3 20 5.3 14 3.7 17 4.4

65+ 34 6.5 39 7.4 38 7.1 44 8.0 35 6.3 26 4.6 29 4.9 19 3.2 21 3.4 22 3.5

Total 183 204 169 213 152 131 136 142 114 116

2009 20132010 2011 20152014Age Group

20122006 2007 2008




Table A4. Number and Percentage of Tuberculosis Cases in Wales by Ethnic Group, 2006-2015

1Average number of cases and rates calculated using the last 5 years data (2011 to 2015)

2Rate per 100,000 using ONS 2011 population estimates by ethnic group

Table A5. Number and Percentage of Tuberculosis Cases in Wales by Place of Birth, 2006-2015

cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Cases Rate

White 81 44.3 87 42.6 80 47.3 97 45.5 66 43.4 40 30.5 58 42.6 62 43.7 42 36.8 53 45.7 51 1.7

Black-Caribbean 1 0.5 0 0.0 1 0.6 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Black-African 24 13.1 23 11.3 22 13.0 31 14.6 11 7.2 23 17.6 13 9.6 18 12.7 15 13.2 11 9.5 16 134.6

Black-Other 1 0.5 3 1.5 1 0.6 3 1.4 3 2.0 1 0.8 1 0.7 0 0.0 1 0.9 1 0.9 1 31.0

Indian 20 10.9 26 12.7 25 14.8 30 14.1 21 13.8 23 17.6 27 19.9 22 15.5 21 18.4 13 11.2 21 122.9

Pakistani 20 10.9 17 8.3 10 5.9 20 9.4 18 11.8 12 9.2 13 9.6 12 8.5 16 14.0 19 16.4 14 117.8

Bangladeshi 7 3.8 7 3.4 3 1.8 6 2.8 9 5.9 3 2.3 1 0.7 7 4.9 2 1.8 6 5.2 4 35.6

Chinese 2 1.1 5 2.5 6 3.6 6 2.8 3 2.0 3 2.3 1 0.7 4 2.8 3 2.6 2 1.7 3 19.1

Mixed/Other 20 10.9 20 9.8 12 7.1 5 2.3 8 5.3 15 11.5 15 11.0 13 9.2 10 8.8 8 6.9 12 19.3

Unknown 7 3.8 16 7.8 9 5.3 15 7.0 12 7.9 11 8.4 7 5.1 4 2.8 4 3.5 3 2.6 6

Total 183 204 169 213 152 131 136 142 114 116 128 4.2

2008 2009 2010 2011 20142012 5 year Average2

Ethnic Group20132006 2007 2015

cases % cases % cases % cases % cases % cases % cases % cases % cases % cases %

Born in UK 68 37.2 81 39.7 81 47.9 103 48.4 73 48.0 46 35.1 57 41.9 58 40.8 43 37.7 53 45.7

Born Abroad 90 49.2 97 47.5 75 44.4 89 41.8 68 44.7 80 61.1 74 54.4 82 57.7 65 57.0 61 52.6

Not Known 25 13.7 26 12.7 13 7.7 21 9.9 11 7.2 5 3.8 5 3.7 2 1.4 6 5.3 2 1.7

Total 183 204 169 213 152 131 136 142 114 116

20142011 2015Place of

Birth

201320122007 2008 2009 20102006




Table A6. Number and Percentage of Tuberculosis Cases in Wales by World Region of Birth for Non-UK Born Cases, 2006-2015

Table A7. Time between UK Entry and Tuberculosis Diagnosis for Non-UK Born Cases, 2006-2015


North Africa 2 2.2 1 1.0 1 1.3 4 4.5 1 1.5 0 0.0 1 1.4 3 3.7 3 4.6 3 4.9

Sub-Saharan Africa 23 25.6 27 27.8 20 26.7 27 30.3 12 17.6 25 31.3 15 20.3 19 23.2 11 16.9 10 16.4

East Asia 3 3.3 5 5.2 4 5.3 2 2.2 0 0.0 4 5.0 1 1.4 3 3.7 3 4.6 3 4.9

South Asia 38 42.2 36 37.1 32 42.7 42 47.2 35 51.5 37 46.3 40 54.1 41 50.0 36 55.4 34 55.7

South East Asia 4 4.4 13 13.4 9 12.0 3 3.4 8 11.8 8 10.0 7 9.5 8 9.8 3 4.6 3 4.9

Central Europe 3 3.3 2 2.1 0 0.0 0 0.0 2 2.9 1 1.3 1 1.4 3 3.7 0 0.0 4 6.6

East Europe 0 0.0 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 2 2.7 1 1.2 1 1.5 0 0.0

West Europe 11 12.2 12 12.4 7 9.3 9 10.1 9 13.2 2 2.5 3 4.1 2 2.4 3 4.6 2 3.3

East Mediterranean 4 4.4 1 1.0 1 1.3 2 2.2 0 0.0 2 2.5 2 2.7 1 1.2 2 3.1 2 3.3

North America 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 0 0.0 1 1.5 0 0.0

South & Central America 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 1 1.2 1 1.5 0 0.0

Not Known 1 1.1 0 0.0 0 0.0 0 0.0 1 1.5 1 1.3 0 0.0 0 0.0 1 1.5 0 0.0

Total 90 97 75 89 68 80 74 82 65 61

Region of Birth20122006 2007 20152008 2009 20132010 2011 2014


< 2 years 19 21.1 29 29.9 19 25.3 20 22.5 9 13.2 19 23.8 19 25.7 22 26.8 15 23.1 11 18.0

2-5 years 32 35.6 20 20.6 15 20.0 32 36.0 20 29.4 20 25.0 25 33.8 17 20.7 15 23.1 10 16.4

6-10 years 7 7.8 4 4.1 11 14.7 10 11.2 8 11.8 20 25.0 11 14.9 15 18.3 5 7.7 6 9.8

>10 years 9 10.0 13 13.4 15 20.0 6 6.7 13 19.1 11 13.8 11 14.9 13 15.9 16 24.6 19 31.1

Not Recorded 23 25.6 31 32.0 15 20.0 21 23.6 18 26.5 10 12.5 8 10.8 15 18.3 14 21.5 15 24.6

Total 90 97 75 89 68 80 74 82 65 61

2010 2011Time between UK

Entry and Diagnosis

2006 20152014201320122007 2008 2009




Table A8. Number and Percentage of Tuberculosis Cases in Wales by Site of Disease, 2006-2015

1Patients may have disease at more than one site 2Pulmonary TB includes miliary TB in accordance with the WHO’s recommendation and international reporting definitions [5]. Revised trends in site of disease are presented for previous years using the revised WHO definitions.

Table A9. Number and Percentage of Cases in Wales with a History of BCG Vaccination by Age Group, 2015

Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases %

Pulmonary2

112 61.2 135 66.2 102 60.4 126 59.2 93 61.2 71 54.2 78 57.4 84 59.2 64 56.1 65 56.0

Extra thoracic lymph nodes 41 22.4 39 19.1 26 15.4 39 18.3 28 18.4 33 25.2 33 24.3 25 17.6 19 16.7 22 19.0

Intra thoracic lymph nodes 9 4.9 21 10.3 16 9.5 11 5.2 9 5.9 1 0.8 5 3.7 6 4.2 8 7.0 10 8.6

Pleural 12 6.6 17 8.3 10 5.9 14 6.6 6 3.9 12 9.2 10 7.4 8 5.6 8 7.0 8 6.9

Gastrointestinal 11 6.0 7 3.4 10 5.9 6 2.8 6 3.9 8 6.1 5 3.7 5 3.5 3 2.6 3 2.6

CNS-meningitis 3 1.6 4 2.0 4 2.4 4 1.9 5 3.3 3 2.3 2 1.5 3 2.1 7 6.1 3 2.6

CNS-other 2 1.1 4 2.0 3 1.8 4 1.9 4 2.6 2 1.5 4 2.9 4 2.8 4 3.5 3 2.6

Bone-Spine 4 2.2 4 2.0 4 2.4 8 3.8 2 1.3 4 3.1 3 2.2 8 5.6 8 7.0 4 3.4

Bone-other 3 1.6 3 1.5 3 1.8 4 1.9 1 0.7 5 3.8 4 2.9 2 1.4 1 0.9 3 2.6

Genitourinary 2 1.1 6 2.9 2 1.2 6 2.8 3 2.0 2 1.5 5 3.7 4 2.8 5 4.4 5 4.3

Laryngeal 1 0.5 1 0.5 1 0.6 0 0.0 2 1.3 1 0.8 0 0.0 1 0.7 0 0.0 2 1.7

Cryptic 1 0.5 0 0.0 1 0.6 1 0.5 0 0.0 2 1.5 1 0.7 1 0.7 3 2.6 3 2.6

Other extra pulmonary 10 5.5 5 2.5 13 7.7 22 10.3 14 9.2 21 16.0 8 5.9 8 5.6 7 6.1 10 8.6

Unknown extra pulmonary 44 24.0 36 17.6 33 19.5 40 18.8 37 24.3 40 30.5 45 33.1 30 21.1 29 25.4 20 17.2

Total cases 183 204 169 213 152 131 136 142 114 116

2008 2009 2010 20142013 2015Site of Disease

1 201220112006 2007

Age Group VaccinatedKnown

Status

Vaccinated

%

Known

Status %

0-4 - - - -

5-14 0 1 0.0 100.0

15-24 5 9 55.6 81.8

25-34 13 17 76.5 70.8

35-44 12 14 85.7 58.3

45-54 9 10 90.0 58.8

55-64 9 10 90.0 58.8

65+ 4 7 57.1 31.8

Total 52 68 76.5 58.6




Table A10. Number and Percentage of Tuberculosis Cases in Wales with Previous Tuberculosis Diagnosis, 2006-2015

Table A11. Number and Percentage of Tuberculosis Cases in Wales with Bacteriological Confirmation, 2006-2015

1 Denominator for percentage is total number of TB cases 2 Denominator for percentage is total number of pulmonary TB cases 3 Denominator for percentage is number of pulmonary cases with sputum smear taken


Yes 8 4.4 17 8.3 15 8.9 23 10.8 6 3.9 10 7.6 6 4.4 8 5.6 9 7.9 2 1.7

No 140 76.5 147 72.1 127 75.1 152 71.4 122 80.3 108 82.4 121 89.0 125 88.0 91 79.8 110 94.8

Not Reported 35 19.1 40 19.6 27 16.0 38 17.8 24 15.8 13 9.9 9 6.6 9 6.3 14 12.3 4 3.4

Total 183 204 169 213 152 131 136 142 114 116

2007 2008 201520132010 2011 2014Previous Diagnosis

201220092006


Culture Confirmed 1 128 69.9 128 62.7 102 60.4 119 55.9 107 70.4 94 71.8 105 77.2 87 61.3 81 71.1 80 69.0

Culture Confirmed

Pulmonary Cases 289 79.5 93 68.9 73 71.6 80 63.5 72 77.4 56 78.9 63 80.8 62 73.8 55 85.9 59 90.8

Pulmonary Cases with

Sputum Smear Taken 289 79.5 94 69.6 55 53.9 39 31.0 41 44.1 39 54.9 39 50.0 43 51.2 35 54.7 40 61.5

Positive Sputum Smear

Pulmonary Cases 3 45 50.6 42 44.7 27 49.1 19 48.7 23 56.1 29 74.4 32 82.1 36 83.7 20 57.1 26 65.0

2007 2008 201520122010 20132006 2009 2014Bacteriological Results

2011




Table A12. Species Identification in Culture Confirmed Tuberculosis Case, Wales, 2006-15

Table A13. TB outcome at 12 months after treatment start for drug sensitive cases with expected treatment duration <12 months

1, Wales, 2005 -

2014

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB 2Not evaluated includes missing, unknown and transferred out.

Species Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases %

M. africanum 0 0.0 0 0.0 0 0.0 1 0.8 0 0.0 4 4.3 1 1.0 0 0.0 0 0.0 1 1.3

M. bovis 0 0.0 1 0.8 2 2.0 4 3.4 1 0.9 0 0.0 3 2.9 0 0.0 1 1.2 3 3.8

M. tuberculosis 128 100.0 127 99.2 100 98.0 114 95.8 105 98.1 90 95.7 101 96.2 87 100.0 80 98.8 76 95.0

M. tuberculosis complex 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Total 128 128 102 119 107 94 105 87 81 80

201520142013201220112006 2007 2008 2009 2010

Total

Year n % n % n % n % n % n % n

2005 116 67.4 17 9.9 8 4.7 13 7.6 2 1.2 16 9.3 172

2006 115 66.9 14 8.1 5 2.9 6 3.5 4 2.3 28 16.3 172

2007 113 60.8 13 7.0 11 5.9 21 11.3 3 1.6 25 13.4 186

2008 115 76.2 12 7.9 3 2.0 14 9.3 0 0.0 7 4.6 151

2009 145 75.9 17 8.9 6 3.1 11 5.8 5 2.6 7 3.7 191

2010 107 77.5 17 12.3 5 3.6 7 5.1 1 0.7 1 0.7 138

2011 90 76.3 8 6.8 8 6.8 5 4.2 6 5.1 1 0.8 118

2012 91 75.8 11 9.2 6 5.0 9 7.5 1 0.8 2 1.7 120

2013 100 82.6 4 3.3 6 5.0 3 2.5 2 1.7 6 5.0 121

2014 77 83.7 8 8.7 3 3.3 3 3.3 0 0.0 1 1.1 92

Completed Died Lost to follow-up Still on treatment Stopped Not evaluated2




Table A14. Treatment completion at 12 months by age group for drug sensitive cases with expected treatment duration <12 months1, Wales, 2005 -

2014

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB

Table A15. Treatment completion at 12 months by sex for drug sensitive cases with expected treatment duration <12 months

1, Wales, 2005 - 2014


Year n % n % n % n % n % n % n % n %

2005 2 50.0 4 100.0 12 66.7 28 82.4 23 85.2 14 66.7 7 58.3 26 50.0

2006 4 100.0 2 50.0 15 71.4 33 80.5 19 61.3 14 73.7 14 77.8 14 41.2

2007 6 54.5 0 - 15 68.2 29 67.4 22 64.7 18 72.0 4 44.4 19 48.7

2008 7 100.0 7 87.5 13 81.3 23 79.3 20 80.0 15 93.8 13 76.5 17 51.5

2009 11 100.0 3 100.0 19 73.1 31 75.6 21 80.8 26 86.7 13 76.5 21 56.8

2010 1 100.0 4 100.0 13 86.7 23 82.1 20 83.3 14 82.4 11 68.8 21 63.6

2011 1 100.0 6 100.0 13 72.2 21 80.8 18 78.3 10 100.0 7 87.5 14 53.8

2012 0 - 2 100.0 11 84.6 30 83.3 11 68.8 16 84.2 5 62.5 16 61.5

2013 2 100.0 2 66.7 18 90.0 25 83.3 13 86.7 13 76.5 16 84.2 11 73.3

2014 0 - 0 - 15 93.8 18 90.0 13 86.7 13 81.3 10 90.9 8 57.1

65+35-4425-340-4 5-14 15-24 45-54 55-64

Year n % n %

2005 67 69.8 49 64.5

2006 70 66.7 45 67.2

2007 61 58.1 52 64.2

2008 65 77.4 48 76.2

2009 83 76.1 58 75.3

2010 60 71.4 46 88.5

2011 46 74.2 42 79.2

2012 58 71.6 33 84.6

2013 62 83.8 38 80.9

2014 46 78.0 31 93.9

Male Female




Table A16. TB outcome at 12 months by site of disease for drug sensitive cases with expected treatment duration < 12 months, 20141

1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB 2 Not evaluated includes missing, unknown and transferred out 3 Multiple sites of disease can be reported so the total does not add up to the total number of cases 4 All other extra-pulmonary sites includes gastrointestinal, genitourinary, laryngeal, other and unknown extra-pulmonary disease

Total3

Site of disease n % n % n % n % n % n % n

Pulmonary only 35 79.5 5 11.4 0 0.0 3 6.8 0 0.0 1 2.3 44

Pulmonary, with or without EP 43 76.8 7 12.5 2 3.6 3 5.4 0 0.0 1 1.8 56

Extrapulmonary only 34 94.4 1 2.8 1 2.8 0 0.0 0 0.0 0 0.0 36

Extra-thoracic lymph nodes 17 94.4 0 0.0 1 5.6 0 0.0 0 0.0 0 0.0 18

Intra-thoracic lymph nodes 6 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 6

Pleural 6 75.0 1 12.5 1 12.5 0 0.0 0 0.0 0 0.0 8

Bone Other 1 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1

All other EP sites4 31 86.1 2 5.6 3 8.3 0 0.0 0 0.0 0 0.0 36

Total 77 83.7 8 8.7 3 3.3 3 3.3 0 0.0 1 1.1 92





Table A17. TB outcome at 12 months after treatment start for drug sensitive cases with expected treatment duration <12 months by LA and LHB,

Wales, 2013 – 20141


2013 2014

LHB and LA

n n % n n %


University 20 12 60.0 10 8 80.0

Bridgend 3 2 66.7 0 0 -

Neath Port Talbot 9 3 33.3 2 1 50.0

Swansea 8 7 87.5 8 7 87.5

Aneurin Bevan 19 16 84.2 24 21 87.5

Blaenau Gwent 2 2 100.0 1 1 100.0

Caerphilly 3 3 100.0 2 2 100.0

Monmouthshire 3 3 100.0 2 2 100.0

Newport 10 7 70.0 18 15 83.3

Torfaen 1 1 100.0 1 1 100.0

Betsi Cadwaladr University 25 23 92.0 13 10 76.9

Anglesey 6 5 83.3 3 3 100.0

Conwy 3 3 100.0 4 2 50.0

Denbighshire 4 4 100.0 1 1 100.0

Flintshire 3 3 100.0 1 1 100.0

Gwynedd 4 4 100.0 2 1 50.0

Wrexham 5 4 80.0 2 2 100.0

Cardiff and Vale University 36 33 91.7 24 22 91.7

Cardiff 34 32 94.1 23 21 91.3

Vale of Glamorgan 2 1 50.0 1 1 100.0

Cwm Taf 8 5 62.5 6 6 100.0

Merthyr Tydfil 3 1 33.3 0 0 -

Rhondda Cynon Taf 5 4 80.0 6 6 100.0

Hywel Dda 10 9 90.0 14 9 64.3

Carmarthenshire 7 7 100.0 10 6 60.0

Ceredigion 1 1 100.0 0 0 -

Pembrokeshire 2 1 50.0 4 3 75.0

Powys Teaching 3 2 66.7 1 1 100.0

Powys 3 2 66.7 1 1 100.0

Total 121 100 82.6 92 77 83.7

Total Treatment completed Total Treatment completed




Table A18. Last recorded TB outcome for entire drug sensitive cohort, Wales, 2005-20141

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases 2 Not evaluated includes missing, unknown and transferred out

Total

Year n % n % n % n % n % n % n

2005 123 67.2 19 10.4 8 4.4 13 7.1 3 1.6 17 9.3 183

2006 127 70.2 14 7.7 6 3.3 1 0.6 4 2.2 29 16.0 181

2007 138 69.0 17 8.5 15 7.5 1 0.5 3 1.5 26 13.0 200

2008 139 83.7 14 8.4 4 2.4 0 0.0 1 0.6 8 4.8 166

2009 169 79.7 20 9.4 8 3.8 3 1.4 5 2.4 7 3.3 212

2010 122 80.3 22 14.5 6 3.9 0 0.0 1 0.7 1 0.7 152

2011 105 81.4 8 6.2 9 7.0 0 0.0 6 4.7 1 0.8 129

2012 106 78.5 15 11.1 6 4.4 3 2.2 3 2.2 2 1.5 135

2013 113 81.3 7 5.0 8 5.8 1 0.7 3 2.2 7 5.0 139

2014 91 82.0 11 9.9 3 2.7 5 4.5 0 0.0 1 0.9 111





Table A19. Last recorded TB outcome for entire drug sensitive cohort by LHB and LA, Wales, 2013-20141

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases

2013 2014

LHB and LA

n n % n n %


University 22 13 59.1 11 9 81.8

Bridgend 3 2 66.7 0 0 -

Neath Port Talbot 9 4 44.4 2 1 50.0

Swansea 10 7 70.0 9 8 88.9

Aneurin Bevan 24 21 87.5 31 25 80.6

Blaenau Gwent 2 2 100.0 2 2 100.0

Caerphilly 4 3 75.0 2 2 100.0

Monmouthshire 3 3 100.0 2 2 100.0

Newport 14 12 85.7 24 18 75.0

Torfaen 1 1 100.0 1 1 100.0

Betsi Cadwaladr University 30 26 86.7 14 10 71.4

Anglesey 6 5 83.3 3 3 100.0

Conwy 4 3 75.0 4 2 50.0

Denbighshire 4 4 100.0 1 1 100.0

Flintshire 4 3 75.0 1 1 100.0

Gwynedd 6 6 100.0 3 1 33.3

Wrexham 6 5 83.3 2 2 100.0

Cardiff and Vale University 40 37 92.5 28 26 92.9

Cardiff 38 36 94.7 27 25 92.6

Vale of Glamorgan 2 1 50.0 1 1 100.0

Cwm Taf 9 5 55.6 8 7 87.5

Merthyr Tydfil 3 1 33.3 1 0 -

Rhondda Cynon Taf 6 4 66.7 7 7 100.0

Hywel Dda 11 9 81.8 17 12 70.6

Carmarthenshire 7 7 100.0 10 7 70.0

Ceredigion 1 1 100.0 1 1 100.0

Pembrokeshire 3 1 33.3 6 4 66.7

Powys Teaching 3 2 66.7 2 2 100.0

Powys 3 2 66.7 2 2 100.0

Total 139 113 81.3 111 91 82.0

Total Treatment completed Total Treatment completed




Table A20. All drug sensitive TB cases reported to have died at last recorded outcome, Wales, 2005 – 20141

1Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases

Cases reported

Year n n % n % n % n % n %

2005 183 19 10.4 6 31.6 5 26.3 8 42.1 6 31.6

2006 181 14 7.7 6 42.9 3 21.4 5 35.7 5 35.7

2007 200 17 8.5 7 41.2 1 5.9 9 52.9 4 23.5

2008 166 14 8.4 3 21.4 6 42.9 5 35.7 4 28.6

2009 212 20 9.4 5 25.0 2 10.0 13 65.0 3 15.0

2010 152 22 14.5 7 31.8 4 18.2 11 50.0 6 27.3

2011 129 8 6.2 2 25.0 3 37.5 3 37.5 2 25.0

2012 135 15 11.1 3 20.0 1 6.7 11 73.3 6 40.0

2013 139 7 5.0 1 14.3 1 14.3 5 71.4 3 42.9

2014 111 11 9.9 3 27.3 2 18.2 6 54.5 2 18.2

Total deathsTB caused or

contributed to death

TB incidental to

deathUnknown Post mortem

Documents

Tuberculosis in Wales Annual Report 2016 · Public Health Wales Tuberculosis in Wales Annual Report 2016: Data to the end of 2015 Author: CDSC Date: 03/11/2016 Status: Final Version: