Tuberculosis - RNOH/GIRFT review: national report

7 Epidemiology

There was a wide variation and number of notifications during the review, with the bulk of notifications being in two sectors of Glasgow, especially the South, and the Lothian Health Board. In these two higher incidence services we were told that there is an evolution from older UK- born individuals to those individuals who were born outside of the UK.

This is not a uniform change, as we noted in some deep dive meetings that there continued to be significant disease burden in UK-born individuals, especially where there were social risk factors, leading to the need for enhanced case management and more resources. Undoubtedly this variation will relate to where migrants and asylum seekers are residing. Generally, during the deep dives, we did not comment on the local epidemiology (as the numbers were relatively small) to draw conclusions apart from the South Glasgow sector and Lothian Health Board. As such we have not included specific graphs on epidemiology, though these are available in the data pack found via the link in Annex E).

With the evolving epidemiology of tuberculosis, we noted several providers who had seen a significant increase in notifications but had little infrastructure to deal with the increased volumes of work, thus creating strain on resource within services who already have limited capacity.

It is worth noting that increased notifications generate substantially more work with the need for contact tracing and subsequent management. Additionally with more active cases who may be identified late, the risk of outbreaks increases, adding to the workload.

Furthermore, there is the markedly expanding aspect of preventative treatments needed for different populations, as outlined in the Preventative Strategies section 11.

Recommendation: Epidemiology

1. Continued entry of notification information into the National TB surveillance system is important to support planning for future services and to understand local and national epidemiology. Administrative support is required to enable timely and complete data entry.

P, HB