Cases of tuberculosis (TB), a contagious lung infection that dates back to Victorian England, are rising once again in England, with experts highlighting growing concerns about antibiotic resistance that could complicate treatment efforts. Recent data from the UK Health Security Agency (UKHSA) reveals a worrying increase in TB cases, alongside a surge in multi-drug resistant strains.

Tuberculosis, caused by the bacteria Mycobacterium tuberculosis, primarily affects the lungs and spreads through the air when an infected person coughs, sneezes or spits. It was historically a leading cause of death in Victorian England, responsible for approximately four million deaths between 1851 and 1910. Despite major advances in medicine, the World Health Organization (WHO) reported 1.25 million TB deaths worldwide in 2023, making it the leading cause of death from an infectious agent, surpassing Covid-19.

The most recent quarterly report from the UKHSA, released on 24 April 2025, examined TB infection levels between January and March 2025. Provisional figures show an increase of 2.1 per cent compared to the same period in 2024, with case numbers rising from 1,196 to 1,266. Regional increases were most significant in the North East (21.2 per cent), London (9.6 per cent), the South West (9.3 per cent), and the East Midlands (8.7 per cent).

Dr Suzie Hingley-Wilson, Senior Lecturer in Bacteriology at the University of Surrey, said the data reflects a continued upward trend in TB cases seen over recent years. "There is a treatment regime for multi-drug resistant TB (MDR-TB), but the treatment regime is incredibly lengthy, hard to tolerate for the patient and often doesn’t work," she told the Manchester Evening News. Dr Hingley-Wilson also described the rise in drug-resistant TB as a "ticking time bomb," noting an 8.5 per cent increase in MDR-TB cases in 2024 compared to 2023. She stressed the urgent need for more rapid diagnostic tools to identify MDR-TB cases promptly.

The UKHSA's earlier annual report underscored the rise in TB over 2023 and 2024, with an 11 per cent increase in 2023 followed by a further 13 per cent rise in 2024. If this trend continues, the UK risks losing its WHO "low incidence" status, defined as fewer than 10 cases per 100,000 population. A significant public health challenge is the spread of MDR-TB strains resistant to several standard antibiotics, which complicates both treatment and control measures.

Another concern raised by Dr Hingley-Wilson regards diagnostic confirmation. England currently falls short of the European standard that requires at least 80 per cent of pulmonary TB cases to be confirmed by laboratory testing. She warned: "If we don’t diagnose, we don’t treat – so more transmission and more cases."

The data also highlighted that 81.6 per cent of TB cases in England occurred in people born outside the UK, consistent with previous years' figures.

Attention has also turned to vaccination. On World Tuberculosis Day in March 2025, experts called for the development of new vaccines, noting that the century-old BCG vaccine provides limited protection, particularly against pulmonary TB. The UK has scaled back universal BCG vaccination since 2005, now targeting only high-risk groups, a strategy that has coincided with a decline in vaccine coverage.

Professor Helen McShane, Professor of Vaccinology at Oxford’s Jenner Institute, emphasised the urgency of vaccine development. Speaking to the Manchester Evening News, she said, "Tuberculosis, in the 21st century, still kills more people than any other infectious disease. We urgently need to develop effective vaccines, as the most cost-effective way to control this epidemic."

She added that antimicrobial resistance heightens the challenge, stating: "The increasing rise of antimicrobial resistance globally makes it more important than ever before to discover new ways to protect against this terrible disease before we run out of drugs to treat those suffering with it."

Symptoms of TB include a cough lasting more than three weeks, fever, night sweats, loss of appetite, and weight loss. The infection may also spread beyond the lungs, causing body aches and swollen glands.

The Manchester Evening News is reporting that the surge in TB cases and the rise of antibiotic-resistant strains comprise a “significant public health threat” in England, demanding ongoing surveillance and medical innovation to address this re-emerging disease.

Source: Noah Wire Services