The following table shows the number of cases of multi-drug resistant tuberculosis (TB) in patients reported to the national surveillance system (enhanced tuberculosis surveillance (ETS)) from 1998 to 2006 in England. Numbers smaller than five are not provided because of the risk of deductive disclosure.
1998 1999 2000 2001 2002 2003 2004 2005 2006 East Midlands <5 <5 <5 <5 <5 <5 <5 <5 <5 East of England <5 <5 <5 <5 5 <5 <5 <5 <5 London 14 11 10 12 16 33 21 16 30 North East <5 <5 <5 <5 <5 <5 <5 <5 <5 North West <5 <5 5 <5 <5 <5 <5 6 <5 South East <5 <5 <5 <5 7 <5 <5 <5 5 South West <5 <5 <5 <5 <5 <5 <5 <5 <5 West Midlands <5 <5 <5 <5 <5 <5 <5 <5 <5 Yorkshire and the Humber <5 <5 <5 <5 <5 <5 9 6 5 1 Resistant to isoniazid and rifampicin, with or without resistance to other drugs. 2 Region is equivalent to strategic health authority (SHA) in all places except the South East, which includes South Central and South East Coast SHAs.
Data provided by the Health Protection Agency (HPA) are provided by HPA region, comprising nine regional offices covering the whole of England which correspond to the Government offices of the regions (this equates to SHA in all regions apart from the South East, which includes South Central and South East Coast SHAs).
Information on the proportion of multi-drug resistant TB cases in England from 1998 to 2006 reported to have had previous tuberculosis treatment is provided in the following table. Due to the small numbers and the potential for deductive disclosure, this information has been provided for England as a whole in each year. Among those cases reported to have previously been treated, it is not possible to definitively attribute drug resistance to previously unsuccessful TB treatment as some of these cases may have subsequently acquired a new infection.
Previous history of TB Number Percentage Total number of multi-drug resistant cases 1998 11 48 23 1999 5 36 14 2000 8 36 22 2001 — 22 23 2002 8 31 26 2003 6 18 34 2004 6 22 27 2005 8 27 30 2006 12 30 40 1 Resistant to isoniazid and rifampicin, with or without resistance to other drugs. 2 Of cases with known previous history of tuberculosis.
Following the publication by the World Health Organisation of the definition for extensively drug-resistant (XDR) TB in 2006, the HPA reviewed all cases reported from 2003 to 2006. A single case of XDR TB was identified in a patient reported in England in 2003. A further XDR case has been reported from Scotland in 2008.
A subsequent retrospective review was carried out by the HPA of drug susceptibility testing results, where these were available, on all tuberculosis isolates reported in the United Kingdom from 1993 to 2002. A further six isolates were identified as conforming to the definition of XDR TB from this period.
Treatment outcomes are currently reported 12 months after the start of treatment. Multi-drug resistant and extensively drug-resistant TB cases require treatment for considerably longer than 12 months and outcome of treatment is not, therefore, routinely available in these cases.