Tuberculosis Annual Report for Scotland
2022

About this release​​​​​

This release by Public Health Scotland (PHS) presents the national surveillance of tuberculosis and provides information on the numbers, distribution, and characteristics of cases, drug resistance patterns, and treatment outcomes. It supports the early identification and treatment of cases and enables the identification of high-risk populations. The Enhanced Surveillance of Mycobacterial Infections (ESMI) system was introduced in Scotland in 2000. Tuberculosis cases are identified by NHS boards and notified to Public Health Scotland. All 14 NHS boards contribute epidemiological data to ESMI in three parts; on detection and notification of a case, when bacteriological results are known (at around three months) and at treatment completion (usually 12 months post notification). This report describes tuberculosis in Scotland through 2022, including treatment outcomes of cases first reported in 2021 (12-month outcomes) and 2020 (24-month outcomes). Please note that data in this report are provisional and may be subject to change as data continues to be received.

Main points

• A total of 201 cases of tuberculosis were reported to the Enhanced Surveillance of Mycobacterial Infections system in 2022, equating to an annual incidence of 3.7 cases per 100,000 population. Scotland remains well within the World Health Organization’s 'End TB Strategy' target of fewer than 10 cases per 100,000 population.
• There was a 10.7% decrease in annual incidence when compared with 2021 (225 cases, 4.1 cases per 100,000 population). While notifications for 2021 showed an annual increase from the preceding year, this decrease continues the downward trend in annual decreases in incidence. Since 2010, Scotland has observed a decrease in incidence of almost two-thirds (60.0%).
• Tuberculosis incidence was highest among males in the age groups 25 to 34 years and 35 to 44 years (8.0 and 7.3 cases per 100,000 population, respectively), which combined account for 27.4% of all tuberculosis cases in 2022.
• In 2022, 72.2% of tuberculosis cases in Scotland were born outside of the UK, where place of birth was known. Tuberculosis incidence in individuals born outside of the UK was 24 times higher than in individuals born in the UK. The most reported risk factor for tuberculosis was being a refugee or asylum seeker (14%).
• In non-UK born tuberculosis cases, 76.0% were diagnosed two or more years after arriving in the UK. While it is not fully understood why individuals develop TB more than two years following entry to the UK, this could be related to either reactivation of latent infection following entry to the UK, infection within the UK, or frequent travel abroad to countries with a high incidence of tuberculosis.
• The association between tuberculosis and deprivation persists with 37.6% of cases reported in 2022 being resident in the most deprived Scottish Index of Multiple Deprivation (SIMD) quintile compared with 12.9% of cases in the least deprived quintile.
• Scotland has observed a continued reduction in the proportion of cases that present with pulmonary disease which is now at its lowest (49.3%) since reporting began in 2000. This is a positive development, as pulmonary cases pose a higher risk of transmission to others.
• The proportion of pulmonary tuberculosis cases with a positive sputum result decreased to 59.0% in 2022 from 59.5% in 2021, and 63.5% in 2020 which remains below the European target of 73%. This is important for the prompt identification and treatment of infectious pulmonary disease.
• To achieve optimal detection of infectious cases and assist the detection of drug resistance, a high proportion of cases should be bacteriologically confirmed. In 2022, 84.8% of pulmonary tuberculosis cases were confirmed by culture, a small increase from 83.8% in 2021, but a reduction from 87.1% in 2020, remaining above the ECDC target of 80% culture confirmation for all new pulmonary tuberculosis cases.
• Of the tuberculosis cases reported in 2021, 81.6% successfully completed treatment by 12 months. ECDC recommend that 85% of cases complete treatment within 12 months. While cases may be complex, this an area where further work is required to understand the barriers to treatment completion in Scotland.
• Mortality for reported tuberculosis cases in Scotland is higher than that reported in England and lower than that reported in Europe. In 2021, 14 cases (6.6%) were reported to have died before completion of treatment compared to 5.2% in England and 8.4% in the European Union and European Economic Area countries (treatment outcomes reported in 2021 for 2020 cases).
• There were two multi-drug (MDR-TB) resistant isolates detected in 2022. These are the first cases of MDR-TB detected in Scotland since 2018.

Further information

The next release of this publication will be December 2024.