Recent increases in tuberculosis notifications in England and Wales--real or artefact?

BACKGROUND In light of recent increases in tuberculosis notifications in England and Wales, this study examines data on the occurrence of tuberculosis from other sources to see if the increase seen in notifications is corroborated. METHODS Tuberculosis notifications for 1988-2000 were compared with laboratory reports of Mycobacterium tuberculosis complex isolates (1994-2000), national survey data for 1988, 1993 and 1998, and enhanced tuberculosis surveillance data for 1999 and 2000. RESULTS Data from all three sources reveal a similar overall trend, with the increase most marked in 1999 and 2000 and a steady increase in the number of cases reported from London. The largest increase is seen in the 15-34 year age group. National survey and enhanced surveillance data show a continuing increase in the proportion of tuberculosis patients born abroad, and in number of patients from most non-White ethnic groups. All sources show an increased number of patients with extra-pulmonary disease. CONCLUSION A similar level in the overall increase in cases, and their distribution by geographic region, age, sex and site of disease, observed using data from all three sources, suggests that much of the increase is likely to be real. Data from additional continuous years of enhanced surveillance will permit more accurate assessment of trends in population subgroups.