Enhanced Surveillance of Mycobacterial Infections (ESMI) in Scotland

30 October 2018

Article: 52/4301

Tuberculosis (TB) surveillance was introduced in Scotland in 2000 through the Enhanced Surveillance of Mycobacterial Infections (ESMI) scheme. In 2017, there was a decrease of 7% in both the number of cases and annual incidence of TB when compared with 2016. These represent the lowest number of cases (288) and incidence (5.3 cases per 100,000) reported since enhanced surveillance began. More than one-third (38.6%) of cases reported in 2017 were resident in the most deprived Scottish Index of Multiple Deprivation (SIMD) areas. This exemplifies a major issue with TB in the underserved populations within Scotland. A working group has been set up with stakeholders across Scotland in order to work through the complex issues associated with these underserved populations.

In 2017, drug resistance was noted to have increased, with resistance to at least one first-line drug at the start of treatment reported for 21 cases (11.0%). Three cases (1.6%) were resistant to both isoniazid and rifampicin and therefore defined as multidrug-resistant tuberculosis (MDR-TB). Successful treatment outcomes of TB cases first notified in 2016 were increased slightly when compared with 2015 (82% compared with 79%) but narrowly failed to meet the European Centre for Disease Prevention and Control (ECDC) target of 85%. Finally, 34 TB cases (12.6% case fatality ratio) were known to have died, which is the highest reported since enhanced surveillance began. Again, this highlights that while there may be a decreasing incidence of TB, it is becoming an increasingly more complex disease to treat.

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