Tuberculosis in Wales Annual Report 2013

Tuberculosis in Wales Annual Report 2013 Author: Communicable Disease Surveillance Centre Date: 16/12/13 Version: 1 Status: Final Intended Audience: Health Purpose and Summary of Document: This report summarises the latest annual trends in the cases of tuberculosis in Wales reported through the enhanced tuberculosis surveillance system. Publication/Distribution: Head of Public Health Wales Health Protection Division Public Health Wales TB Programme Group Public Health Wales Intranet and Internet Public Health England TB Section Version: 1 Page: 1 of 26 Intended Audience: Health

Acknowledgements Public Health Wales Communicable Disease Surveillance Centre would like to thank the microbiologists, clinicians, respiratory nurses and Health Protection Teams for their contributions to the running of the Enhanced Tuberculosis Surveillance scheme in Wales. Public Health England coordinates the UK wide Enhanced Tuberculosis Surveillance scheme and provides Public Health Wales with support in conducting tuberculosis surveillance. Background The Enhanced Tuberculosis Surveillance scheme commenced on the 1 st January 1999 with the aim of providing detailed and comparable information on the epidemiology of tuberculosis. The scheme is coordinated in England, Wales and Northern Ireland by Public Health England. In Wales, the scheme is administered by Public Health Wales in collaboration with colleagues in Local Health Boards. This report summarises the latest annual trends in the cases of tuberculosis in Wales reported through the Enhanced Tuberculosis Surveillance scheme. Wales data for the last ten years are summarised in a series of tables and graphs by: demographic, geographical, clinical and microbiological characteristics. Suggested Citation: Tuberculosis in Wales Annual Report, December 2013. Public Health Wales Communicable Disease Surveillance Centre. Note: The data used in this report were derived from the Enhanced Tuberculosis Surveillance scheme. Figures for recent years should be considered provisional. Version: 1 Page: 2 of 26 Intended Audience: Health

Key Points In 2012, 136 cases of tuberculosis were reported in Wales (4.4 per 100,000 population). This represents a small increase in the number of cases reported in 2011. However, rates of infection remain low in Wales relative to other areas of the UK. The rate per 100,000 population was highest in those aged 25 to 34 years (10.7); continuing the trend identified in the last six years. The rate per 100,000 population decreased in all the age groups between 2011 and 2012; with the exception of those aged 25 to 34, 45 to 54 and 65 years and older, where increases were observed. Of the 136 cases reported in 2012, 68% were male and 32% female (rates of 6.1 and 2.8 per 100,000 respectively). In 2012, 43% of tuberculosis cases were reported in the White ethnic group, 52% were in the non-white population and 5% were of an unknown ethnic group. Forty one percent of tuberculosis cases reported in Wales were born in the UK, 54% of cases were born abroad and 5% of cases had unknown place of birth. Completeness of recording of social risk factors varied from 81% to 90% in 2012. Of those reported, a history of alcohol misuse or abuse, have been or are currently homeless or have been or are currently in prison were reported for 2% of cases. No cases reported a history or current drug abuse problem. Over half of the cases in 2012 (57%) were diagnosed with pulmonary tuberculosis; of which 11 (14%) of these cases also had extra pulmonary disease. Isoniazid resistance in culture confirmed tuberculosis cases increased to 10% in 2012 from 2% in 2011. Information on the outcome of treatment at 12 months was received for 124 (97%) of the 128 tuberculosis cases reported in 2011, excluding patients with rifampicin resistance or multi-drug resistance. Of the treatment outcomes reported, 98 (79%) cases were reported as having completed treatment within 12 months. Completion was lowest in over 65 year olds (52%, 13/25). Version: 1 Page: 3 of 26 Intended Audience: Health

Contents 1. Geographical Distribution........................ 5 1.1. TB Rates in Wales and the UK 1.2. Area of Residence 2. Demographic Characteristics of TB in Wales.......... 8 2.1. Age and Sex 2.2. Ethnicity 2.3. Place of Birth 2.4. Time Since Entry into the UK to Diagnosis 3. Social Determinants............................ 12 4. Clinical Characteristics.......................... 13 4.1. Site of Disease 4.2. Planned Course of Treatment 4.3. Vaccination Status 4.4. Previous Diagnosis 5. Bacteriology, Speciation and Drug Susceptibility..... 14 5.1. Bacteriology 5.2. Species Identification 5.3. Antimicrobial Resistance 6. Treatment Outcomes........................... 15 7. Conclusion................................... 16 Notes on Methods................................ 17 References..................................... 17 Appendix...................................... 18 Version: 1 Page: 4 of 26 Intended Audience: Health

1 Geographical Distribution 1.1 TB Rates in Wales and the UK In Wales in 2012, 136 cases of tuberculosis were reported to the Enhanced Tuberculosis Surveillance (ETS) scheme, a rate of 4.4 per 100,000 population (95% confidence interval (CI) 3.7-5.2 per 100,000 population). This represents a 5% increase in the number of cases reported in 2011 (130, 4.2 (95% CI 3.6-5.0) per 100,000 population) which recorded the lowest annual number of cases since enhanced surveillance commenced in 1999 (Fig 1). Provisionally, for 2013, there have been 129 cases reported on ETS that reside in Wales at 16/12/2013. Fig 1. Number of Cases and Rate of TB per 100,000 population in Wales, 2003-2012 6.9 7.1 5.6 164 6.4 6.3 6.1 188 186 182 204 5.6 168 214 5.1 153 4.2 130 4.4 136 Number of cases Rate per 100 000 Figures published by Public Health England (August 2013) [1], report the total UK rate per 100,000 population was 13.9 (95% CI 13.6-14.1) in 2012. For the first time, Wales reported the lowest rate of tuberculosis in the UK (Fig 2). England continues to account for the highest rate of tuberculosis in the UK, a rate of 15.2 (95% CI 14.9 15.5) per 100,000 population, followed by 7.5 (95% CI 6.8-8.3) per 100,000 population in Scotland and 4.8 (95% CI 3.8-5.9) per 100,000 population in Northern Ireland. Between 2011 and 2012, the rate of tuberculosis per 100,000 population increased in Northern Ireland and Wales but decreased in Scotland and England. Version: 1 Page: 5 of 26 Intended Audience: Health

Fig 2. Rate of TB per 100,000 population in the UK, 2012 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Rate per 100,000 England Scotland Northern Ireland Wales Version: 1 Page: 6 of 26 Intended Audience: Health

1.2 Area of Residence Between 2011 and 2012, the rate of tuberculosis increased in Powys Teaching, Cwm Taf and Aneurin Bevan Local Health Boards, remained stable in Betsi Cadwaladr University Health Board and decreased in the remaining three Local Health Boards (Table 1). In 2012, the highest tuberculosis rate of 7.6 per 100,000 population was found in Cardiff and Vale Health Board and the lowest rate was in Powys Teaching Health Board at 2.3 per 100,000 population. Between 2011 and 2012 the rate of tuberculosis increased in eight of the 22 Local Authorities, remained stable in five and decreased in nine (Table 1). The rate of tuberculosis ranged from 0.0 per 100,000 in Conwy, where no cases were reported in 2012, to 10.3 per 100,000 population in Newport (Fig 3a). Figure 3b shows the five year average rate of tuberculosis per 100,000 population by Local Authority over the period of 2008 to 2012. Comparison of the five year average rate per 100,000 with the rate of tuberculosis in 2012 highlights that rates continue to be highest in Cardiff and Newport. However, in Pembrokeshire the rate of tuberculosis per 100,000 in 2012 was higher than the five year average rate whereas the rate of tuberculosis per 100,000 in 2012 was lower in Powys, Conwy and Flintshire than the average rate from 2008 to 2012. Fig 3. Rate of TB by Local Authority a. 2012 b. 2008-2012 Crown Copyright and database right 2013. Ordnance Survey 100044810 Version: 1 Page: 7 of 26 Intended Audience: Health

2 Demographic Characteristics of Tuberculosis in Wales 2.1 Age and Sex Over two thirds of the cases reported in 2012 were male (68%, 92/136), a rate of 6.1 (95% CI 4.9-7.5) per 100,000 male population, with a lower rate of 2.8 (95% CI 2.0-3.8) per 100,000 females (Table 2). Cases were most frequently aged 25 to 34 years of age (29%, 39/136) and 65 years of age and older (23%, 31/136). In comparison to 2003 the highest proportion (29%) of active tuberculosis disease identified amongst the Welsh population was found in those aged 65 years and over (Table 3). Changes in the rate of tuberculosis amongst different age groups from 2003-2012 are presented in Figure 5. 2.2 Ethnicity In 2012, 43% (59/136) of tuberculosis cases reported were in the White ethnic group compared to 57% in 2003. This decrease has been accompanied by a rise in tuberculosis amongst those of Indian ethnic origin. The five year (2008 to 2012) average annual rate was highest in the Black-African ethnic group; 174.6 (95% CI 106.7-269.6) per 100,000 population and lowest in the White ethnic group, a rate of 2.4 (95% CI 1.9-3.0) per 100,000 population (Fig 6, Table 4). Version: 1 Page: 8 of 26 Intended Audience: Health

Fig 5. Rate of TB per 100,000 population by Age Group and Year in Wales, 2003-2012 0-4 Age Group 5-14 Age Group 6.7 4.7 6.4 0.6 3.1 2.5 3.1 1.1 1.1 0.0 2.4 0.5 1.1 1.4 0.8 2.6 0.9 1.2 1.8 0.9 15-24 Age Group 25-34 Age Group 15.4 4.5 4.2 5.2 5.1 6.2 4.2 6.9 4.4 4.9 3.2 8.6 11.3 10.1 12.5 9.2 12.5 9.0 8.0 10.7 35-44 Age Group 45-54 Age Group 5.7 4.7 6.8 8.2 8.4 6.6 8.2 6.2 6.9 4.7 5.2 6.0 6.0 5.2 7.1 4.5 7.8 4.6 5.4 2.6 55-64 Age Group 65+ Age Group 12.0 11.2 4.4 5.7 3.4 5.2 2.3 4.6 4.3 4.6 2.3 2.3 9.2 6.5 7.4 7.1 8.2 6.3 4.6 5.3 Version: 1 Page: 9 of 26 Intended Audience: Health

Fig 6. Average Annual Number of TB Cases and Rate per 100,000 population in Wales by Ethnic Group, 2008-2012 174.6 140.4 105.8 83.0 69 46.4 2.4 8.9 <1 20 2 25 15 26.4 4 3 19.4 11 Average Number of Cases Rate 2.3 Place of Birth In 2012, 41% (56/136) of tuberculosis cases reported in Wales were born in the UK, 54% (73/136) were born abroad and 5% (7/136) of unknown origin (Fig 7, Table 5). In comparison, 35% of cases in 2003 were reported to be born abroad. However, it should be noted that the reporting of place of birth has improved over the last decade; in 2003 13% of cases had unknown origins. As with previous years, in 2012 the majority of cases born outside the UK originated from South Asia (55%, 40/73) and Sub-Saharan Africa (21%, 15/73) (Table 6). 2.4 Time between Entry into the UK and Diagnosis The time between entry to the UK and tuberculosis diagnosis was known for 89% (65/73) of non-uk born cases diagnosed in 2012, comparable to 2011 (Table 7). Where time since entry was known, the proportion of cases varied across the classifications: less than two years of entry and between two and four years (26% each), between five and nine years (19%) and over ten years (18%) since UK entry. Version: 1 Page: 10 of 26 Intended Audience: Health

Number of TB cases Public Health Wales Tuberculosis in Wales Annual Report 2013: Fig 7. Number of TB Cases in Wales born abroad, 2003-2012 1 Number of TB cases born abroad Total number of TB cases 250 200 150 100 50 0 1 During 2003-2012 between 4-15% of cases were reported with an unknown origin for place of birth. Version: 1 Page: 11 of 26 Intended Audience: Health

3 Social Determinants The collection of information on social risk factors for tuberculosis was introduced to the Enhanced Tuberculosis Surveillance scheme in 2009. In 2012, information on social risk factors was known for between 81% and 90% of cases in Wales, depending on the risk factor investigated (Fig 8). The completeness of recording social risk factors increased between 2011 and 2012, but the proportion of cases for which a social risk factor was implicated remained stable or decreased between this time period: 2011 2012 History or current drug use 3% 0% History or current alcohol misuse 2% 2% History or current homelessness 3% 2% History or current imprisonment 2% 2% Fig. 8 Completeness (%) of Recording Risk Factors, 2010-2012 73% 80% 83% 71% 87% 92% 91% 86% 82% 90% 89% 81% 2010 2011 2012 History of Drug Abuse History of Homelessness History of Alcohol Abuse History of Prison Overall 4% (6/136) of cases had at least one social risk factor. Of those, 33% (2/6) were on Directly Observed Therapy (DOT). Version: 1 Page: 12 of 26 Intended Audience: Health

4 Clinical Characteristics 4.1 Site of Disease Miliary tuberculosis is now classified as pulmonary tuberculosis in accordance with the WHO s recommendation and international reporting definitions [2]. In 2012, over half of tuberculosis cases had pulmonary disease (57%, 77/136). Fourteen percent (11/77) of pulmonary cases were reported to also have extra pulmonary disease. Many cases reported disease at multiple sites. For cases with extra pulmonary disease, the extra thoracic lymph nodes were the most common site of infection (22%, 32/148) (Table 8). 4.2 Planned Course of Treatment In 2012, planned course of treatment was known for 93% (126/136) of cases; of these 94% (118/126) were assigned to a standard six month course of treatment. In 90% of cases (122/136), it was known whether a patient was assigned to DOT, which is similar to the 88% of cases reported in last year s report. Of these 7% (8/122) were assigned DOT treatment. 4.3 Vaccination Status The collection of data on Bacillus Calmette-Guérin (BCG) vaccination was introduced to the Enhanced Tuberculosis Surveillance scheme in 2009. In 2012, BCG vaccination status was known for 51% (69/136) of tuberculosis cases. Of these, 74% (51/69) were vaccinated. Vaccination coverage varied between age groups ranging from 33% (1/3) for 5 to 14 year olds to 100% (4/4) in 55 to 64 year olds (Table 9). 4.4 Previous Diagnosis Information on previous tuberculosis diagnosis was known for 93% (127/136) of cases, of which seven had a previous diagnosis of tuberculosis (Table 10). Of these seven patients, one was assigned to DOT with the remaining patients either not assigned to DOT (5/7) or it was not reported whether they were assigned to DOT (1/7). Version: 1 Page: 13 of 26 Intended Audience: Health

5 Bacteriology, Speciation and Drug Susceptibility 5.1 Bacteriology Seventy-four percent (100/136) of all cases in 2012 were culture confirmed, and 77% (59/77) of pulmonary cases (with or without additional extra pulmonary disease) were culture confirmed. This is higher than the 69% UK average reported by Public Health England as well as compared to other UK counterparts [1] but is slightly below the European Centre for Disease Prevention and Control (ECDC) target of 80% for culture confirmation of pulmonary tuberculosis [3]. For 53% (41/77) of pulmonary cases in 2012 a sputum smear result was recorded, of which 78% (32/41) were positive (Table 11). Seventy-four percent (40/54) of cases which reported extra pulmonary disease only were culture confirmed. 5.2 Species Identification The Enhanced Tuberculosis Surveillance scheme collates data on species identification, including an additional questionnaire for completion when an isolate is identified as Mycobacterium bovis. However, the completeness of these data is unclear. Therefore, more detailed analysis of all M.bovis cases reported between 2001 and 2010 in Wales can be found on Public Health Wales website (http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=59379). Among culture-confirmed cases reported through the Enhanced Tuberculosis Surveillance scheme in 2012, 96% (96/100) were due to infection by Mycobacterium tuberculosis (Table 12). 5.3 Antimicrobial Resistance Drug susceptibility results for isoniazid and rifampicin were reported for 100% (100/100) of culture confirmed tuberculosis cases. As with previous years, surveillance data continues to show that resistance to first line antimicrobials is low, however, isoniazid resistance has increased from 2% in 2011 to 10% in 2012, comparable to the highest reported in 2007 (10%). Isoniazid 10% Rifampicin 1% Ethambutol 1% Pyrazinamide 0% One culture confirmed sample was resistant to isoniazid, rifampicin and ethambutol. Version: 1 Page: 14 of 26 Intended Audience: Health

6 Treatment Outcomes Treatment outcomes in 2012 are reported in accordance with the revised 2013 World Health Organisation (WHO) treatment outcome definitions [2]. Under these revised definitions, treatment outcome at 12 months is reported for the cohort of patients with drug sensitive TB (excluding patients with rifampicin resistance or multi-drug resistance). Revised trends in treatment outcomes are presented for previous years using the revised WHO definitions. Cases where treatment outcome is missing or were transferred to another clinic outside Wales and a treatment outcome form was not received are assigned the outcome unknown outcome. Information on the outcome of treatment, 12 months after treatment commenced, was reported for 97% (124/128) of drug sensitive TB cases notified in 2011 (Table 13). Treatment outcome was missing for 3% (4/128) of cases. Seventy-nine percent (98/124) of cases completed treatment within 12 months. The most common reasons for not completing treatment were lost to follow-up and death (6.5%, 8/124 for both). Moving outside the UK was most frequently the reason provided for cases lost to follow-up. The cessation of treatment was reported for 5% (6/124) of cases, the highest reported in Wales compared to previous years and to the UK. Of the eight deaths, tuberculosis was incidental to death in 38% (3/8), contributed to death in 25% (2/8) and the relationship between tuberculosis and death was unknown for 33% (3/8) of deaths. Amongst those reported to have died, 25% (2/8) were diagnosed with tuberculosis postmortem. Treatment completion at 12 months varied between Local Health Boards (Table 14); Hywel Dda 81% Aneurin Bevan 83% Cardiff and Vale University 81% Betsi Cadwaladr University 72% Cwm Taf 67% Abertawe Bro Morgannwg 78% Powys 100% 1 Treatment completion differed between age groups; with 100% completion reported in cases aged less than 15 years (7/7) and those aged between 45 and 64 years old (19/19) but only 52% (13/25) treatment completion in those aged 65 and older (Table 15). Death was the most frequent reason (58%, 7/12) for those over 65 years of age not completing treatment. The majority of deaths (88%, 7/8) occurred in those aged 65 and older (Table 15). 1 Interpret with caution as small number of cases in Powys Version: 1 Page: 15 of 26 Intended Audience: Health

Completion was higher in non-uk born cases (81%, 61/75) compared to UK born cases (75%, 33/44). A higher proportion of UK born cases died (9%, 4/44) compared to non-uk born cases (4%, 3/75). 7 Conclusion In 2012, the annual number of tuberculosis cases in residents of Wales increased by 5% to 136 but rates remain low relative to other parts of the UK. In 2012, Wales reported the lowest rate of tuberculosis in the UK (4.4 per 100,000 cases) [4]. Consistent with the rest of the UK, the majority of cases in Wales were reported from urban areas, with over 50% of cases born outside the UK, originating from high tuberculosis burden countries. Encouragingly, in Wales the proportion of pulmonary cases that were culture confirmed exceeded the UK average and other UK countries. The introduction of the Cohort Review in 2012 by Public Health Wales to improve tuberculosis management by systematically reviewing case management and contact investigation may have led to the observed improvements [5]. It is important that every effort should be made to maintain these achievements. Of concern, is the increase in isoniazid resistance which is higher than that recorded for the UK and is on par with the highest ever recorded in Wales. Drug resistance is a worldwide concern and identification of an increase in first line drug resistance is important to monitor. Consequently, obtaining drug susceptibility results is imperative for tackling any further rise. The proportion of cases completing treatment at 12 months in Wales remained stable in comparison to 2011 but is slightly lower than that reported for the UK and remains below the Department of Health s recommended 85% completion target [6]. In 2012, Wales reported the highest proportion of cases that stopped treatment since 2002. This is of concern as these patients may continue to transmit tuberculosis within the community. Further efforts should be made to encourage patients to complete treatment in order to reduce transmission. The cohort review should be continued as a platform to discuss difficulties in treatment completion with the aim to improve case management. Version: 1 Page: 16 of 26 Intended Audience: Health

Notes on Methods All analysis was conducted using Stata 12.1, using 95% confidence intervals. Population figures were obtained from the Office of National Statistics (ONS) mid-year estimates for Wales and used as the denominator to calculate rates. Rates for ethnic groups were calculated using ONS estimates by ethnic group in Wales. Five year average rates for ethnic groups were calculated using a combination of 2008, 2009 and 2011 ONS estimates. This report only includes tuberculosis cases which have been reported on ETS. All Local Health Board and Local Authority figures are based on the area of residence of tuberculosis cases. References [1] Public Health England, Tuberculosis in the UK: Annual report on tuberculosis surveillance in the UK, 2013. http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1317139689583 [2] Definitions and reporting framework for tuberculosis 2013 revision. WHO 2013. http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf [3]European Centre for Disease Control and Prevention (ECDC), Progress towards TB elimination, 2010. http://ecdc.europa.eu/en/publications/publications/101111_spr_progressing_to wards_tb_elimination.pdf [4] Public Health England, Annual report on Tuberculosis surveillance in the UK 2013 Slideset http://www.hpa.org.uk/webw/hpaweb&hpawebstandard/hpaweb_c/131713968 9732 [5] Health Protection Agency and London TB Service, Evaluation of cohort review in North Central London, 2010 http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1296687649609 [6] Department of Health, Stopping Tuberculosis in England: An action plan from the Chief Medical Officier, 2004. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov. uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/ dh_4100860.pdf Version: 1 Page: 17 of 26 Intended Audience: Health

Appendix Table 1. Number of Cases and Rate 1 of Tuberculosis in Wales by LHB and LA, 2003-2012 LHB and LA 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 5 Year Average 2 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Betsi Cadwaladr University 25 3.7 32 4.8 34 5.1 49 7.2 35 5.2 27 4.0 36 5.3 28 4.1 19 2.8 19 2.8 26 3.8 Anglesey 7 10.3 3 4.4 5 7.2 13 18.7 0 0.0 3 4.3 5 7.2 4 5.7 0 0.0 2 2.9 3 4.0 Conwy 3 2.7 5 4.5 3 2.7 4 3.5 7 6.2 6 5.2 6 5.2 5 4.4 2 1.7 0 0.0 4 3.3 Denbighshire 4 4.3 2 2.1 2 2.1 5 5.3 3 3.2 4 4.2 3 3.2 2 2.1 3 3.2 3 3.2 3 3.2 Flintshire 2 1.3 5 3.3 5 3.3 4 2.7 3 2.0 5 3.3 6 3.9 2 1.3 5 3.3 3 2.0 4 2.8 Gwynedd 3 2.5 8 6.7 9 7.6 10 8.4 13 10.9 3 2.5 8 6.6 10 8.3 4 3.3 7 5.7 6 5.3 Wrexham 6 4.7 9 7.0 10 7.7 13 10.0 9 6.9 6 4.5 8 6.0 5 3.7 5 3.7 4 2.9 6 4.2 Powys Teaching 3 2.3 6 4.6 3 2.3 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 4 3.2 Powys 3 2.3 6 4.6 3 2.3 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 4 3.2 Hywel Dda 10 2.7 28 7.6 13 3.5 19 5.1 11 2.9 7 1.8 8 2.1 12 3.2 18 4.7 17 4.4 12 3.3 Carmarthenshire 7 4.0 15 8.5 8 4.5 9 5.0 9 5.0 0 0.0 5 2.7 9 4.9 9 4.9 5 2.7 6 3.1 Ceredigion 1 1.3 6 7.9 1 1.3 3 4.0 1 1.3 1 1.3 1 1.3 1 1.3 5 6.6 3 3.9 2 2.9 Pembrokeshire 2 1.7 7 6.0 4 3.4 7 5.9 1 0.8 6 5.0 2 1.6 2 1.6 4 3.3 9 7.3 5 3.8 Abertawe Bro Morgannwg University 25 5.1 37 7.4 32 6.4 28 5.6 41 8.1 33 6.5 36 7.0 23 4.5 19 3.7 18 3.5 26 5.0 Bridgend 7 5.3 6 4.5 3 2.3 8 6.0 11 8.1 8 5.8 3 2.2 3 2.2 5 3.6 1 0.7 4 2.9 Neath Port Talbot 6 4.4 9 6.6 12 8.7 10 7.2 6 4.3 2 1.4 7 5.0 5 3.6 5 3.6 5 3.6 5 3.4 Swansea 12 5.3 22 9.6 17 7.4 10 4.3 24 10.3 23 9.8 26 11.0 15 6.3 9 3.8 12 5.0 17 7.2 Cwm Taf 18 6.2 15 5.2 15 5.2 9 3.1 13 4.5 23 7.9 22 7.5 16 5.5 6 2.0 18 6.1 17 5.8 Merthyr Tydfil 7 12.5 3 5.4 2 3.6 0 0.0 2 3.5 2 3.5 3 5.2 3 5.1 2 3.4 4 6.8 3 4.8 Rhondda, Cynon, Taff 11 4.7 12 5.1 13 5.6 9 3.8 11 4.7 21 8.9 19 8.1 13 5.5 4 1.7 14 5.9 14 6.0 Cardiff and Vale University 52 12.0 43 9.8 54 12.2 49 11.0 70 15.5 54 11.8 66 14.2 46 9.8 43 9.1 36 7.6 49 10.5 Cardiff 46 14.7 39 12.3 46 14.3 41 12.7 57 17.4 49 14.7 61 18.1 42 12.3 35 10.1 32 9.2 44 12.8 Vale of Glamorgan 6 5.0 4 3.3 8 6.5 8 6.5 13 10.4 5 4.0 5 4.0 4 3.2 8 6.3 4 3.2 5 4.1 Aneurin Bevan 30 5.4 26 4.6 35 6.2 23 4.1 32 5.6 20 3.5 37 6.5 24 4.2 24 4.2 25 4.3 26 4.5 Blaenau Gwent 1 1.4 2 2.9 2 2.9 2 2.9 3 4.3 0 0.0 3 4.3 4 5.7 1 1.4 1 1.4 2 2.6 Caerphilly 5 2.9 2 1.2 5 2.9 2 1.2 4 2.3 4 2.3 2 1.1 3 1.7 5 2.8 5 2.8 4 2.1 Monmouthshire 7 8.1 2 2.3 2 2.3 4 4.5 5 5.6 3 3.3 0 0.0 2 2.2 5 5.5 3 3.3 3 2.9 Newport 14 10.1 17 12.2 26 18.6 14 10.0 18 12.7 13 9.1 28 19.5 15 10.4 12 8.2 15 10.3 17 11.5 Torfaen 3 3.3 3 3.3 0 0.0 1 1.1 2 2.2 0 0.0 4 4.4 0 0.0 1 1.1 1 1.1 1 1.3 Not known 1 1 0 0 0 0 0 0 0 0 0 Total 164 5.6 188 6.4 186 6.3 182 6.1 204 6.8 168 5.6 214 7.0 153 5.0 130 4.2 136 4.4 160 5.3 1 Rate per 100,000 using ONS Mid-Year population estimates 2 Average number of cases and rate calculated using the last 5 years data (2008 to 2012) Version: 1 Page: 18 of 26 Intended Audience: Health

Table 2. Number of Cases and Rate 1 of Tuberculosis in Wales by Sex, 2003-2012 Sex 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Male 105 7.4 109 7.6 99 6.8 110 7.6 114 7.8 93 6.3 123 8.3 93 6.2 70 4.7 92 6.1 Female 59 3.9 79 5.2 87 5.7 72 4.7 90 5.9 70 4.5 86 5.5 58 3.7 57 3.7 44 2.8 Unknown 0 0 0 0 0 5 5 2 3 0 Total 164 5.6 188 6.4 186 6.3 182 6.1 204 6.8 168 5.6 214 7.0 153 5.0 130 4.2 136 4.4 1 Rate per 100,000 using ONS Mid-Year population estimates Table 3. Number of Cases and Rate 1 of Tuberculosis in Wales by Age Group, 2003-2012 Age Group Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate 0-4 1 0.6 5 3.1 4 2.5 5 3.1 11 6.7 8 4.7 11 6.4 2 1.1 2 1.1 0 0.0 5-14 9 2.4 2 0.5 4 1.1 5 1.4 3 0.8 9 2.6 3 0.9 4 1.2 6 1.8 3 0.9 15-24 17 4.5 16 4.2 20 5.2 20 5.1 25 6.2 17 4.2 28 6.9 18 4.4 20 4.9 13 3.2 25-34 30 8.6 39 11.3 35 10.1 43 12.5 53 15.4 32 9.2 44 12.5 32 9.0 29 8.0 39 10.7 35-44 24 5.7 20 4.7 29 6.8 35 8.2 36 8.4 28 6.6 34 8.2 25 6.2 27 6.9 18 4.7 45-54 20 5.2 23 6.0 23 6.0 20 5.2 28 7.1 18 4.5 32 7.8 19 4.6 11 2.6 23 5.4 55-64 16 4.4 21 5.7 13 3.4 20 5.2 9 2.3 18 4.6 17 4.3 18 4.6 9 2.3 9 2.3 65+ 47 9.2 62 12.0 58 11.2 34 6.5 39 7.4 38 7.1 45 8.2 35 6.3 26 4.6 31 5.3 1 Rate per 100,000 using ONS Mid-Year population estimates Version: 1 Page: 19 of 26 Intended Audience: Health

Table 4. Number and Percentage of Tuberculosis Cases in Wales by Ethnic Group, 2003-2012 Ethnic Group 5 year Average 1 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Cases Rate 2 White 94 57.3 101 53.7 99 53.2 81 44.5 87 42.6 80 47.6 98 45.8 66 43.1 40 30.8 59 43.4 69 2.4 Black-Caribbean 0 0.0 1 0.5 1 0.5 1 0.5 0 0.0 1 0.6 0 0.0 1 0.7 0 0.0 0 0.0 0.4 8.9 Black-African 30 18.3 16 8.5 16 8.6 24 13.2 23 11.3 22 13.1 31 14.5 11 7.2 23 17.7 13 9.6 20 174.6 Black-Other 0 0.0 2 1.1 1 0.5 1 0.5 3 1.5 1 0.6 3 1.4 3 2.0 1 0.8 1 0.7 2 83.0 Indian 14 8.5 23 12.2 19 10.2 20 11.0 26 12.7 25 14.9 31 14.5 21 13.7 23 17.7 27 19.9 25 140.4 Pakistani 9 5.5 11 5.9 20 10.8 19 10.4 17 8.3 10 6.0 20 9.3 18 11.8 12 9.2 13 9.6 15 105.8 Bangladeshi 4 2.4 4 2.1 5 2.7 7 3.8 7 3.4 3 1.8 5 2.3 10 6.5 3 2.3 1 0.7 4 46.4 Chinese 2 1.2 5 2.7 2 1.1 2 1.1 5 2.5 5 3.0 6 2.8 3 2.0 3 2.3 0 0.0 3 26.4 Mixed/Other 8 4.9 16 8.5 17 9.1 20 11.0 20 9.8 12 7.1 5 2.3 8 5.2 15 11.5 15 11.0 11 19.4 Unknown 3 1.8 9 4.8 6 3.2 7 3.8 16 7.8 9 5.4 15 7.0 12 7.8 10 7.7 7 5.1 11 Total 164 188 186 182 204 168 214 153 130 136 160 5.3 1 Average number of cases and rates calculated using the last 5 years data (2008 to 2012) 2 Rate per 100,000 using ONS 2008, 2009 and 2011 population estimates by ethnic group Table 5. Number and Percentage of Tuberculosis Cases in Wales by Place of Birth, 2003-2012 Place of Birth cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Born in UK 85 52 86 46 87 47 68 37 81 40 81 48 103 48 73 48 46 35 56 41 Born Abroad 58 35 75 40 71 38 89 49 97 48 74 44 90 42 69 45 79 61 73 54 Not Known 21 13 27 14 28 15 25 14 26 13 13 8 21 10 11 7 5 4 7 5 Total 164 188 186 182 204 168 214 153 130 136 Version: 1 Page: 20 of 26 Intended Audience: Health

Table 6. Number and Percentage of Tuberculosis Cases in Wales by World Region of Birth for Non-UK Born Cases, 2003-2012 Region of Birth cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % North Africa 3 5.2 1 1.3 2 2.8 2 2.2 1 1.0 1 1.4 4 4.4 1 1.4 0 0.0 1 1.4 Sub-Saharan Africa 24 41.4 13 17.3 14 19.7 23 25.8 27 27.8 20 27.0 27 30.0 12 17.4 25 31.6 15 20.5 East Asia 2 3.4 4 5.3 2 2.8 3 3.4 5 5.2 3 4.1 2 2.2 0 0.0 4 5.1 0 0.0 South Asia 23 39.7 35 46.7 36 50.7 37 41.6 36 37.1 32 43.2 43 47.8 36 52.2 37 46.8 40 54.8 South East Asia 1 1.7 6 8.0 8 11.3 4 4.5 13 13.4 9 12.2 3 3.3 8 11.6 8 10.1 7 9.6 Central Europe 0 0.0 3 4.0 0 0.0 3 3.4 2 2.1 0 0.0 0 0.0 2 2.9 1 1.3 1 1.4 East Europe 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 0 0.0 0 0.0 0 0.0 2 2.7 West Europe 0 0.0 3 4.0 2 2.8 4 4.5 2 2.1 1 1.4 2 2.2 2 2.9 2 2.5 2 2.7 East Mediterranean 0 0.0 3 4.0 2 2.8 4 4.5 1 1.0 1 1.4 2 2.2 0 0.0 2 2.5 2 2.7 North America 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 South & Central America 0 0.0 0 0.0 1 1.4 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 Not Known 5 8.6 6 8.0 4 5.6 8 9.0 10 10.3 6 8.1 7 7.8 8 11.6 0 0.0 1 1.4 Total 58 75 71 89 97 74 90 69 79 73 Table 7. Time between UK Entry and Tuberculosis Diagnosis for Non-UK Born Cases, 2003-2012 Time between UK Entry and Diagnosis cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % < 2 years 21 36.2 30 40.0 28 39.4 19 21.3 29 29.9 19 25.7 20 22.2 10 14.5 19 24.1 19 26.0 2-4 years 4 6.9 13 17.3 15 21.1 29 32.6 16 16.5 10 13.5 23 25.6 17 24.6 15 19.0 19 26.0 5-9 years 6 10.3 4 5.3 5 7.0 8 9.0 7 7.2 13 17.6 19 21.1 10 14.5 20 25.3 14 19.2 >10 years 12 20.7 12 16.0 9 12.7 11 12.4 14 14.4 17 23.0 7 7.8 14 20.3 16 20.3 13 17.8 Not Recorded 15 25.9 16 21.3 14 19.7 22 24.7 31 32.0 15 20.3 21 23.3 18 26.1 9 11.4 8 11.0 Version: 1 Page: 21 of 26 Intended Audience: Health

Table 8. Number and Percentage of Tuberculosis Cases in Wales by Site of Disease, 2003-12 2009 2010 Site of Disease 1 2003 2004 2005 2006 2007 2008 2011 2012 Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Pulmonary 2 113 60.8 127 60.5 118 55.1 112 53.3 134 56.3 101 52.6 126 52.3 93 55.0 70 45.2 77 52.0 Extra thoracic lymph nodes 24 12.9 30 14.3 32 15.0 41 19.5 39 16.4 26 13.5 39 16.2 25 14.8 31 20.0 32 21.6 Intra thoracic lymph nodes 5 2.7 9 4.3 13 6.1 9 4.3 21 8.8 16 8.3 11 4.6 9 5.3 1 0.6 4 2.7 Pleural 9 4.8 13 6.2 21 9.8 12 5.7 17 7.1 10 5.2 14 5.8 6 3.6 12 7.7 10 6.8 Gastrointestinal 3 1.6 3 1.4 7 3.3 11 5.2 6 2.5 10 5.2 5 2.1 6 3.6 7 4.5 5 3.4 CNS-meningitis 0 0.0 3 1.4 2 0.9 3 1.4 4 1.7 4 2.1 4 1.7 5 3.0 3 1.9 1 0.7 CNS-other 1 0.5 0 0.0 1 0.5 1 0.5 0 0.0 1 0.5 4 1.7 2 1.2 0 0.0 2 1.4 Bone-Spine 6 3.2 4 1.9 5 2.3 4 1.9 4 1.7 4 2.1 8 3.3 2 1.2 4 2.6 3 2.0 Bone-other 9 4.8 4 1.9 1 0.5 3 1.4 3 1.3 2 1.0 4 1.7 2 1.2 4 2.6 3 2.0 Genitourinary 4 2.2 5 2.4 2 0.9 2 1.0 4 1.7 2 1.0 3 1.2 3 1.8 0 0.0 1 0.7 Laryngeal 1 0.5 1 0.5 0 0.0 1 0.5 1 0.4 1 0.5 0 0.0 2 1.2 1 0.6 0 0.0 Cryptic 1 0.5 0 0.0 2 0.9 1 0.5 0 0.0 1 0.5 1 0.4 0 0.0 2 1.3 1 0.7 Other extra pulmonary 10 5.4 11 5.2 10 4.7 10 4.8 5 2.1 13 6.8 22 9.1 14 8.3 20 12.9 9 6.1 Unknown extra pulmonary 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.5 0 0.0 0 0.0 0 0.0 0 0.0 1 Patients may have disease at more than one site 2 Miliary TB is now classified as pulmonary TB in accordance with the WHO s recommendation and international reporting definitions [2]. Revised trends in site of disease are presented for previous years using the revised WHO definitions. Table 9. Number and Percentage of Cases in Wales with a History of BCG Vaccination by Age Group, 2012 Age Group Vaccinated Known Status Vaccinated % Known Status % 0-4 0 0 - - 5-14 1 3 33.3 100.0 15-24 6 8 75.0 61.5 25-34 17 21 81.0 53.8 35-44 12 13 92.3 72.2 45-54 7 9 77.8 39.1 55-64 4 4 100.0 44.4 65+ 4 11 36.4 35.5 Total 51 69 73.9 50.7 Version: 1 Page: 22 of 26 Intended Audience: Health

Table 10. Number and Percentage of Tuberculosis Cases in Wales with Previous Tuberculosis Diagnosis, 2003-2012 Previous Diagnosis cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Yes 15 9.1 14 7.4 14 7.5 7 3.8 17 8.3 14 8.3 22 10.3 6 3.9 10 7.7 7 5.1 No 119 72.6 126 67.0 142 76.3 140 76.9 147 72.1 126 75.0 153 71.5 123 80.4 108 83.1 120 88.2 Not Reported 30 18.3 48 25.5 30 16.1 35 19.2 40 19.6 28 16.7 39 18.2 24 15.7 12 9.2 9 6.6 Table 11. Number and Percentage of Tuberculosis Cases in Wales with Bacteriological Confirmation, 2003-2012 Previous Diagnosis cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Culture Confirmed 1 107 65.2 100 53.2 116 62.4 123 67.6 122 59.8 101 60.1 112 52.3 106 69.3 90 69.2 100 76.9 Culture Confirmed Pulmonary Cases 2 79 69.9 71 55.9 77 65.3 87 77.7 88 65.7 72 71.3 72 57.1 73 78.5 53 75.7 59 76.6 Pulmonary Cases with Sputum Smear Taken 2 90 79.6 96 75.6 85 72.0 89 79.5 94 70.1 55 54.5 40 31.7 42 45.2 39 55.7 41 53.2 Positive Sputum Smear Pulmonary Cases 3 58 64.4 53 55.2 44 51.8 45 50.6 42 44.7 27 49.1 19 47.5 22 52.4 29 74.4 32 78.0 1 Denominator for percentage is total number of TB cases 2 Denominator for percentage is total number of pulmonary TB cases 3 Denominator for percentage is number of pulmonary cases with sputum smear taken Version: 1 Page: 23 of 26 Intended Audience: Health

Table 12. Species Identification in Culture Confirmed Tuberculosis Case, Wales 2003-12 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Species Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % M.african 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 1 1.1 1 1.0 M.bovis 0 0.0 1 1.0 4 3.4 0 0.0 1 0.8 2 2.0 4 3.6 1 0.9 0 0.0 3 3.0 M.tuberculosis 106 99.1 99 99.0 112 96.6 123 100.0 121 99.2 99 98.0 107 95.5 104 98.1 89 98.9 96 96.0 M.tuberculosis complex 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 Table 13. Number and Percentage of Tuberculosis Cases in Wales with Treatment Outcome 1 Reported at 12 Months, 2002-2011 Year Total TB cases Excluded cases 2 Unknown Outcome 3 Total for Evaluation 4 Completed Treatment Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Died Lost to Follow-up Still on Treatment Stopped Not completed (reason unknown) 2002 156 1 0.6 8 5.4 147 94.2 106 72.1 16 10.9 3 2.0 14 9.5 2 1.4 6 4.1 2003 164 3 1.8 15 10.3 146 89.0 104 71.2 15 10.3 5 3.4 17 11.6 3 2.1 2 1.4 2004 188 2 1.1 24 14.8 162 86.2 117 72.2 20 12.3 18 11.1 4 2.5 1 0.6 2 1.2 2005 186 2 1.1 18 10.8 166 89.2 123 74.1 19 11.4 7 4.2 12 7.2 3 1.8 2 1.2 2006 182 0 0.0 28 18.2 154 84.6 127 82.5 15 9.7 6 3.9 1 0.6 4 2.6 1 0.6 2007 204 3 1.5 28 16.2 173 84.8 132 76.3 14 8.1 13 7.5 10 5.8 3 1.7 1 0.6 2008 168 3 1.8 7 4.4 158 94.0 134 84.8 14 8.9 4 2.5 5 3.2 1 0.6 0 0.0 2009 214 1 0.5 8 3.9 205 95.8 165 80.5 19 9.3 9 4.4 6 2.9 5 2.4 1 0.5 2010 153 0 0.0 2 1.3 151 98.7 119 78.8 22 14.6 6 4.0 3 2.0 1 0.7 0 0.0 2011 130 2 1.5 4 3.2 124 95.4 98 79.0 8 6.5 8 6.5 4 3.2 6 4.8 0 0.0 1 Treatment outcomes are reported in accordance with revised 2013 World Health Organization (WHO) treatment outcome definitions [2]. Under these revised definitions, treatment outcome is reported for the cohort of patients with drug sensitive TB (excluding patients with rifampicin resistance or multi-drug resistance) at 12 months. Revised trends in treatment outcomes are presented for previous years using the revised WHO definitions. 2 Excludes multi-drug resistant and rifampicin resistant patients. 3 Refers to cases where treatment outcome is missing or were transferred to another clinic outside Wales. 4 Refers to drug sensitive TB cases excluding patients with rifampicin resistance or multi-drug resistance and that that an unknown outcome. Version: 1 Page: 24 of 26 Intended Audience: Health

Table 14. Number and Percentage of Tuberculosis Cases in Wales Completing Treatment 1 by 12 Months by LA, 2010-2011 LHB and LA Total TB cases Excluded cases 2 2010 2011 Unknown Total for Treatment Total TB Excluded Unknown Outcome 3 Evaluation 4 Completed cases cases 2 Outcome 3 Version: 1 Page: 25 of 26 Intended Audience: Health Total for Evaluation 4 Treatment Completed Betsi Cadwaladr University 28 0 2 26 (92.9) 21 (80.8) 19 0 1 18 (94.7) 13 (72.2) Anglesey 4 0 1 3 (75.0) 2 (66.7) 0 - - - - Conwy 5 0 1 4 (80.0) 4 (100.0) 2 0 0 2 (100.0) 2 (100.0) Denbighshire 2 0 0 2 (100.0) 2 (100.0) 3 0 0 3 (100.0) 2 (66.7) Flintshire 2 0 0 2 (100.0) 2 (100.0) 5 0 0 5 (100.0) 4 (80.0) Gwynedd 10 0 0 10 (100.0) 8 (80.0) 4 0 1 3 (75.0) 0 (0.0) Wrexham 5 0 0 5 (100.0) 3 (60.0) 5 0 0 5 (100.0) 5 (100.0) Powys Teaching 4 0 0 4 (100.0) 2 (50.0) 1 0 0 1 (100.0) 1 (100.0) Powys 4 0 0 4 (100.0) 2 (50.0) 1 0 0 1 (100.0) 1 (100.0) Hywel Dda 12 0 0 12 (100.0) 11 (91.7) 18 0 2 16 (88.9) 13 (81.3) Carmarthenshire 9 0 0 9 (100.0) 8 (88.9) 9 0 0 9 (100.0) 7 (77.8) Ceredigion 1 0 0 1 (100.0) 1 (100.0) 5 0 1 4 (80.0) 3 (75.0) Pembrokeshire 2 0 0 2 (100.0) 2 (100.0) 4 0 1 3 (75.0) 3 (100.0) Abertawe Bro Morgannwg University 23 0 0 23 (100.0) 16 (69.6) 19 0 1 18 (94.7) 14 (77.8) Bridgend 3 0 0 3 (100.0) 1 (33.3) 5 0 1 4 (80.0) 2 (50.0) Neath Port Talbot 5 0 0 5 (100.0) 4 (80.0) 5 0 0 5 (100.0) 5 (100.0) Swansea 15 0 0 15 (100.0) 11 (73.3) 9 0 0 9 (100.0) 7 (77.8) Cwm Taf 16 0 0 16 (100.0) 12 (75.0) 6 0 0 6 (100.0) 4 (66.7) Merthyr Tydfil 3 0 0 3 (100.0) 3 (100.0) 2 0 0 2 (100.0) 1 (50.0) Rhondda, Cynon, Taff 13 0 0 13 (100.0) 9 (69.2) 4 0 0 4 (100.0) 3 (75.0) Cardiff and Vale University 46 0 0 46 (100.0) 37 (80.4) 43 1 0 42 (97.7) 34 (81.0) Cardiff 42 0 0 42 (100.0) 34 (81.0) 35 1 0 34 (97.1) 26 (76.5) Vale of Glamorgan 4 0 0 4 (100.0) 3 (75.0) 8 0 0 8 (100.0) 8 (100.0) Aneurin Bevan 24 0 0 24 (100.0) 20 (83.3) 24 1 0 23 (95.8) 19 (82.6) Blaenau Gwent 4 0 0 4 (100.0) 2 (50.0) 1 0 0 1 (100.0) 1 (100.0) Caerphilly 3 0 0 3 (100.0) 3 (100.0) 5 0 0 5 (100.0) 4 (80.0) Monmouthshire 2 0 0 2 (100.0) 1 (50.0) 5 1 0 4 (80.0) 3 (75.0) Newport 15 0 0 15 (100.0) 14 (93.3) 12 0 0 12 (100.0) 10 (83.3) Torfaen 0 - - - 1 0 0 1 (100.0) 1 (100.0) Total 153 0 2 151 (98.7) 119 (78.8) 130 2 4 124 (95.4) 98 (79.0) 1 Treatment outcomes are reported in accordance with revised 2013 WHO treatment outcome definitions [2]. Under these revised definitions, treatment outcome is reported for the cohort of patients with drug sensitive TB (excluding patients with rifampicin resistance or multi-drug resistance) at 12 months. Revised trends in treatment outcomes are presented for previous years using the revised WHO definitions. 2 Excludes multi-drug resistant and rifampicin resistant patients. 3 Refers to cases where treatment outcome is missing or were transferred to another clinic outside Wales. 4 Refers to drug sensitive TB cases excluding patients with rifampicin resistance or multi-drug resistance and that that an unknown outcome.

Table 15. Number and Percentage of Tuberculosis Cases in Wales Completing Treatment 1 by 12 Months by Age Group, 2010-2011 Age Group 2010 2011 Total for Evaluation Treatment Completed Died Total for Evaluation Treatment Completed Died cases % cases % cases % cases % cases % cases % 0-4 2 100.0 2 100.0 0 0.0 2 100.0 2 100.0 0 0.0 5-14 4 100.0 4 100.0 0 0.0 5 83.3 5 100.0 0 0.0 15-24 18 100.0 15 83.3 0 0.0 18 94.7 15 83.3 0 0.0 25-34 31 96.9 26 83.9 2 6.5 29 100.0 24 82.8 0 0.0 35-44 25 100.0 22 88.0 2 8.0 24 92.3 20 83.3 1 4.0 45-54 19 100.0 16 84.2 1 5.3 11 100.0 11 100.0 0 0.0 55-64 18 100.0 13 72.2 4 22.2 8 88.9 8 100.0 0 0.0 65+ 34 97.1 21 61.8 13 38.2 25 96.2 13 52.0 7 28.0 1 Treatment outcomes are reported in accordance with revised 2013 WHO treatment outcome definitions [2]. Under these revised definitions, treatment outcome is reported for the cohort of patients with drug sensitive TB (excluding patients with rifampicin resistance or multi-drug resistance) at 12 months. Revised trends in treatment outcomes are presented for previous years using the revised WHO definitions. 2 Refers to drug sensitive TB cases excluding patients with rifampicin resistance or multi-drug resistance and that that an unknown outcome. Version: 1 Page: 26 of 26 Intended Audience: Health