Tuberculosis in Wales Annual Report 2015

Tuberculosis in Wales Annual Report 2015 Author: Communicable Disease Surveillance Centre Date: 10/03/2016 Version: 1 Status: Final Intended Audience: Health Purpose and Summary of Document: This annual report summarises trends in the epidemiology of tuberculosis in Wales. 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 32 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 Enhanced Tuberculosis Surveillance scheme in England, Wales and Northern Ireland 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 Local Health Boards. This report summarises the latest annual trends in the epidemiology of tuberculosis in Wales, using data 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, March 2016. 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 32 Intended Audience: Health

Key Points Notification rates for tuberculosis remain low in Wales relative to other countries in the UK. In 2014, 115 cases of tuberculosis were reported in Wales (3.7 per 100,000 population), a decrease on recent years. Notification rates vary geographically, with rates highest in the urban centres of South East Wales. The notification rate was highest in those aged 25 to 34 years (6.4 per 100,000 population). Between 2013 and 2014 the notification rate decreased in all age groups apart from those aged 45-54 years where the rate remained stable, and those aged 35-44 years where the rate increased. Of the 115 cases reported in 2014, 63% were male and 37% female (rates of 4.8 and 2.7 per 100,000, respectively). In 2014, 37% of tuberculosis cases were reported in the White ethnic group, 59% were in the non-white population and 4% were of an unknown ethnic group. Thirty-eight percent of tuberculosis cases reported in Wales were born in the UK, 57% of cases were born abroad and 5% of cases had unknown place of birth. Completeness of recording of social risk factors varied from 77% to 90% in 2014. Of those reported, seven percent of cases reported a history of, or current drug abuse, seven percent reported a history of, or current alcohol misuse or abuse, eight percent reported they had been, or are currently, homeless and six percent reported they had been, or are currently, in prison. Over half of the cases in 2014 (57%, 65/115) had pulmonary tuberculosis (with or without extra-pulmonary disease); of which 16 (25%) also had extra pulmonary disease. In 2014 there was one case of XDR-TB and two further cases of MDR-TB reported in culture confirmed tuberculosis in Wales. There was an increase in both isoniazid and rifampicin resistance in culture confirmed cases of tuberculosis in 2014 compared to 2013, from 9% to 11% and 2% to 4% respectively. Outcome data are available for cases newly diagnosed in 2013. The proportion of drug sensitive cases with expected treatment duration of less than 12 months who had completed treatment by 12 months increased in 2013 to 79.3%, compared to 73.3% in 2012. Treatment completion was lowest in those aged 65 years and older (66.7%, 10/15) and those aged 5-14 years (66.7%, 2/3). The proportion of deaths in drug sensitive cases has decreased from 11% in 2012 to 5% in 2013, the lowest reported since ETS was introduced. The proportion of cases not evaluated was three times higher in 2013 (9%, 13/139) compared to 2012 (3%, 4/135), the highest proportion of cases not evaluated since 2007. Version: 1 Page: 3 of 32 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. Tuberculosis case outcomes..................... 15 Notes on Methods................................ 19 References..................................... 19 Appendix...................................... 20 Version: 1 Page: 4 of 32 Intended Audience: Health

1 Geographical Distribution 1.1 TB Rates in Wales and the UK In Wales, 115 cases of tuberculosis were reported in 2014 to the Enhanced Tuberculosis Surveillance (ETS) scheme, equivalent to a rate of 3.7 per 100,000 population (95% confidence interval (CI) 3.1-4.5 per 100,000 population). This represents a decrease as compared to 2013 and the lowest rate reported since ETS was introduced (Figure 1). Provisionally, for 2015, there have been 115 cases reported on ETS that reside in Wales at 09/03/2016. Figure 1. Number of Cases and Rate of TB per 100,000 population in Wales, 2005-2014 6.8 7 6.2 6.1 185 183 204 5.6 169 213 5 152 4.3 4.4 4.6 3.7 131 136 142 115 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Number of cases Rate per 100 000 Public Health England [1], reports the UK rate of tuberculosis as 11.0 per 100,000 population in 2014. England continues to have the highest rate of tuberculosis in the UK, with a rate of 12.0 (95% CI 11.7 12.3) per 100,000 population, followed by Scotland (6.5 (95% CI 5.8-7.2) per 100,000 population) and Northern Ireland (5.2 (95% CI 4.2-6.3) per 100,000 population). Of the UK countries, Wales had the lowest rate of tuberculosis in 2014. Between 2013 and 2014, the rate of tuberculosis per 100,000 population decreased in Wales, England and Scotland and increased in Northern Ireland. Version: 1 Page: 5 of 32 Intended Audience: Health

Figure 2. Rate of TB per 100,000 population in the UK, 2014 England Scotland Northern Ireland Wales 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Rate per 100,000 Version: 1 Page: 6 of 32 Intended Audience: Health

1.2 Area of Residence In 2014, the highest tuberculosis rate was observed in Cardiff and Vale University Health Board (5.8 per 100,000 population) and the lowest rate was in Powys Teaching University Health Board (1.5 per 100,000 population). Between 2013 and 2014, the rate of tuberculosis increased in Aneurin Bevan University and Hywel Dda Health Boards, remained stable in Powys Teaching Health Board and decreased in Abertawe Bro Morgannwg University, Betsi Cadwaladr University, Cardiff and Vale University and Cwm Taf University Health Boards (Table A1). Between 2013 and 2014 the rate of tuberculosis increased in three of the 22 Local Authorities in Wales, remained stable in nine and decreased in ten (Table A1). The rate of tuberculosis ranged from 0 per 100,000 in Merthyr Tydfil to 16.3 per 100,000 population in Newport (Figure 3a). Figure 3b shows the five year average rate of tuberculosis per 100,000 population by Local Authority for the period 2010 to 2014. Tuberculosis rates continue to be highest in Cardiff and Newport. By comparing 2014 with the average in the five years 2010 to 2014, the rate in 2014 was higher in Newport, remained stable in eleven Local Authorities and was lower in ten Local Authorities (Figure 3). Figure 3. Rate of TB by Local Authority a. 2014 b. 2010-2014 Crown Copyright and database right 2014. Ordnance Survey 100044810 Version: 1 Page: 7 of 32 Intended Audience: Health

2 Demographic Characteristics of Tuberculosis Cases in Wales 2.1 Age and Sex In 2014, around two thirds of newly diagnosed tuberculosis cases were male (63%, 73/115), a rate of 4.8 (95% CI 3.8-6.0) per 100,000 male population, with a lower rate of 2.7 (95% CI 1.9-3.6) per 100,000 females (Table A2). The highest incidence was seen in people aged 25-34 (6.4 per 100,000; 21% of cases). During 2014 there was only one reported case of tuberculosis in a child aged under 15 years, the lowest proportion in this age group in over ten years (Table A3). Changes in the rate of tuberculosis amongst different age groups from 2005-2014 are presented in Figure 4. 2.2 Ethnicity Information on ethnic group was known for 97% (111/115) of cases notified in 2014. The largest proportions of cases were from White (37.4%, 43/115) and Indian (18.3%, 21/115) ethnic groups. Compared to 2013, the number of cases has decreased in all ethnic groups apart from Pakistani and Black-Other. The five year (2010 to 2014) average annual rate was highest in the Black-African ethnic group; 134.6 per 100,000 population (95% CI 77.0-218.5) and lowest in the White ethnic group, a rate of 1.8 per 100,000 population (95% CI 1.4-2.4) (Figure 5, Table A4). Version: 1 Page: 8 of 32 Intended Audience: Health

Figure 4. Rate of TB per 100,000 population by Age Group and Year in Wales, 2005-2014 0-4 Age Group 35-44 Age Group 2.5 3.1 6.7 4.7 6.4 1.1 1.1 0.0 1.1 0.6 6.8 8.2 8.4 6.9 8.0 6.2 6.9 4.5 4.3 5.2 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 5-14 Age Group 45-54 Age Group 6.0 5.4 7.1 4.5 7.8 4.6 5.6 4.4 4.4 1.1 1.1 0.8 2.6 0.9 1.2 1.8 0.9 0.9 0.0 2.6 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 15-24 Age Group 55-64 Age Group 4.9 5.3 6.2 4.2 7.1 4.2 5.1 3.4 6.3 4.4 3.4 5.2 2.3 4.6 4.3 4.6 2.3 2.3 5.0 3.9 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 15.4 25-34 Age Group 65+ Age Group 10.1 12.5 9.2 12.5 9.0 8.0 11.0 10.3 6.4 11.2 6.5 7.4 7.1 8.0 6.3 4.6 4.9 3.2 3.1 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Version: 1 Page: 9 of 32 Intended Audience: Health

Figure 5. Average Annual Number of TB Cases and Rate per 100,000 population in Wales by Ethnic Group, 2010-2014 134.6 132.1 116.1 54 46.5 41.2 20.5 19.3 1.8 5.3 <1 16 1 23 14 4 3 12 Average Number of Cases Rate 2.3 Place of Birth Information on place of birth was known for 95% (109/115) of tuberculosis cases notified in Wales in 2014. Fifty-seven percent of cases (65/115) were known to have been born outside of the UK whilst 38% of cases (44/115) were known to have been born in the UK (Figure 6, Table A5). As in previous years, in 2014 the majority of cases known to be born outside the UK originated from South Asia (55.4%, 36/65) and Sub-Saharan Africa (16.9%, 11/65) (Table A6). Information on region of birth was unknown for 4.6% (3/65) of cases born outside of the UK. Version: 1 Page: 10 of 32 Intended Audience: Health

Number of TB cases Public Health Wales Tuberculosis in Wales Annual Report 2015: Figure 6. Number of non-uk born TB Cases in Wales, 2005-2014 1 Number of non-uk born TB cases Total number of TB cases 250 200 150 100 50 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 1 During 2005-2014 between 1-15% of cases were reported with an unknown origin for place of birth. 2.4 Time between Entry into the UK and Diagnosis The time between entry to the UK and tuberculosis diagnosis was known for 79% (51/65) of non-uk born cases diagnosed in 2014 (Table A7). Where time since entry was known, the highest proportion of cases were diagnosed within 2 years of UK entry (31%, 16/51) followed by over 10 years since UK entry (29%, 15/51). Version: 1 Page: 11 of 32 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 2014, information on social risk factors was known for between 77% and 90% of cases in Wales, depending on the risk factor investigated (Figure 7). In 2014, 19% of cases reported at least one social risk factor. Seven percent of cases reported a history of, or current, drug use, 7% reported a history of, or current, alcohol misuse, 8% reported a history of, or current, homelessness, and 6% reported a history of, or current, imprisonment (Table 1). The proportion of cases for which a social risk factor was recorded increased between 2013 and 2014. However, the completeness of recording social risk factors decreased between 2013 and 2014 for all risk factors. Table 1. Social risk factors among TB patients in Wales, 2009-2014 2009 2010 2011 2012 2013 2014 History or current drug use 3% 11% 3% 0% 7% 7% History or current alcohol misuse 5% 5% 2% 2% 5% 7% History or current homelessness 8% 5% 3% 2% 4% 8% History or current imprisonment 4% 5% 2% 1% 3% 6% Any risk factor 17% 17% 8% 6% 12% 19% Figure. 7 Completeness (%) of Recording Risk Factors, 2009-2014 77% 79% 74% 83% 80% 72% 70% 92% 90% 92% 94% 90% 90% 90% 86% 88% 85% 83% 85% 86% 84% 80% 77% 63% 2009 2010 2011 2012 2013 2014 History of Drug Abuse History of Homelessness History of Alcohol Abuse History of Prison Version: 1 Page: 12 of 32 Intended Audience: Health

4 Clinical Characteristics 4.1 Site of Disease Information on site of disease was known for 99% (114/115) of cases notified in 2014. Over half of tuberculosis cases with a known site of disease had pulmonary disease (with or without extra-pulmonary disease) (57%, 65/114). Twenty five percent (16/65) of pulmonary cases were reported to also have extra pulmonary disease in at least one additional site. Many cases reported disease at multiple sites. The extra thoracic lymph nodes were the most common extra-pulmonary site of infection 17%, 19/114 (Table A8). 4.2 Planned Course of Treatment In 2014, planned course of treatment was known for 94% (108/115) of cases. Of these 108 cases, 85% (92) were assigned to a standard six month course of treatment. It was known whether a patient was assigned to DOT treatment in 92% of cases (106/115). Thirteen percent of these cases (14/106) were assigned DOT treatment. In 2014, 47% (8/17) of cases reported at least one social risk factor were known to be on Directly Observed Therapy (DOT). 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 2014, BCG vaccination status was known for 50% (57/115) of tuberculosis cases, a similar level of completeness to 2013. Of the 57 cases with known BCG vaccination status, 79% (45) were vaccinated, an increase from 74% (54/73) in 2013. Coverage was over 77% in all age groups apart from those aged 65 years and older where coverage was 50% (3/6) (Table A9). 4.4 Previous Diagnosis Information on previous tuberculosis diagnosis was known for 88% (101/115) of cases, of which eight had a previous diagnosis of tuberculosis (Table A10). Of these eight patients, three were assigned to DOT with the remaining patients not assigned to DOT (5/8). Version: 1 Page: 13 of 32 Intended Audience: Health

5 Bacteriology, Speciation and Drug Susceptibility 5.1 Bacteriology Sixty nine percent (79/115) of all cases in 2014 were culture confirmed, and 83% (54/65) of pulmonary cases (with or without extra pulmonary disease) were culture confirmed. This is higher than the 72% UK average reported by Public Health England as well as compared to other UK counterparts [1] and 3% above the European Centre for Disease Prevention and Control (ECDC) target of 80% for culture confirmation of pulmonary tuberculosis [2]. For 55% (36/65) of pulmonary cases in 2014 a sputum smear result was recorded, of which 56% (20/36) were positive (Table A11). Fifty-one percent (25/49) of cases which reported extra pulmonary disease only were culture confirmed. 5.2 Other mycobacterium species 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. 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 89 culture-confirmed cases reported through the Enhanced Tuberculosis Surveillance scheme in 2014, all cases were due to infection by Mycobacterium tuberculosis (Table A12). 5.3 Antimicrobial Resistance Drug susceptibility results for first line drugs isoniazid and rifampicin were reported for 100% (79/79) of culture confirmed tuberculosis cases. As with previous years, surveillance data continues to show that resistance to first line antimicrobials is low, although there was an increase in isoniazid resistance in culture confirmed cases from 9% (8/87) in 2013 to 11% (9/79) in 2014 and also an increase in rifampicin resistance in culture confirmed cases from 2% (2/87) in 2013 to 4% (3/79) in 2014. These resistance levels are higher than those reported in England but, since the number of TB cases in Wales is much smaller, these proportions should be interpreted with caution [3]. In 2014, there was a single case of extensively drug resistant TB (XDR-TB). XDR-TB is resistant to at least one fluoroquinolone and at least one second line injectable drug (amikacin, capreomycin or kanamycin) [2]. There were a further two cases of multidrug resistant (MDR) TB reported in 2014, TB strains that are resistant to both isoniazid and rifampicin. Version: 1 Page: 14 of 32 Intended Audience: Health

6 Tuberculosis case outcomes Drug sensitive cohort, 2004 2013 In accordance with the revised World Health Organization (WHO) TB outcome definitions, the drug sensitive cohort is defined as all TB cases excluding those with rifampicin resistant TB or MDR-TB (initial or amplified), or non-culture confirmed cases treated as MDR-TB [2]. In this report, treatment outcomes at 12 months for drug sensitive TB cases are reported for cases with an expected duration of treatment less than 12 months. This group excludes cases with CNS disease who have an expected treatment duration of 12 months. Cases with spinal, cryptic disseminated or miliary disease are also excluded from this group, as CNS involvement cannot be reliably ruled out for the purposes of reporting. TB outcomes, loss to follow up and deaths in the entire drug sensitive cohort (including cases with CNS, spinal, cryptic disseminated or miliary TB disease) are presented by last recorded outcome. TB outcomes reported using these new cohort definitions will not be directly comparable with outcome data presented in previous reports. Treatment outcomes for all cases notified from 2004-2013 have been calculated using these new definitions, so that trends can be monitored. TB outcomes at 12 months for drug sensitive cohort with expected duration of treatment less than 12 months Information on the outcome of treatment, 12 months after treatment commenced, was reported for 90.9% (110/121) of cases in this cohort notified in 2013 (Table A13). Seventy-nine percent (96/121) of cases completed treatment within 12 months within this cohort notified in 2013, compared to 73.3% (88/120) in 2012 (Table A13, Figure 8). From 2004 to 2012 the proportion of outcomes not evaluated had largely decreased but it increased again in 2013. Version: 1 Page: 15 of 32 Intended Audience: Health

Figure 8: TB outcome percentages at 12 months for drug sensitive cases with expected treatment duration <12 months 1, Wales, 2013 79.3% 3.3% 5.0% 2.5% 0.8% 9.1% Completed Died Lost to follow up Still on treatment Stopped Not evaluated 2 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB cases and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB. 2 Not evaluated includes missing, unknown and transferred out. The proportion of cases who completed treatment within 12 months varied with age in 2013 (Table A14). Treatment completion was highest in 0-4 year olds (100%, 2/2) and lowest in those aged 65 years and older (66.7%, 10/15) and those aged 5-14 years (66.7%, 2/3). The proportion of cases that completed treatment was similar in males (80%, 59/74) and females (79%, 37/47, Table A15). The proportion of cases with a known site of disease and who completed treatment within 12 months was higher in those with extra-pulmonary disease only (84.8%, 39/46) compared to those with pulmonary disease only (76.2%, 48/63, Table A16). In those with a known site of disease, completion was highest in those with lymph node TB (intra-thoracic lymph node 100.0%, 5/5 and extra-thoracic lymph node 95.7% 22/23). In 2013, treatment completion at 12 months varied by Health Board ranging from 55.0% (Abertawe Bro Morgannwg UHB) to 92.0% (Betsi Cadwaladr UHB) (Table A17). Table 2. Treatment completion at 12 months for drug sensitive TB cases with expected treatment duration <12 months by Health Board, Wales, 2013 Abertawe Bro Morgannwg UHB 55.0% Aneurin Bevan UHB 78.9% Betsi Cadwaladr UHB 92.0% Cardiff and Vale UHB 91.7% Cwm Taf UHB 62.5% Hywel Dda UHB 70.0% Powys THB 1 66.7% 1 Interpret with caution as number of cases in Powys is small Version: 1 Page: 16 of 32 Intended Audience: Health

TB outcomes at last reported outcome Information on the outcome of treatment based on the last reported outcome was reported for 91% (126/139) of cases in this cohort notified in 2013 (Table A18). The proportion of cases in this cohort notified in 2013 who completed treatment was 77.7% (108/139) (Table A18, Figure 9). Figure 9: Last recorded TB outcome percentages for the entire drug sensitive cohort 1, Wales 2013 77.7% 5.0% 5.8% 0.7% 1.4% 9.4% Completed Died Lost to follow up Still on treatment Stopped Not evaluated 2 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB cases and MDR-TB treated cases. 2 Not evaluated includes missing, unknown and transferred out In 2013, treatment completion in the entire drug sensitive cohort varied by Health Board from 50.0% (Abertawe Bro Morgannwg UHB) to 92.5% (Cardiff and Vale UHB) (Table A19). Table 3. Treatment completion at last reported outcome for drug sensitive TB cases by Health Board, Wales, 2013 Abertawe Bro Morgannwg UHB 50.0% Aneurin Bevan UHB 83.3% Betsi Cadwaladr UHB 86.7% Cardiff and Vale UHB 92.5% Cwm Taf UHB 55.6% Hywel Dda UHB 63.6% Powys THB 1 66.7% 1 Interpret with caution as number of cases in Powys is small Version: 1 Page: 17 of 32 Intended Audience: Health

Deaths at last reported outcome In 2013, the proportion of cases who were reported to have died at the last reported outcome among all drug sensitive TB cases was 5.0% (7/139), less than half the proportion reported in 2012 (Table A20). Of the 7 deaths in 2013, tuberculosis caused or contributed to death in 14.3% (1), was incidental in 14.3% (1) and the relationship between tuberculosis and death was unknown for the remaining 71.4% (5). Among those reported to have died, 42.9% (3/7) were diagnosed post-mortem. Wales had the second lowest proportion of deaths in drug sensitive cases notified in 2013 (5%) compared to other countries in the UK (Scotland: 8.3%, Northern Ireland: 6.8%, and England: 4.6%) [1]. Loss to follow up at last reported outcome In 2013, 5.8% (8/139) of all drug sensitive TB cases were lost to follow up at the last reported outcome (Table A18). Of the six cases where reason for loss to follow up was recorded, all of the cases had left the UK. Version: 1 Page: 18 of 32 Intended Audience: Health

Notes on Methods All analysis was conducted using Stata 13.0. Rates were calculated using mid-year population estimates for Wales obtained from the Office of National Statistics (ONS). Rates for ethnic groups were calculated using ONS 2011 population estimates for ethnic groups resident in Wales. This report only includes tuberculosis cases which have been notified to ETS. All Local Health Board and Local Authority figures are based on the area of residence of tuberculosis cases. Miliary tuberculosis is classified as pulmonary tuberculosis in accordance with the WHO s recommendation and international reporting definitions [4]. Data presented in this report are correct as at March 2015. As treatment outcomes are reported at 12 months, treatment outcomes are only available to be reported on for cases notified in the previous year, at the time data is extracted for the report. References [1] Reports of cases of tuberculosis to enhanced tuberculosis surveillance systems: United Kingdom, 2000 to 2014. Public Health England 2015. https://www.gov.uk/government/statistics/reports-of-cases-of-tuberculosis-toenhanced-tuberculosis-surveillance-systems-uk-2000-to-2014 [2] European Centre for Disease Control and Prevention (ECDC), Progress towards TB elimination, 2010. http://ecdc.europa.eu/en/publications/publications/101111_spr_progressing_towar ds_tb_elimination.pdf [3] Public Health England. (2015) Tuberculosis in England: 2015 report version 1.1. Public Health England: London. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/49 2431/TB_Annual_Report_v2.6_07012016.pdf [4] Definitions and reporting framework for tuberculosis 2013 revision. WHO 2013. http://apps.who.int/iris/bitstream/10665/79199/1/9789241505345_eng.pdf Version: 1 Page: 19 of 32 Intended Audience: Health

Appendix Table A1. Number of Cases and Rate 1 of Tuberculosis in Wales by LHB and LA, 2005-2014 HB and LA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 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 Abertawe Bro Morgannwg University 32 6.4 28 5.6 41 8.1 33 6.5 36 7.0 23 4.5 19 3.7 17 3.3 23 4.4 15 2.9 19 3.7 Bridgend 4 3.0 8 6.0 11 8.1 8 5.8 3 2.2 3 2.2 5 3.6 1 0.7 3 2.1 1 0.7 3 1.9 Neath Port Talbot 11 8.0 10 7.2 6 4.3 2 1.4 7 5.0 5 3.6 5 3.6 4 2.9 9 6.4 2 1.4 5 3.6 Swansea 17 7.4 10 4.3 24 10.3 23 9.8 26 11.0 15 6.3 9 3.8 12 5.0 11 4.6 12 5.0 12 4.9 Aneurin Bevan University 35 6.2 24 4.3 32 5.6 20 3.5 37 6.5 24 4.2 24 4.2 25 4.3 25 4.3 31 5.3 26 4.5 Blaenau Gwent 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 2.9 2 2.9 2 2.9 Caerphilly 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 2.2 2 1.1 4 2.1 Monmouthshire 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 3.3 2 2.2 3 3.3 Newport 26 18.6 15 10.7 18 12.7 13 9.1 28 19.5 15 10.4 12 8.2 15 10.3 15 10.2 24 16.3 16 11.1 Torfaen 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 1.1 1 1.1 1 0.9 Betsi Cadwaladr University 34 5.1 49 7.2 35 5.2 28 4.1 36 5.3 28 4.1 19 2.8 19 2.8 30 4.3 16 2.3 22 3.2 Anglesey 5 7.2 13 18.7 0 0.0 4 5.7 7 10.0 4 5.7 0 0.0 2 2.9 6 8.6 3 4.3 3 4.3 Conwy 3 2.7 4 3.5 7 6.2 7 6.1 6 5.2 5 4.4 2 1.7 0 0.0 4 3.5 4 3.4 3 2.6 Denbighshire 2 2.1 5 5.3 3 3.2 4 4.2 2 2.1 2 2.1 3 3.2 3 3.2 4 4.2 1 1.1 3 2.8 Flintshire 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 2.6 1 0.7 3 2.0 Gwynedd 9 7.6 10 8.4 13 10.9 2 1.7 7 5.8 10 8.3 4 3.3 7 5.7 6 4.9 3 2.5 6 4.9 Wrexham 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 4.4 4 2.9 5 3.5 Cardiff and Vale University 53 11.9 49 11.0 70 15.5 54 11.8 65 14.0 45 9.6 43 9.1 36 7.6 40 8.4 28 5.8 38 8.1 Cardiff 44 13.7 42 13.0 57 17.4 49 14.7 59 17.5 41 12.0 35 10.1 32 9.2 38 10.8 27 7.6 35 9.9 Vale of Glamorgan 9 7.3 7 5.7 13 10.4 5 4.0 6 4.8 4 3.2 8 6.3 4 3.2 2 1.6 1 0.8 4 3.0 Cwm Taf University 15 5.2 9 3.1 13 4.5 23 7.9 22 7.5 16 5.5 6 2.0 16 5.4 10 3.4 6 2.0 11 3.7 Merthyr Tydfil 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 5.1 0 0.0 2 4.1 Rhondda Cynon Taff 13 5.6 9 3.8 11 4.7 21 8.9 19 8.1 13 5.5 4 1.7 12 5.1 7 3.0 6 2.5 8 3.6 Hywel Dda University 13 3.5 19 5.1 11 2.9 7 1.8 8 2.1 12 3.2 19 5.0 20 5.2 11 2.9 17 4.4 16 4.1 Carmarthenshire 8 4.5 9 5.0 9 5.0 0 0.0 5 2.7 9 4.9 9 4.9 7 3.8 7 3.8 10 5.4 8 4.6 Ceredigion 1 1.3 3 4.0 1 1.3 1 1.3 1 1.3 1 1.3 5 6.6 2 2.6 1 1.3 1 1.3 2 2.6 Pembrokeshire 4 3.4 7 5.9 1 0.8 6 5.0 2 1.6 2 1.6 5 4.1 11 8.9 3 2.4 6 4.9 5 4.4 Powys Teaching 3 2.3 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 3 2.3 2 1.5 3 2.0 Powys 3 2.3 5 3.8 2 1.5 4 3.0 9 6.8 4 3.0 1 0.8 3 2.3 3 2.3 2 1.5 3 2.0 Not known 0 0 0 0 0 0 0 0 0 0 0 Total 185 6.2 183 6.1 204 6.8 169 5.6 213 7.0 152 5.0 131 4.3 136 4.4 142 4.6 115 3.7 135.2 4.4 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 (2010 to 2014) Version: 1 Page: 20 of 32 Intended Audience: Health

Table A2. Number of Cases and Rate 1 of Tuberculosis in Wales by Sex, 2005-2014 Sex 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Male 98 6.8 111 7.6 114 7.8 94 6.4 122 8.2 92 6.2 71 4.7 91 6.0 90 5.9 73 4.8 Female 87 5.7 72 4.7 90 5.9 71 4.6 86 5.5 58 3.7 57 3.7 45 2.9 52 3.3 42 2.7 Unknown 0 0 0 4 5 2 3 0 0 0 Total 185 6.2 183 6.1 204 6.8 169 5.6 213 7.0 152 5.0 131 4.3 136 4.4 142 4.6 115 3.7 1 Rate per 100,000 using ONS Mid-Year population estimates Table A3. Number of Cases and Rate 1 of Tuberculosis in Wales by Age Group, 2005-2014 Age Group 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate 0-4 4 2.5 5 3.1 11 6.7 8 4.7 11 6.4 2 1.1 2 1.1 0 0.0 2 1.1 1 0.6 5-14 4 1.1 4 1.1 3 0.8 9 2.6 3 0.9 4 1.2 6 1.8 3 0.9 3 0.9 0 0.0 15-24 19 4.9 21 5.3 25 6.2 17 4.2 29 7.1 17 4.2 21 5.1 14 3.4 26 6.3 18 4.4 25-34 35 10.1 43 12.5 53 15.4 32 9.2 44 12.5 32 9.0 29 8.0 40 11.0 38 10.3 24 6.4 35-44 29 6.8 35 8.2 36 8.4 29 6.9 33 8.0 25 6.2 27 6.9 17 4.5 16 4.3 19 5.2 45-54 23 6.0 21 5.4 28 7.1 18 4.5 32 7.8 19 4.6 11 2.6 24 5.6 19 4.4 19 4.4 55-64 13 3.4 20 5.2 9 2.3 18 4.6 17 4.3 18 4.6 9 2.3 9 2.3 19 5.0 15 3.9 65+ 58 11.2 34 6.5 39 7.4 38 7.1 44 8.0 35 6.3 26 4.6 29 4.9 19 3.2 19 3.1 1 Rate per 100,000 using ONS Mid-Year population estimates Version: 1 Page: 21 of 32 Intended Audience: Health

Table A4. Number and Percentage of Tuberculosis Cases in Wales by Ethnic Group, 2005-2014 Ethnic Group 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 5 year Average 2 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Cases Rate White 98 53.0 81 44.3 87 42.6 80 47.3 97 45.5 66 43.4 40 30.5 58 42.6 62 43.7 43 37.4 54 1.8 Black-Caribbean 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 0.0 0 0.0 0 5.3 Black-African 16 8.6 24 13.1 23 11.3 22 13.0 31 14.6 11 7.2 23 17.6 13 9.6 18 12.7 15 13.0 16 134.6 Black-Other 1 0.5 1 0.5 3 1.5 1 0.6 3 1.4 3 2.0 1 0.8 1 0.7 0 0.0 1 0.9 1 46.5 Indian 19 10.3 20 10.9 26 12.7 25 14.8 30 14.1 21 13.8 23 17.6 27 19.9 22 15.5 21 18.3 23 132.1 Pakistani 20 10.8 20 10.9 17 8.3 10 5.9 20 9.4 18 11.8 12 9.2 13 9.6 12 8.5 16 13.9 14 116.1 Bangladeshi 5 2.7 7 3.8 7 3.4 3 1.8 6 2.8 9 5.9 3 2.3 1 0.7 7 4.9 2 1.7 4 41.2 Chinese 2 1.1 2 1.1 5 2.5 6 3.6 6 2.8 3 2.0 3 2.3 1 0.7 4 2.8 3 2.6 3 20.5 Mixed/Other 17 9.2 20 10.9 20 9.8 12 7.1 5 2.3 8 5.3 15 11.5 15 11.0 13 9.2 10 8.7 12 19.3 Unknown 6 3.2 7 3.8 16 7.8 9 5.3 15 7.0 12 7.9 11 8.4 7 5.1 4 2.8 4 3.5 8 Total 185 183 204 169 213 152 131 136 142 115 135 4.4 1 Average number of cases and rates calculated using the last 5 years data (2010 to 2014) 2 Rate per 100,000 using ONS 2011 population estimates by ethnic group Table A5. Number and Percentage of Tuberculosis Cases in Wales by Place of Birth, 2005-2014 Place of Birth 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Born in UK 87 47 68 37 81 40 81 48 103 48 73 48 46 35 57 42 58 41 44 38 Born Abroad 70 38 90 49 97 48 75 44 89 42 68 45 80 61 74 54 82 58 65 57 Not Known 28 15 25 14 26 13 13 8 21 10 11 7 5 4 5 4 2 1 6 5 Total 185 183 204 169 213 152 131 136 142 115 Version: 1 Page: 22 of 32 Intended Audience: Health

Table A6. Number and Percentage of Tuberculosis Cases in Wales by World Region of Birth for Non-UK Born Cases, 2005-2014 Region of Birth 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % North Africa 2 2.9 2 2.2 1 1.0 1 1.3 4 4.5 1 1.5 0 0.0 1 1.4 3 3.7 3 4.6 Sub-Saharan Africa 14 20.0 23 25.6 27 27.8 20 26.7 27 30.3 12 17.6 25 31.3 15 20.3 19 23.2 11 16.9 East Asia 2 2.9 3 3.3 5 5.2 4 5.3 2 2.2 0 0.0 4 5.0 1 1.4 3 3.7 3 4.6 South Asia 36 51.4 38 42.2 36 37.1 32 42.7 42 47.2 35 51.5 37 46.3 40 54.1 41 50.0 36 55.4 South East Asia 8 11.4 4 4.4 13 13.4 9 12.0 3 3.4 8 11.8 8 10.0 7 9.5 8 9.8 3 4.6 Central Europe 0 0.0 3 3.3 2 2.1 0 0.0 0 0.0 2 2.9 1 1.3 1 1.4 3 3.7 0 0.0 East Europe 0 0.0 0 0.0 0 0.0 1 1.3 0 0.0 0 0.0 0 0.0 2 2.7 1 1.2 1 1.5 West Europe 1 1.4 4 4.4 2 2.1 1 1.3 2 2.2 2 2.9 2 2.5 2 2.7 1 1.2 1 1.5 East Mediterranean 2 2.9 4 4.4 1 1.0 1 1.3 2 2.2 0 0.0 2 2.5 2 2.7 1 1.2 2 3.1 North America 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 0 0.0 1 1.5 South & Central America 1 1.4 1 1.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.4 1 1.2 1 1.5 Not Known 4 5.7 8 8.9 10 10.3 6 8.0 7 7.9 8 11.8 1 1.3 1 1.4 1 1.2 3 4.6 Total 70 90 97 75 89 68 80 74 82 65 Table A7. Time between UK Entry and Tuberculosis Diagnosis for Non-UK Born Cases, 2005-2014 Time between UK Entry and Diagnosis 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % < 2 years 27 38.6 19 21.1 29 29.9 19 25.3 20 22.5 9 13.2 19 23.8 19 25.7 22 26.8 16 24.6 2-4 years 15 21.4 29 32.2 16 16.5 11 14.7 22 24.7 17 25.0 15 18.8 20 27.0 13 15.9 12 18.5 5-9 years 5 7.1 8 8.9 7 7.2 13 17.3 19 21.3 10 14.7 20 25.0 14 18.9 16 19.5 8 12.3 >10 years 9 12.9 11 12.2 14 14.4 17 22.7 7 7.9 14 20.6 16 20.0 13 17.6 16 19.5 15 23.1 Not Recorded 14 20.0 23 25.6 31 32.0 15 20.0 21 23.6 18 26.5 10 12.5 8 10.8 15 18.3 14 21.5 Version: 1 Page: 23 of 32 Intended Audience: Health

Table A8. Number and Percentage of Tuberculosis Cases in Wales by Site of Disease, 2005-14 2013 2014 Site of Disease 1 2005 2006 2007 2008 2009 2010 2011 2012 Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Pulmonary 2 117 63.2 112 61.2 135 66.2 102 60.4 126 59.2 92 60.5 71 54.2 78 57.4 83 58.5 65 56.5 Extra thoracic lymph nodes 32 17.3 41 22.4 39 19.1 26 15.4 39 18.3 28 18.4 33 25.2 33 24.3 25 17.6 19 16.5 Intra thoracic lymph nodes 13 7.0 9 4.9 21 10.3 16 9.5 11 5.2 9 5.9 1 0.8 5 3.7 6 4.2 8 7.0 Pleural 22 11.9 12 6.6 17 8.3 10 5.9 14 6.6 6 3.9 12 9.2 10 7.4 8 5.6 8 7.0 Gastrointestinal 6 3.2 11 6.0 7 3.4 10 5.9 5 2.3 6 3.9 8 6.1 5 3.7 5 3.5 3 2.6 CNS-meningitis 2 1.1 3 1.6 4 2.0 4 2.4 4 1.9 5 3.3 3 2.3 2 1.5 3 2.1 7 6.1 CNS-other 2 1.1 2 1.1 4 2.0 3 1.8 4 1.9 4 2.6 2 1.5 4 2.9 4 2.8 3 2.6 Bone-Spine 5 2.7 4 2.2 4 2.0 4 2.4 8 3.8 2 1.3 4 3.1 3 2.2 8 5.6 9 7.8 Bone-other 1 0.5 3 1.6 3 1.5 3 1.8 4 1.9 1 0.7 5 3.8 4 2.9 2 1.4 1 0.9 Genitourinary 3 1.6 2 1.1 6 2.9 2 1.2 6 2.8 3 2.0 2 1.5 5 3.7 4 2.8 5 4.3 Laryngeal 0 0.0 1 0.5 1 0.5 1 0.6 0 0.0 2 1.3 1 0.8 0 0.0 1 0.7 0 0.0 Cryptic 2 1.1 1 0.5 0 0.0 1 0.6 1 0.5 0 0.0 2 1.5 1 0.7 1 0.7 3 2.6 Other extra pulmonary 10 5.4 10 5.5 5 2.5 13 7.7 22 10.3 14 9.2 21 16.0 8 5.9 8 5.6 9 7.8 Unknown extra pulmonary 37 20.0 44 24.0 36 17.6 33 19.5 40 18.8 37 24.3 40 30.5 45 33.1 30 21.1 28 24.3 1 Patients may have disease at more than one site 2 Pulmonary TB includes miliary 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 A9. Number and Percentage of Cases in Wales with a History of BCG Vaccination by Age Group, 2014 Age Group Vaccinated Known Status Vaccinated % Known Status % 0-4 1 1 100.0 100.0 5-14 - - - - 15-24 7 9 77.8 50.0 25-34 15 19 78.9 79.2 35-44 6 7 85.7 36.8 45-54 8 10 80.0 52.6 55-64 5 5 100.0 33.3 65+ 3 6 50.0 31.6 Total 45 57 78.9 49.6 Version: 1 Page: 24 of 32 Intended Audience: Health

Table A10. Number and Percentage of Tuberculosis Cases in Wales with Previous Tuberculosis Diagnosis, 2005-2014 Previous Diagnosis 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Yes 14 7.6 8 4.4 17 8.3 14 8.3 22 10.3 6 3.9 10 7.6 6 4.4 8 5.6 8 7.0 No 141 76.2 140 76.5 147 72.1 127 75.1 153 71.8 122 80.3 108 82.4 121 89.0 125 88.0 93 80.9 Not Reported 30 16.2 35 19.1 40 19.6 28 16.6 38 17.8 24 15.8 13 9.9 9 6.6 9 6.3 14 12.2 Table A11. Number and Percentage of Tuberculosis Cases in Wales with Bacteriological Confirmation, 2005-2014 Previous Diagnosis 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 cases % cases % cases % cases % cases % cases % cases % cases % cases % cases % Culture Confirmed 1 121 65.4 128 69.9 129 63.2 103 60.9 119 55.9 107 70.4 94 71.8 105 77.2 87 61.3 79 68.7 Culture Confirmed Pulmonary Cases 2 81 69.2 89 79.5 94 69.6 74 72.5 80 63.5 72 78.3 56 78.9 63 80.8 62 74.7 54 83.1 Pulmonary Cases with Sputum Smear Taken 2 84 71.8 89 79.5 94 69.6 55 53.9 39 31.0 41 44.6 39 54.9 39 50.0 43 51.8 36 55.4 Positive Sputum Smear Pulmonary Cases 3 43 51.2 45 50.6 42 44.7 27 49.1 19 48.7 23 56.1 29 74.4 32 82.1 36 83.7 20 55.6 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: 25 of 32 Intended Audience: Health

Table A12. Species Identification in Culture Confirmed Tuberculosis Case, Wales, 2005-14 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Species Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % Cases % M. africanum 0 0.0 0 0.0 0 0.0 0 0.0 1 0.8 0 0.0 4 4.3 2 1.9 0 0.0 0 0.0 M. bovis 4 3.3 0 0.0 1 0.8 2 1.9 4 3.4 1 0.9 0 0.0 3 2.9 0 0.0 0 0.0 M. tuberculosis 117 96.7 128 100.0 128 99.2 101 98.1 114 95.8 105 98.1 90 95.7 100 95.2 87 100.0 79 100.0 M. tuberculosis complex 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.9 0 0.0 0 0.0 0 0.0 0 0.0 Table A13. TB outcome at 12 months after treatment start for drug sensitive cases with expected treatment duration <12 months 1, Wales, 2004-2013 Completed Died Lost to follow-up Still on treatment Stopped Not evaluated 2 Total Year n % n % n % n % n % n % n 2004 112 65.1 17 9.9 14 8.1 3 1.7 1 0.6 25 14.5 172 2005 116 67.4 17 9.9 8 4.7 13 7.6 2 1.2 16 9.3 172 2006 115 66.9 14 8.1 5 2.9 6 3.5 4 2.3 28 16.3 172 2007 113 60.8 13 7.0 11 5.9 21 11.3 3 1.6 25 13.4 186 2008 115 76.2 12 7.9 3 2.0 14 9.3 0 0.0 7 4.6 151 2009 145 75.9 17 8.9 6 3.1 11 5.8 5 2.6 7 3.7 191 2010 107 77.5 17 12.3 5 3.6 7 5.1 1 0.7 1 0.7 138 2011 90 76.3 8 6.8 8 6.8 5 4.2 6 5.1 1 0.8 118 2012 88 73.3 11 9.2 6 5.0 9 7.5 2 1.7 4 3.3 120 2013 96 79.3 4 3.3 6 5.0 3 2.5 1 0.8 11 9.1 121 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB 2 Not evaluated includes missing, unknown and transferred out. Version: 1 Page: 26 of 32 Intended Audience: Health

Table A14. Treatment completion at 12 months by age group for drug sensitive cases with expected treatment duration <12 months 1, Wales, 2004-2013 0-4 5-14 15-24 25-34 35-44 45-54 55-64 65+ Year n % n % n % n % n % n % n % n % 2004 3 75.0 2 100.0 10 66.7 22 64.7 12 70.6 15 75.0 13 59.1 35 60.3 2005 2 50.0 4 100.0 12 66.7 28 82.4 23 85.2 14 66.7 7 58.3 26 50.0 2006 4 100.0 2 50.0 15 71.4 33 80.5 19 61.3 14 73.7 14 77.8 14 41.2 2007 6 54.5 0-15 68.2 29 67.4 22 64.7 18 72.0 4 44.4 19 48.7 2008 7 100.0 7 87.5 13 81.3 23 79.3 20 80.0 15 93.8 13 76.5 17 51.5 2009 11 100.0 3 100.0 19 73.1 31 75.6 21 80.8 26 86.7 13 76.5 21 56.8 2010 1 100.0 4 100.0 13 86.7 23 82.1 20 83.3 14 82.4 11 68.8 21 63.6 2011 1 100.0 6 100.0 13 72.2 21 80.8 18 78.3 10 100.0 7 87.5 14 53.8 2012 0-2 100.0 11 84.6 29 80.6 10 62.5 16 84.2 5 62.5 15 57.7 2013 2 100.0 2 66.7 18 90.0 24 77.4 13 86.7 12 70.6 15 83.3 10 66.7 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB Table A15. Treatment completion at 12 months by sex for drug sensitive cases with expected treatment duration <12 months 1, Wales, 2004-2013 Male Female Year n % n % 2004 66 68.0 46 61.3 2005 67 69.8 49 64.5 2006 70 66.7 45 67.2 2007 61 58.1 52 64.2 2008 65 77.4 48 76.2 2009 83 76.1 58 75.3 2010 60 71.4 46 88.5 2011 46 74.2 42 79.2 2012 55 67.9 33 84.6 2013 59 79.7 37 78.7 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB Version: 1 Page: 27 of 32 Intended Audience: Health

Table A16. TB outcome at 12 months by site of disease for drug sensitive cases with expected treatment duration < 12 months, 2013 1 Completed Died Lost to follow-up Still on treatment Stopped Not evaluated 2 Total 3 Site of disease n % n % n % n % n % n % n Pulmonary only 48 76.2 2 3.2 2 3.2 2 3.2 1 1.6 8 12.7 63 Pulmonary, with or without EP 57 78.1 3 4.1 2 2.7 2 2.7 1 1.4 8 11.0 73 Extrapulmonary only 39 84.8 0 0.0 4 8.7 1 2.2 0 0.0 2 4.3 46 Extra-thoracic lymph nodes 22 95.7 0 0.0 0 0.0 0 0.0 0 0.0 1 4.3 23 Intra-thoracic lymph nodes 5 100.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 Pleural 7 87.5 0 0.0 1 12.5 0 0.0 0 0.0 0 0.0 8 Bone Other 1 50.0 0 0.0 1 50.0 0 0.0 0 0.0 0 0.0 2 All other EP sites 4 28 80.0 1 2.9 4 11.4 1 2.9 0 0.0 1 2.9 35 Unknown site 0 0.0 1 33.3 0 0.0 0 0.0 0 0.0 2 66.7 3 Total 96 79.3 4 3.3 6 5.0 3 2.5 1 0.8 11 9.1 121 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB 2 Not evaluated includes missing, unknown and transferred out 3 Multiple sites of disease can be reported so the total does not add up to the total number of cases 4 All other extra-pulmonary sites includes gastrointestinal, genitourinary, laryngeal, other and unknown extra-pulmonary disease Version: 1 Page: 28 of 32 Intended Audience: Health

Table A17. TB outcome at 12 months after treatment start for drug sensitive cases with expected treatment duration <12 months by LA and LHB, Wales, 2012 2013 1 LHB and LA 2012 2013 Total Treatment completed Total Treatment completed n n % n n % Abertawe Bro Morgannwg University 15 12 80.0 20 11 55.0 Bridgend 1 0 0.0 3 2 66.7 Neath Port Talbot 3 2 66.7 9 2 22.2 Swansea 11 10 90.9 8 7 87.5 Aneurin Bevan 22 15 68.2 19 15 78.9 Blaenau Gwent 1 1 100.0 2 2 100.0 Caerphilly 4 2 50.0 3 2 66.7 Monmouthshire 3 2 66.7 3 3 100.0 Newport 13 9 69.2 10 7 70.0 Torfaen 1 1 100.0 1 1 100.0 Betsi Cadwaladr University 16 11 68.8 25 23 92.0 Anglesey 2 1 50.0 6 5 83.3 Conwy 0 0-3 3 100.0 Denbighshire 2 1 50.0 4 4 100.0 Flintshire 3 2 66.7 3 3 100.0 Gwynedd 5 3 60.0 4 4 100.0 Wrexham 4 4 100.0 5 4 80.0 Cardiff and Vale University 31 25 80.6 36 33 91.7 Cardiff 28 22 78.6 34 32 94.1 Vale of Glamorgan 3 3 100.0 2 1 50.0 Cwm Taf 15 11 73.3 8 5 62.5 Merthyr Tydfil 4 2 50.0 3 1 33.3 Rhondda Cynon Taf 11 9 81.8 5 4 80.0 Hywel Dda 18 11 61.1 10 7 70.0 Carmarthenshire 6 5 83.3 7 7 100.0 Ceredigion 2 1 50.0 1 0 0.0 Pembrokeshire 10 5 50.0 2 0 0.0 Powys Teaching 3 3 100.0 3 2 66.7 Powys 3 3 100.0 3 2 66.7 Total 120 88 73.3 121 96 79.3 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases and those with CNS, spinal, miliary or cryptic disseminated TB Version: 1 Page: 29 of 32 Intended Audience: Health

Table A18. Last recorded TB outcome for entire drug sensitive cohort, Wales, 2004-2013 1 Completed Died Lost to follow-up Still on treatment Stopped Not evaluated 2 Total Year n % n % n % n % n % n % n 2004 117 63.2 21 11.4 18 9.7 3 1.6 1 0.5 25 13.5 185 2005 123 67.2 19 10.4 8 4.4 13 7.1 3 1.6 17 9.3 183 2006 127 70.2 14 7.7 6 3.3 1 0.6 4 2.2 29 16.0 181 2007 138 69.0 17 8.5 15 7.5 1 0.5 3 1.5 26 13.0 200 2008 139 83.7 14 8.4 4 2.4 0 0.0 1 0.6 8 4.8 166 2009 169 79.7 20 9.4 8 3.8 3 1.4 5 2.4 7 3.3 212 2010 122 80.3 22 14.5 6 3.9 0 0.0 1 0.7 1 0.7 152 2011 105 81.4 8 6.2 9 7.0 0 0.0 6 4.7 1 0.8 129 2012 103 76.3 15 11.1 6 4.4 3 2.2 4 3.0 4 3.0 135 2013 108 77.7 7 5.0 8 5.8 1 0.7 2 1.4 13 9.4 139 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases 2 Not evaluated includes missing, unknown and transferred out Version: 1 Page: 30 of 32 Intended Audience: Health

Table A19. Last recorded TB outcome for entire drug sensitive cohort by LHB and LA, Wales, 2012-2013 1 LHB and LA 2012 2013 Total Treatment completed Total Treatment completed n n % n n % Abertawe Bro Morgannwg University 17 14 82.4 22 11 50.0 Bridgend 1 0 0.0 3 2 66.7 Neath Port Talbot 4 2 50.0 9 2 22.2 Swansea 12 12 100.0 10 7 70.0 Aneurin Bevan 25 19 76.0 24 20 83.3 Blaenau Gwent 1 1 100.0 2 2 100.0 Caerphilly 5 3 60.0 4 3 75.0 Monmouthshire 3 2 66.7 3 3 100.0 Newport 15 12 80.0 14 11 78.6 Torfaen 1 1 100.0 1 1 100.0 Betsi Cadwaladr University 18 13 72.2 30 26 86.7 Anglesey 2 1 50.0 6 5 83.3 Conwy 0 0-4 3 75.0 Denbighshire 2 1 50.0 4 4 100.0 Flintshire 3 2 66.7 4 3 75.0 Gwynedd 7 5 71.4 6 6 100.0 Wrexham 4 4 100.0 6 5 83.3 Cardiff and Vale University 36 29 80.6 40 37 92.5 Cardiff 32 25 78.1 38 36 94.7 Vale of Glamorgan 4 4 100.0 2 1 50.0 Cwm Taf 16 11 68.8 9 5 55.6 Merthyr Tydfil 4 2 50.0 3 1 33.3 Rhondda Cynon Taf 12 9 75.0 6 4 66.7 Hywel Dda 20 14 70.0 11 7 63.6 Carmarthenshire 7 6 85.7 7 7 100.0 Ceredigion 2 2 100.0 1 0 - Pembrokeshire 11 6 54.5 3 0 - Powys Teaching 3 3 100.0 3 2 66.7 Powys 3 3 100.0 3 2 66.7 Total 135 103 76.3 139 108 77.7 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases Version: 1 Page: 31 of 32 Intended Audience: Health

Table A20. All drug sensitive TB cases reported to have died at last recorded outcome, Wales, 2004 2013 1 Cases reported Total deaths TB caused or contributed to death Year n n % n % n % n % n % 2004 185 21 11.4 10 47.6 0 0.0 11 52.4 6 28.6 2005 183 19 10.4 6 31.6 5 26.3 8 42.1 6 31.6 2006 181 14 7.7 6 42.9 3 21.4 5 35.7 5 35.7 2007 200 17 8.5 7 41.2 1 5.9 9 52.9 4 23.5 2008 166 14 8.4 3 21.4 6 42.9 5 35.7 4 28.6 2009 212 20 9.4 5 25.0 2 10.0 13 65.0 3 15.0 2010 152 22 14.5 7 31.8 4 18.2 11 50.0 6 27.3 2011 129 8 6.2 2 25.0 3 37.5 3 37.5 2 25.0 2012 135 15 11.1 3 20.0 1 6.7 11 73.3 6 40.0 2013 139 7 5.0 1 14.3 1 14.3 5 71.4 3 42.9 1 Excludes initial and amplified to rifampicin resistant TB and MDR-TB treated cases TB incidental to death Unknown Post mortem Version: 1 Page: 32 of 32 Intended Audience: Health