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Free Content The annual risk of infection with Mycobacterium tuberculosis in England and Wales since 1901

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SETTING: England and Wales.

OBJECTIVE: To estimate the magnitude and trend in the annual risk of infection with Mycobacterium tuberculosis in England and Wales since 1901.

DESIGN: Estimates for the prechemotherapy era are derived assuming that 1% of new infections among 0–4 year olds led to fatal tuberculosis meningitis, as found in the Netherlands. The estimates are validated against data from the 1949–1950 national tuberculin survey. We explore the trend thereafter using tuberculous meningitis notifications and data from the 1971–1973 national tuberculin survey, and discuss the utility of data collected under the national bacille Calmette-GuĂ©rin (BCG) vaccination scheme for estimating the annual risk of infection.

RESULTS: Tuberculosis meningitis mortality rates among 0–4 year olds declined at 4% per annum until 1950, and suggest that the annual risk of infection declined from 12% in 1901 to 1.9% in 1949. The decline in the annual risk of infection probably accelerated in 1950, although its magnitude cannot be determined accurately.

CONCLUSION: An accelerated decline in the annual risk of infection in England and Wales from 1950 probably resulted from the introduction of chemotherapy, which dramatically reduced the prevalence of sources of infection in the population. Data collected during the national BCG vaccination scheme were found to be unsuitable for estimating infection risks.

Keywords: England and Wales; annual risk of tuberculous infection; tuberculous meningitis mortality

Document Type: Regular Paper

Affiliations: Communicable Diseases Epidemiology Unit, Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London, UK

Publication date: October 1, 1997

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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