A West Midlands city has been identified as a hotspot for a Victorian superbug. Birmingham had the highest number of tuberculosis cases last year, health data showed.

The disease, associated with the 19th century, was once incredibly deadly. It caused the deaths of an estimated four million people between 1851 and 1910 in England and Wales.

Worldwide, TB is still the second-leading infectious killer after Covid, causing the death of 1.3 million people in 2022, according to the World Health Organisation (WHO). In England and Wales, there were 182 deaths in 2022, up from 168 in 2021, but below pre-pandemic figures.

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It is generally considered to be fairly rare in Britain today, however. Case numbers were among the highest in Birmingham last year, when there were 38 - close to one report every week. TB case numbers are very low in most areas, either in single figures or none at all.

But there are some areas which have been hotspots, and Birmingham is one of these. Cases had been falling nationally since 2011, but progress to eliminate the disease has now “stalled”, the WHO said.

The latest figures show there were 4,850 cases of TB in England last year - an 11% increase from 4,380 cases in 2022. In the first 10 weeks of this year, the UKHSA received notifications of 919 suspected cases of TB in England, up from 878 during the same period of 2023.

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These are notifications sent by GPs to the UKHSA when they diagnose an infection they believe to be TB. They are used to prompt local investigation and action to control disease. So far this year the highest number of cases have been seen in Birmingham (38), followed by Brent (25), Bradford (24) and Manchester (24).

There were 13 in Sandwell, 11 in Wolverhampton, nine in Walsall and three in Dudley. TB is associated with deprivation and is more common in large urban areas. It can be spread by close contact with anyone who has TB.

Dr Esther Robinson, Head of the TB Unit at UKHSA, said: “We need collective action to tackle TB and we are working with partners across the health system to understand how we can best refocus efforts to stamp out this preventable and treatable infection. Not every persistent cough, along with a fever, is caused by flu or Covid.

"A cough that usually has mucus and lasts longer than three weeks can be caused by a range of other issues, including TB. Please speak to your GP if you think you could be at risk.” Around the world, 7.5million people were diagnosed with TB in 2022, which health experts say is the highest number ever recorded.