Tuberculosis (TB) is one of the world’s deadliest infectious diseases, despite being curable and preventable.1 Following a resurgence in England in 2011, cases of TB are declining but rates are still high in the UK compared to Western Europe.
Reports show that approximately three-quarters of TB cases in the UK occur in people born outside the country, and with the UK consistently ranking as one of the most popular locations for higher education, it is essential that foreign students from high TB risk countries are screened for TB infection.2
TB testing and treatment protects the health of these students and helps to limit the potential transmission and spread of the disease.3 During an active TB infection, the disease is extremely dangerous and highly contagious.
Are you protecting students from TB at your university? Find the answers to common questions and test your knowledge at www.quantiferon.com/studentsUK
This article was initiated, funded and reviewed by Qiagen
Thankfully, TB can be identified in its latent form and treated before it poses a threat. People with latent TB infection (LTBI) do not feel sick or show symptoms. However, LTBI can progress to active TB when a person’s immune system is compromised by conditions like diabetes or cancer or certain medications.
The WHO estimates that nearly a quarter (23%) of the world’s population could have LTBI and are at risk of developing active TB during their lifetime.4 Accurate testing is essential to properly detect LTBI and limit the spread of TB, with the goal of eradicating the disease.
Tuberculosis outbreaks at universities and colleges can be dangerous, and many institutions underestimate the real risk of TB in their community. The UK is a popular destination for international students, and the risks of TB are amplified in congregate settings like university dormitories. It is important to educate incoming students about the risks of TB infection to protect classmates and the local community.
TB is more prevalent than you may think
In recent years, TB outbreaks continue to occur across a number of educational institutions, including primary and secondary schools in Dagenham, Manchester and Devon. The risk of transmission is heightened in schools and on university and college campuses due to the frequent close interactions that take place. TB is also more likely to spread among people living in overcrowded accommodation, and social and academic constraints may keep students from obtaining proper medical care at the onset of symptoms.
Nearly three quarters of all TB cases occur in those born abroad, mainly in high TB burden countries, with the vast majority of these cases (85%) occurring among settled migrants who have been in the country for more than two years, rather than in new entrants.5
Foreign students from countries where TB is more common are required to take part in the UK pre-entry screening programme, which primarily looks for active pulmonary TB.6 Many universities and colleges provide guidance to incoming students on TB testing, and the use of new, efficient and less subjective tests can help to identify LTBI, so that preventive treatment can be initiated quickly and efficiently to keep their campuses safe from reactivation of TB.
University health centre’s one-stop approach
Sue Belton, a TB nurse specialist at Cripps Health Centre in Nottingham, said: ‘At the University of Nottingham Health Service, we screen all international students within a few days of their arrival in the country at our dedicated Freshers Fair. We would expect to see in excess of 2,000 international students.
‘We register the students at this time, offer Meningitis ACWY and MMR vaccinations and complete any chronic disease checks. All students identified as being from a high-risk country for TB are asked to complete a screening questionnaire and have their blood taken for a QuantiFERON® TB test by one of our team of nurses or HCAs.’
TB blood tests, also called an Interferon Gamma Release Assay or IGRA, are recognised by Public Health England7 and the World Health Organization8 for their high specificity and efficiency in detecting latent TB, especially among individuals previously vaccinated with the BCG vaccine, which is commonly used in high-risk countries. Unlike the century-old skin test, TB blood tests do not cross-react with BCG, resulting in fewer false-positives and quicker identification of students with true LTBI.
|Benefits of QuantiFERON-TB Gold Plus (QFT-Plus)|
|QuantiFERON-TB Gold Plus (QFT-Plus)||Tuberculin Skin Test (TST)|
|One visit to the doctor||Two visits to the doctor|
|A small sample of blood is taken||Tuberculin is injected into the skin|
|Results are unaffected by BCG vaccine||Results may be affected by BCG vaccine|
|Results determined in a laboratory||Results determined by subjective/visual assessment|
The health centre has found that providing a one-stop service ensures higher testing participation. ‘Last year we identified 330 students as being from high-risk countries and 14% were shown to be positive for latent TB infection,' Ms Belton said.
'We have a good working relationship with the TB clinic at Nottingham University Hospitals, and the consultant and TB nurses will operate a clinic from our premises to treat those shown to have latent TB infection. We hope that by providing this service, it will improve the public health of Nottingham as a whole.'
- WHO. WHO calls for urgent action to end TB. Available at: https://www.who.int/news-room/detail/18-09-2018-who-calls-for-urgent-action-to-end-tb-
- Public Health England. Tuberculosis in England: 2018 report. Available at: https://www.gov.uk/government/publications/tuberculosis-in-england-annual-report
- NICE. Tuberculosis. NG33. January 2016. Recommendations on latent TB are available here: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations#latent-tb
- WHO. Global Tuberculosis Report 2018. Available at: https://www.who.int/tb/publications/global_report/en/
- Public Health England and NHS England. Collaborative Tuberculosis Strategy for England (2015-2020). Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/403231/Collaborative_TB_Strategy_for_England_2015_2020_.pdf
- Public Health England. UK pre-entry tuberculosis screening report 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821336/UK_pre-entry_tuberculosis_screening_report_2018.pdf
- Public Health England. Tuberculosis (TB): Interferon Gamma Release Assay tests. 2013. Available at: https://www.gov.uk/government/publications/tuberculosis-tb-interferon-gamma-release-assay-tests.
- WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. 2018. Available at: https://www.who.int/tb/publications/2018/latent-tuberculosis-infection/en/.
QuantiFERON-TB Gold Plus (QFT-Plus) is an in vitro diagnostic aid for detection of Mycobacterium tuberculosis infection. QFT-Plus is an indirect test for M. tuberculosis infection (including disease) and is intended for use in conjunction with risk assessment, radiography, and other medical and diagnostic evaluations. QFT-Plus package inserts, up-to-date licensing information and product-specific disclaimers can be found at www.QuantiFERON.com
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