Widening TB screening would cut burden

The UK should screen more new immigrants for latent TB as a cost-effective way to reduce rising disease burden, researchers have said.

TB cases could be cut if the UK screened more immigrants (Photograph: SPL)
TB cases could be cut if the UK screened more immigrants (Photograph: SPL)

A study published in The Lancet found that one in five new immigrants to the UK from the Indian subcontinent, and almost a third from sub-Saharan Africa, carried latent TB.

In contrast to the current focus on symptomatic individuals, widened testing for latent TB would help to cut new cases, the researchers said.

The UK currently screens migrants from countries with incidence over 40 cases per 100,000, but only checks for latent infection in a subset of individuals.

This policy does not include those from the Indian subcontinent and so many latent cases are being missed, researchers said.

TB cases in the UK rose by half to 9,040 between 1998 and 2009. Cases from overseas rose 98% in this time and now account for three quarters of all TB cases in the UK.

Ajit Lalvani from Imperial College London and his team examined which immigrants should be screened to halt this rise. They assessed demographic and TB test result data from 2008-10 at three UK immigration centres. They found current UK policy has missed 70% of imported latent TB.

Researchers calculated the cost effectiveness of screening various groups for latent TB.

They concluded that the UK could identify 92% of all latent TB by testing everyone under 35 years immigrating from countries with TB rates of 150 per 100,000 or more.

This would include immigrants from a number of Asian countries.

Professor Lalvani concluded: 'Our findings provide the missing evidence-base for the new national strategy to expand immigrant screening.'

Stephen Robinson

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The Lancet online

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