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Tuberculosis screening beneficial in UK areas with high migrant populations

Lancet

Tuberculosis screening in areas of the UK where the disease has increasing prevalence due to increasing immigration rates could increase diagnosis of both active and latent forms of this disease and help prevent its spread, according to an article published in this week's edition of The Lancet.

Professor Chris Griffiths, Centre for Health Sciences, Queen Mary's School of Medicine and Dentistry, London, UK and colleagues did their outreach study on 50 general practices in Hackney, East London, UK, to promote screening for tuberculosis in primary care. The practices were divided into two groups of 25: intervention and control.

The research team found that detection rates for active tuberculosis in intervention practices were 13% higher than those in the control group, while detection rates for the latent form of the disease were also 10% higher in the practices with the screening programme. And the rates of BCG vaccination against Tuberculosis were seven times higher for the practices implementing screening against the control group.

The authors say: "A seven fold increase in BCG overage in people aged five and over represents a striking improvement, since most interventions boost immunisation in primary care by five to 20 per cent."

Hackney was selected as it is one of just 19 local authorities across England, Wales and Northern Ireland which has yearly tuberculosis rates of more than 40 per 100,000 - this is the threshold rate above which tuberculosis is defined as common in that area. Of these 19 authorities, 16 are in London. Migrants from Africa and Eastern Europe (which has hot spots of multi-drug resistant tuberculosis) are resident in high numbers in these areas (poor, inner city), and tend not to disperse for economic and social reasons.

The authors conclude: "Our study suggests screening could have a clinically important effect, should have useful generalisability, and could be recommended as part of tuberculosis control initiatives in industrialised countries."

In an accompanying comment, Dr David Mant of the Department of Primary Health Care, University of Oxford, UK and Dr Richard Manyon-White, of the Directorate of Public Health, Oxford, UK, say: "An educational research programme and additional local services will be useful in regions in developed countries where migrants cluster and tuberculosis rates are high.

"In the UK, the next step should be applications of the lessons learnt in East London to other areas where tuberculosis is common. In the long term, however, developed countries will gain most by supporting the tuberculosis control strategies in the rest of the world."

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