Posted on May 4, 2007

Screening ‘May Help Stem TB Rise’

BBC News, May 3, 2007

Introducing targeted tuberculosis screening would help to combat the recent rise in UK cases, a study says.

Researchers from Queen Mary’s School of Medicine found that offering screening at GP surgeries increased detection rates by over a third, the Lancet said.

The team said early diagnosis helps with treatment and contains the spread of the respiratory disease.

The government said it was interested in the results and would ask the Health Protection Agency to look into them.

TB rose by 2% last year, to over 8,000 new cases in England, Wales and Northern Ireland.

London accounted for 42% of the cases, with the migrant population identified as the primary source.

The screening programme had been designed to pick up as many TB cases as possible at GP level—rather than after A&E admission, as happens now, when patients tend to have a more advanced condition.

The team analysed data from 50 surgeries in Hackney in east London—an area with a high migrant population.

Half of the practices had a screening programme, while the other half tested people who presented with symptoms, such as persistent coughs, fever and weight loss, or who raised concerns about their TB status.

Among the screening group, new patients were offered verbal screening which involved them being quizzed about their migration history, contact with TB cases and whether they had had the BCG vaccine.

Those deemed at risk were then given skin tests.

In total, 47% of the 141 patients that had TB were identified via the screening programme—the others were diagnosed after admission via A&E.

However, 2,000 skin tests were carried out in the process.

In the control group, 34% of the 157 cases were identified at GP level after patients developed symptoms.

There was also a significant difference in latent TB diagnosed—the bacteria can lie dormant for a number of years before striking when the immune system is weakened.

And it also led to more of the patients getting the BCG vaccination.

‘Moderately effective’

Lead researcher Professor Chris Griffiths said the success of the screening was “moderately effective” and could be considered as a way of stemming the rise in TB cases in particular places.

There are 19 local authority areas across England, Wales and Northern Ireland where TB is classed as common—above 40 cases per 100,000.

Professor Griffiths added: “Increasing the numbers of cases of tuberculosis identified in primary care should reduce diagnostic delay compared with waiting for patients to present at emergency departments.

“This will lead to more prompt treatment with consequent improved outcome and reduced transmission of disease.”

Dr David Mant, an expert in primary care from Oxford University, pointed out that implementation of screening in this way is difficult as only half of the new patients opted for screening.

But he added it was still a “sensible option” to target screening towards at-risk populations.

“Despite the limited compliance, the intervention was effective at increasing the proportion of TB cases detected.”

A Department of Health spokesman said: “We will be interested in the findings of this study.

“We will be asking the Health Protection Agency to study the full paper and advise us.”

Recent statistics indicate that the number of tuberculosis cases in Malta is increasing, and authorities report that most new cases are being diagnosed among immigrants, the Malta Independent reports.

The Public Health Department reported 11 new cases of TB between January and February, compared with three cases recorded during the same time period last year.

According to sources at Malta’s St. Luke’s Hospital, more than 50 TB cases have been recorded in the country during the first three months of this year. They added that they have identified a number of cases of multi-drug resistant TB.

A total of 29 TB cases were recorded in Malta in 2006, and 11 cases of the disease were recorded in 2005, according to the Public Health Department. Immigrants reportedly are screened for TB when they enter the country.

In 2005, a total of 1,861 immigrants and 912 refugees were screened for TB at the health department’s Chest Unit. According to the sources, health officials in Malta have not taken adequate action to control the spread of TB in the country.