Britain: Patients should be screened for tuberculosis in areas with high immigrant populations where the disease is on the rise

David Rose:

A study in today’s Lancet medical journal found that 13 per cent more TB cases were detected when general practices used active screening in Hackney, East London, boosting rates of vaccination against the disease.

Chris Griffiths, of the Centre for Health Sciences at Queen Mary’s School of Medicine and Dentistry in London, and colleagues performed the study at 50 general practices in Hackney, half of which screened for TB and half did not.

The research team found that detection rates for active TB in intervention practices were 13 per cent higher than those in the control group, while detection rates for the latent form of the disease were also 10 per cent higher in the practices with the screening programme.

The rates of BCG vaccination against TB were seven times higher for the practices implementing screening against the control group. The authors say: “A sevenfold increase in BCG coverage in people aged five and over represents a striking improvement, since most interventions boost immunisation in primary care by 5 to 20 per cent.”

It is estimated that a third of the world’s population is infected with the bacterium that causes TB.

The latest figures from the Health Protection Agency, for 2005, show there was a 10 per cent rise in the number of cases in England, Wales and Northern Ireland over a year, with a total of 8,113 cases.

Provisional figures for 2006 suggest that this number will rise even higher.

Hackney was selected for the study because it is one of only 19 local authorities across England, Wales and Northern Ireland that has yearly TB rates of more than 40 per 100,000 – the threshold rate above which TB is defined as common in that area. Of these 19 authorities, 16 are in London.

Migrants from Africa and Eastern Europe are resident in high numbers in these poor, inner-city areas and tend not to disperse for economic and social reasons.

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