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• Contact screening in TB: is it time to re-brand?
  Matthew Burman, Simon Tiberi, Vicky Hickson, Ananna Rahman, Jessica Potter and Heinke Kunst
  Published on: 23 April 2018

• Published on: 23 April 2018

  Contact screening in TB: is it time to re-brand?

  • Matthew Burman, Research Fellow/Respiratory Registrar Institute for Population Health Science, Queen Mary University of London
  • Other Contributors:
    • Simon Tiberi, Infectious Diseases Consultant
    • Vicky Hickson, Research Nurse
    • Ananna Rahman, Research Fellow/Respiratory Registrar
    • Jessica Potter, Research Fellow/Respiratory Registrar
    • Heinke Kunst, Senior Lecturer/Respiratory Consultant

  We welcome the letter by Anna Humphreys and colleagues highlighting the secondary benefits of screening contacts of extra pulmonary tuberculosis for LTBI in areas where active cases are predominantly amongst the non-UK born (1). 
   
  We share the view that novel approaches are needed to identify and offer testing to those at risk of LTBI, and that contact tracing provides a unique opportunity to reach those who may be eligible.  

  Early results from the London Borough of Newham, the pilot site for the national latent TB screening programme highlight that uptake of LTBI screening amongst recent migrants is only 40 percent (2). Efforts are being made to improve awareness including animated health promotion tools (https://youtu.be/tKwAHJ7JeV0) and TB Alert’s Latent TB Handbook (https://www.tbalert.org/health-professionals/ltbi-toolkit/) and novel interventions to improve LTBI screening and treatment uptake are being implemented across the country. We are currently investigating the efficacy of managing LTBI entirely within primary care (https://clinicaltrials.gov/ct2/show/NCT03069807). Recent work has also identified that opportunistic LTBI screening in non-health settings is acceptable to recent migrants (3).
   
  In areas where the majority of active cases are amongst those...

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  We welcome the letter by Anna Humphreys and colleagues highlighting the secondary benefits of screening contacts of extra pulmonary tuberculosis for LTBI in areas where active cases are predominantly amongst the non-UK born (1). 
   
  We share the view that novel approaches are needed to identify and offer testing to those at risk of LTBI, and that contact tracing provides a unique opportunity to reach those who may be eligible.  

  Early results from the London Borough of Newham, the pilot site for the national latent TB screening programme highlight that uptake of LTBI screening amongst recent migrants is only 40 percent (2). Efforts are being made to improve awareness including animated health promotion tools (https://youtu.be/tKwAHJ7JeV0) and TB Alert’s Latent TB Handbook (https://www.tbalert.org/health-professionals/ltbi-toolkit/) and novel interventions to improve LTBI screening and treatment uptake are being implemented across the country. We are currently investigating the efficacy of managing LTBI entirely within primary care (https://clinicaltrials.gov/ct2/show/NCT03069807). Recent work has also identified that opportunistic LTBI screening in non-health settings is acceptable to recent migrants (3).
   
  In areas where the majority of active cases are amongst those born in high TB-burden countries, a reinterpretation of contact screening that encompasses the aims of identifying active TB cases, as well as recently and remotely acquired LTBI would allow TB programmes to reach many more people at risk.

  The National guidelines were updated based on evidence that non-pulmonary TB is a lower risk for transmission (4). Screening contacts is justified given the public health risk of active disease in those recently exposed and a case can be made for screening contacts of extra pulmonary cases as they may have been infected by a previously unknown pulmonary index case.

  However, should we decide to change our approach to screening contacts with the explicit aim of identifying LTBI due to remote infection then we must at least acknowledge this when we talk to patients about their recent contacts and ask them to share personal information. And, as a TB community, we must agree that this approach is ethical.

  We would support this broader eligibility for screening contacts and believe it would strengthen an already vital tool in the fight to eliminate Tuberculosis in the UK. 

  1. Humphreys A, Abbara A, Williams S, John L, Corrah T, McGregor A, et al. Screening contacts of patients with extrapulmonary TB for latent TB infection. Thorax. 2018;73(3):277-8.
  2. Loutet M. National Roll-out of Latent Tuberculosis Testing and Treatment for New Migrants in England: a retrospective evaluation in a high-incidence area. European Respiratory Journal. 2017:1-25.
  3.  Walker CL, Duffield K, Kaur H, Dedicoat M, Gajraj R. Acceptability of latent tuberculosis testing of migrants in a college environment in England. Public Health. 2018;158:55-60.
  4.  Hoppe LE, Kettle R, Eisenhut M, Abubakar I. Tuberculosis—diagnosis, management, prevention, and control: summary of updated NICE guidance. BMJ. 2016:h6747-9.

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  Conflict of Interest:
  None declared.

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