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Further evidence supporting programmatic screening for, and treatment of latent TB Infection (LTBI) in new entrants to the UK from high TB prevalence countries
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  1. Lawrence Peter Ormerod1,2,3
  1. 1Chest Clinic, Royal Blackburn Hospital, Blackburn, Lancs, UK
  2. 2Lancashire Postgraduate School of Medicine, University of Central Lancs, Preston, Lancs, UK
  3. 3University of Manchester, Manchester, UK
  1. Correspondence to Professor Lawrence Peter Ormerod, Department of Chest Clinic, Royal Blackburn Hospital, Blackburn, Lancs BB2 7AE, UK

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A systematic comparison of tuberculosis (TB) cases and rates between the USA and E&W (England and Wales), shows diametrically opposed trends. Between 1993 and 2010 in the USA, active TB cases fell from 25 107 to 11 182,1 a fall of 55%. By contrast in E&W, notified TB cases rose from 5104 in 19932 ,3 to 7901 in 2010,4 an increase of 55%.

Case management is not the explanation for the difference, as both countries use rifampicin and isoniazid based 6-month short course chemotherapy, with high completion rates, 92.7% for the USA1 and 83.6% of survivors in E&W.4 Equally, different BCG policies do not account for the difference as the USA has never used BCG as a health control measure.

Both countries now have a majority of TB cases in foreign-born …

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