In 2012, a total of 8751 cases of TB in the UK were reported at a rate of 13.9 cases per 100 000—this figure is on the background of an increase over two decades in notifications and rates with no evidence of any reduction since peaking in 2005.1 This rise has been largely attributed to TB in the foreign-born, with 73% of all cases of TB being born in high-incidence countries. By contrast, the cases of TB in the UK born have been static over the last decade. Given that these cases are largely due to reactivation disease,2 a strategy of TB control purely based on detection and treatment of active pulmonary disease is unlikely to cause a significant change in these statistics. Hence, despite the change in TB screening to the port of exit, this is also unlikely to be effective given that the major burden of latent disease will not be detected by plain radiology.

A strategy of screening in the USA has been credited with the decreasing rates of TB there which is in stark contrast …