Introduction Most Tuberculosis (TB) cases in England are the result of reactivation of latent TB infection (LTBI) in foreign-born immigrants. The Collaborative TB Strategy recommends LTBI screening in New Entrants, who have entered the UK in the previous 5 years, are aged 16–35 and from countries with a TB incidence of ≥150 cases/100,000 population.¹ This is seen as cost-effective,² but in contrast to National Institute for Health and Care Excellence (NICE) guidance, which recommends screening those aged 0–65 from countries with a lower TB incidence of ≥40 cases/100,000). This study evaluated how the two screening programmes compared.

Methods Patients screened in 2016 by our Secondary Care service using NICE-recommendations were included. Those aged 16–65 had an Interferon Gamma Test (QuantiFERON) and those aged 0–16 a Mantoux Test (reported as positive if ≥5 mm). Results were then stratified by the TB incidence in their country of birth and by age.

Results 345 patients were offered screening, and 235 patients attended (68%). 44 patients (19%) were found to have LTBI and none had active TB. The Results are displayed in Table 1. 120 patients (51%) were in the Strategy-recommended group, which had the lowest LTBI-positivity rate (10%). Restricting screening to just this group would have resulted in 32 of the 44 LTBI cases (72%) being ‘missed’. The LTBI-positivity rate was high in the younger and older age groups from the ≥150 cases/100,000 countries (25% and 33% respectively), and 1/3 of those screened in the age 16–35 group from the 40–150 cases/100,000 countries tested positive, the majority being Romanian.

• Download figure
• Open in new tab
• Download powerpoint

Abstract P170 Table 1

LTBI screening results stratified by TB incidence in the country of birth and by age range (shaded cells indicate the Strategy-recommended screening group results)

Conclusions The LTBI rate in New Entrants is high in groups not currently widely screened. Broadening the programme to include patients from a wider age range and from countries with a TB incidence of ≥40/100,000 would achieve higher LTBI detection and aid National TB control.

References

1. Collaborative TB Strategy for England 2015–2020: PHE2015, January.

2. Pareek M, et al. The Lancet Infectious Disease2011;11:435–444.