Immigrant screening for TB: a missed opportunity to improve TB control in the United Kingdom

Lalvani, Ajit; Pareek, Manish

doi:10.1179/204777312x13305103762501

Cited by 12 publications

(12 citation statements)

References 2 publications

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“…First, it compared the cost-effectiveness of TST and each of the two IGRA platforms for new entrant screening and found that single-step testing is more cost-effective than two-step testing, particularly with QFT-GIT. Second, taken together with a previous new entrant screening study,29 it supports a recently proposed streamlined algorithm to new entrant LTBI screening, reserving chest radiography only for those testing positive by IGRA 25. This emerging approach, however, assumes that IGRA false-negative rates in contacts with asymptomatic active TB are very low, but more data are needed to support this 25.…”

Section: Current and Future Policymentioning

confidence: 73%

“…Given that >75% of the UK’s TB burden is carried by foreign-born immigrants, and most of this is due to reactivation of LTBI within the first several years after arrival, tackling imported LTBI in new entrants is increasingly recognised as an attractive strategy to reverse the relentless rise in UK TB rates 25. Policy is evolving rapidly in this area in response to a growing evidence base.…”

Section: Current and Future Policymentioning

confidence: 99%

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How should I interpret an interferon gamma release assay result for tuberculosis infection?: Table 1

Abubakar

Whitworth

Lalvani

2013

Thorax

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Background Interferon gamma release assays (IGRAs) are the first new diagnostic tests for latent tuberculosis (TB) infection (LTBI) since the century-old tuberculin skin test (TST). They are cell-mediated immune-based blood tests that have revolutionised LTBI diagnosis and are increasingly recommended by national guidelines. Objectives With the rapid expansion of the IGRA evidence-base in recent years, the limitations of IGRA and uncertainties in clinical interpretation of IGRA results have increasingly come into focus. In LTBI diagnosis these include: prognostic power of IGRAs relative to TST for quantifying risk of progression to active disease, false-negative rates in immunocompromised patients, the clinical meaning of IGRA reversion and the significance of the size of IGRA response. Furthermore, the role of IGRAs in the diagnostic work-up of active TB is unclear, and there is little evidence supporting use of the tests in anti-TB treatment monitoring. Methodological approach On-going large prospective longitudinal clinical endpoint cohort studies of active and latent TB will tackle some of the uncertainties regarding IGRAs. Here we discuss clinical practice and guidance in light of the current uncertainties, based on existing evidence. Conclusions and impact Current and planned clinical research will fill the gaps in the evidence-base, narrowing the areas of uncertainty and informing future policy. Translational research into next-generation IGRAs and new T cell-based diagnostic platforms will likely overcome the limitations of current IGRAs in the near future.

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Section: Current and Future Policymentioning

confidence: 73%

Section: Current and Future Policymentioning

confidence: 99%

How should I interpret an interferon gamma release assay result for tuberculosis infection?: Table 1

Abubakar

Whitworth

Lalvani

2013

Thorax

Self Cite

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“…Several studies attribute rising TB rates to a combination of an increased number of TB cases and reactivation of latent infection among immigrants in UK. [9][10][11][12] In the USA, the decline in annual TB rates has been attributed to ongoing improvements in TB control practices and a decline in incidence among the foreign-born. 8 [13][14][15] In this study, we examined trends in the number of reported TB cases and incidence rates between…”

Section: Introductionmentioning

confidence: 99%

Mind the gap: TB trends in the USA and the UK, 2000–2011

Nnadi

Anderson

Armstrong

et al. 2016

Thorax

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Background TB remains a major public health concern, even in low-incidence countries like the USA and the UK. Over the last two decades, cases of TB reported in the USA have declined, while they have increased substantially in the UK. We examined factors associated with this divergence in TB trends between the two countries. Methods We analysed all cases of TB reported to the US and UK national TB surveillance systems from 1 January 2000 through 31 December 2011. Negative binominal regression was used to assess potential demographic, clinical and risk factor variables associated with differences in observed trends. Findings A total of 259 609 cases were reported. From 2000 to 2011, annual TB incidence rates declined from 5.8 to 3.4 cases per 100 000 in the USA, whereas in the UK, TB incidence increased from 11.4 to 14.4 cases per 100 000. The majority of cases in both the USA (56%) and the UK (64%) were among foreign-born persons. The number of foreign-born cases reported in the USA declined by 15% (7731 in 2000 to 6564 in 2011) while native-born cases fell by 54% (8442 in 2000 to 3883 in 2011). In contrast, the number of foreign-born cases reported in the UK increased by 80% (3380 in 2000 to 6088 in 2011), while the number of native-born cases remained largely unchanged (2158 in 2000 to 2137 in 2011). In an adjusted negative binomial regression model, significant differences in trend were associated with sex, age, race/ethnicity, site of disease, HIV status and previous history of TB (p<0.01). Among the foreign-born, significant differences in trend were also associated with time since UK or US entry (p<0.01). Interpretation To achieve TB elimination in the UK, a re-evaluation of current TB control policies and practices with a focus on foreign-born are needed. In the USA, maintaining and strengthening control practices are necessary to sustain the progress made over the last 20 years.

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“…In the UK, TB notifications have increased continuously over the past 30 years and of the 9000 new cases notified in 2011, 74% occurred among foreign-born individuals 3. Strategies for the effective control and elimination of TB in low-incidence countries, such as the UK, depend on the prompt identification and management of active disease, and also those individuals with latent TB infection (LTBI) who are at risk of reactivation, progression to disease and infectiousness 4 5…”

Section: Introductionmentioning

confidence: 99%

Screening for latent tuberculosis and gastrointestinal parasite infections in Gurkha recruits: research driving policy change

O’Shea

Fletcher

Tupper³

et al. 2014

J R Army Med Corps

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Nepalese Gurkha soldiers are recruited from a country endemic for a number of infectious diseases, including tuberculosis and gastrointestinal parasites. This article describes a prospective cohort study which investigated screening strategies for these infections among Gurkha recruits arriving in the UK to begin basic training. Several recommendations were made as a result of the study which were supported for early implementation and subsequently fully adopted. Military screening and treatment policies have been directly influenced by this research which also has translational application to similar migrant civilian populations.

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Immigrant screening for TB: a missed opportunity to improve TB control in the United Kingdom

Cited by 12 publications

References 2 publications

How should I interpret an interferon gamma release assay result for tuberculosis infection?: Table 1

How should I interpret an interferon gamma release assay result for tuberculosis infection?: Table 1

Mind the gap: TB trends in the USA and the UK, 2000–2011

Screening for latent tuberculosis and gastrointestinal parasite infections in Gurkha recruits: research driving policy change

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