Identification of tuberculosis cases by port health screening in Essex 1997–2003

Sally Millership and Amelia Cummins

Abstract
Between 1997 and 2003 an annual average of 1867 new
entrants seen at the port of arrival were notified to the
communicable disease teams who now form the Essex
Health Protection Unit. We examined the number of individuals
who made contact with health services by linking
port health and tuberculosis databases with combinations
of surname, forename and date of birth the number of new
entrants developing tuberculosis. We also searched paper
records for all incidents of active tuberculosis in health
and residential care workers. Eighteen individuals were in
both port health and tuberculosis data sets; only one was
identified by new entrant screening. In the same period
there were 35 cases of active tuberculosis in health care
workers, only one of whom had been screened on arrival
in the United Kingdom, resulting in follow-up of 371 contacts.
The new entrant screening programme in Essex
should be stopped and resources diverted to improve followup
of new entrants, especially those who are health care
workers.
Keywords: new entrant, port health, tuberculosis

Tuberculosis in pregnancy – Case studies and a review of Australia’s screening process

Fergus P. McCARTHY,1 Shelley ROWLANDS1 and Michelle GILES2
1Obstetrics Department and 2Infectious Diseases, Royal Women’s Hospital, Carlton, Victoria, Australia
Abstract
Few changes have occurred in the management of tuberculosis over the past two decades and many of the recent
developments are in the area of diagnostics. The application of these to the pregnant population is not yet established.
Two cases recently managed at the Royal Women’s Hospital, Melbourne highlight the need for clinicians managing pregnant
women to rethink this condition and, with changes in migration and epidemiology, reconsider our screening practice.
Key words: pregnancy, screening, tuberculosis.

From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam

Background: In early 2001 there were indications that tuberculosis (TB) was increasingly becoming a
problem among drug addicts and homeless persons in Rotterdam, after a periodical screening was
discontinued in 1997. A contact investigation around a homeless drug addicted man in Rotterdam
with infectious pulmonary TB is described. Contact investigation: A total of 507 drug addicts, homeless
persons, and staff of facilities for these risk groups were examined with tuberculin skin testing (TST) and
chest radiography. DNA fingerprinting of mycobacteriological cultures through Restricted Fragment
Length Polymorphism methodology and molecular epidemiology investigation through cluster analysis
were performed. Outcome: TST showed an infection prevalence of 29%, especially among staff of services
for drug addicts and homeless persons. Six persons with active intrathoracic TB were identified. Cluster
analysis demonstrated no relation with the initial case but showed intense transmission of TB among
drug addicts and homeless persons in Rotterdam by multiple sources. As a consequence of the findings, a
proposal to the Council of the City of Rotterdam resulted in the re-introduction of a comprehensive TB
screening programme among these risk groups with mobile digital X-ray units (MXUs). Conclusion: This
contact investigation gradually obtained the characteristics of a screening of drug addicts and homeless
persons. Novel technologies, such as MXUs, facilitate appropriate and efficient outreach approaches to
TB control among difficult-to-reach groups. This method and knowledge of individual fingerprints and
clusters of TB patients are indispensable for underpinning proposals for change of local TB control
strategies and convincing local authorities of the rationale.
Keywords: DNA fingerprinting, policy implications, risk groups, screening, tuberculosis

Is screening for tuberculosis acceptable to immigrants? A qualitative study

P. Brewin1, A. Jones2, M. Kelly3, M. McDonald4, E. Beasley4, P. Sturdy5, G. Bothamley1,
C. Griffiths5Background Screening of immigrants has been a widespread response to the global resurgence of tuberculosis but has been criticized as discriminatory
and stigmatising. Acceptability is an essential but neglected ethical prerequisite of screening programmes, particularly those targeting vulnerable
groups such as refugees. No data exist concerning acceptability of tuberculosis screening. We therefore examined the responses of
immigrants to screening for tuberculosis in a range of settings.
Methods We carried out a qualitative interview study of a maximum diversity sample of 53 immigrants offered screening for tuberculosis in east
London. We recruited people screened in three settings: a social service centre for asylum seekers, a hospital clinic for new entrants and primary
care. We confirmed validity of our findings at a focus group of asylum seekers.
Results The opportunity to be screened for tuberculosis was valued highly by recipients. Moreover, many saw being screened as a socially
responsible activity. Of the minority raising concerns, few mentioned the possibility of discrimination. Acceptability was high irrespective of setting,
with respondents expressing preference for their chosen place of screening.
Conclusion Screening for tuberculosis was highly acceptable to recipients in these settings. Screening should be offered in a range of settings.
Keywords public health, screening, tuberculosis