Occupational health screening of doctors must be improved

EDITOR—In her letter Hargreaves says that screening for tuberculosis among refugees and asylum seekers must be improved.1 The number of cases detected by screening of new arrivals in the United Kingdom is, however, low.2 In this health district, which screens on average 40% of 110 new arrivals per year, no case of tuberculosis has been detected in five years. Screening new arrivals for tuberculosis is not easy, given the lack of resources identified by Hargreaves. In addition, refugees and asylum seekers (and their general practitioners) are unlikely to consider screening for tuberculosis to be either their most important or their most immediate health need.

Another group of people for whom tuberculosis screening is important, and in whom it should be easier to implement, is doctors. All doctors are required to undergo pre-employment screening,3 and this provides a backup for doctors recently arrived in the United Kingdom, who might not have been screened through the imperfect port health system.

Recently there have been three cases of smear negative pulmonary tuberculosis within a six month period among doctors living in the doctors' residence of a local hospital in this district. All three doctors had arrived in the United Kingdom within the preceding three years. With the help of DNA typing of isolates from …