Screening immigrants at risk of tuberculosis

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6925.416a (Published 05 February 1994) Cite this as: BMJ 1994;308:416
  1. S Bakhshi
  1. Department of Public Health Medicine, East Birmingham Health Authority, Birmingham B9 5ST.

    EDITOR, - R M Hardie and J M Watson point to many inadequacies in their survey to determine the methods used to identify and screen immigrants at risk of having tuberculosis.1 It is not district health authorities, as the authors claim, but mostly local authorities that manage the service. The local authorities do not see themselves as the correct organisation to administer the service, and any appeal for additional resources would be turned down.

    If an objective of the service is to familiarise new arrivals with the NHS then why is the service confined to immigrants from the Third World? These immigrants now make up only a small proportion of people migrating to study, work, or settle in Britain; a much larger proportion comes, for example, from the countries in the European Union. If, on the other hand, an objective of the service is to screen immigrants at risk of tuberculosis then the authors do not present convincing evidence for its necessity.

    The author's survey indicated that there was radiological evidence of active tuberculosis in 20 out of 20 000 chest x ray examinations - a detection rate of 0.1%. This is hardly an indication for promoting an expensive network of nationwide screening services. Indeed, an audit of 226 chest x ray examinations performed on immigrants in Birmingham during 1992 showed no active tuberculosis. No case of sputum positive tuberculosis has been identified in newly arrived immigrants in the past 10 years in Birmingham, the largest local authority in Britain. The natural course of tuberculosis in Britain shows that this is not surprising. Immigrants may arrive with quiescent tuberculosis, but if this becomes active it does so over the next five years.2

    I accept that all new arrivals need information not only on health but also on other community services and that written information on these can best be provided at the port of entry.

    Ethnic minority organisations regard screening services for selected immigrants as discriminatory and without evidence of medical benefit. Hardie and Watson's paper will add to their suspicions and diverts attention from understanding of the underlying causes and management of tuberculosis in people who are at risk of developing the disease.


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