Is new immigrant screening for tuberculosis still worthwhile?

Abstract

Background: new immigrant screening in the 1980s showed that the official Port of Arrival (POA) system performed poorly, that there was a significant yield in terms of clinical tuberculosis, and that preventive measures (chemoprophylaxis and BCG) were appropriate in a substantial minority Data for the 1990s was sought for comparison.

Methods: prospective data on new immigrant screening for 1990-1994 inclusive in the Blackburn, Hyndburn and Ribble Valley local government areas were analysed, and compared with previous 1983-1988 data.

Results: of the 2242 new immigrants screened, 1333 were from Pakistan, 604 from India and 305 from the rest of the world. A total of 898 (40%) were found via the POA system, but 1344 (60%) were only identified by local links with the Family Health Services Authority (FHSA). Ten cases of active tuberculosis were found (0.45%), chemoprophylaxis was given to 19/465 (4.1%) of children aged 0-15 years, and BCG vaccination to 530/1705 (31%) of those aged under 30 years.

Conclusions: between 1990-1994 the official POA system continued to perform poorly. The yield of new tuberculosis cases detected was lower than in the 1980s. Chemoprophylaxis at 4% and BCG vaccination at 31% showed that preventive health measures were appropriate for over one-third of new immigrants aged under 30.