S39 Migration and tuberculosis: the start of intelligent new entrants screening

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Tuberculosis (TB) remains a problem in the UK, and almost three-quarters of active TB cases occur in the non-UK born. Most of these are likely infected abroad and strategies to detect latent TB in this population are being considered. We investigated how soon after arrival into the UK certain groups developed TB and the implications of this for numbers needed to screen and treat. Numbers of migrants arriving in 2005 from the top 6 countries of origin (of TB cases) were obtained from the Labour Force Survey (LFS). National TB surveillance (ETS) provided information on active cases from these countries. Estimates of interferon γ release assay (IGRA) positive cases (20%–28%), IGRA sensitivity (84%), and efficacy (65%) and completeness (85%) of chemoprophylaxis were obtained from Pareek et al. (Lancet ID 2011). The Abstract S39 table 1 shows numbers needed to screen and treat to prevent one case of TB developing in the UK in the 5 years after arrival. Numbers were relatively low, especially for Bangladesh and Somalia. The Abstract S39 table 1 also shows time between diagnosis and entry into the UK, which varied between countries of the Indian Subcontinent and sub-Saharan Africa and changed over time. While 45% of cases born in India had been in the country more than 10 years prior to arrival in 2000–2004, this was 32% in 2005–2009. Conversely, 57% of cases born in Zimbabwe were diagnosed within 2 years of arrival in 2000–2004, decreasing to 15% in 2005–2009. The relatively low numbers needed to treat among migrants from these high burden countries provide support for new guidance to expand latent infection treatment. The observed trends and differences in time since entry reflect underlying migration patterns, with higher but decreasing levels of migration from sub-Saharan Africa and an established and ongoing migrant population from the Indian Subcontinent. A more detailed analysis of migration patterns and its impact on UK cases of TB is warranted.

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