Abstract
BackgroundIn 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry.MethodsWe designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry.ResultsWe identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively).ConclusionAirport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening.
Highlights
In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end
In response to increasing migration to the UK of individuals born in TB high risk countries, the UK government set up new entrant screening for active TB at ports of entry (“new entrants screening”) in 1965 [6]
When we looked at the groups of new entrants at increased risk of TB diagnosis at any follow up point after screening, we found refugees and asylum seekers having the highest risk compared to the other VISA categories of entrants
Summary
In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry. The incidence of tuberculosis (TB) in the United Kingdom (UK) increased between 1990 and 2005, stabilized until 2011 and decreased in the three following years. In response to increasing migration to the UK of individuals born in TB high risk countries, the UK government set up new entrant screening for active TB at ports of entry (“new entrants screening”) in 1965 [6]. Chest x-rays were introduced at London Heathrow airport for long-stay new entrants. Screening was subsequently extended to London Gatwick airport.
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