Screening of schoolchildren for tuberculosis

Abstract

Sir—Tuberculosis is cause for concern, particularly because there has been an increase in the number of disease notifications in the past few years. Surveillance and screening are seen as the most effective methods in the control and prevention of this disease. The British Thoracic Society recommends that all immigrants or other entrants from Asia, Africa, South and Central America, and other countries where tuberculosis is common (an incidence of 40/100 000 population) who plan to stay longer than 6 months should be screened, either at the port of entry or the district of intended stay. Screening is also advised for children. However, there is no guidance on exclusion and screening of children who have spent substantial time (eg, 12 months or more) in countries with high prevalence of tuberculosis but who are normally resident in the UK. In Walsall, there is not enough justification to continue to screen children who belong to this category, and the policy was changed some years ago. To ascertain the policies of other districts, we sent questionnaires to consultants of communicable disease control in 180 districts in England and Wales in May, 1999, on their screening policy. 35 (19%) of 180 districts replied. Three districts had no policy for screening children on return from countries with high prevalence of tuberculosis because they had few or no people of ethnic origin. 32 districts that had a policy allowed children who were returning after a short stay ( 6 months) to join school immediately without screening. In 30 districts, children returning after a visit of 12 months or longer would be allowed to join immediately without screening. Only two districts screened children on return after a visit of 12 months or longer to areas of high tuberculosis prevalence ( 4 0 / 1 00 000), before they were allowed to join school. Many districts have no policy and expect the children to attend school immediately, which seems to be independent of ethnic origin. Of the districts that responded, the proportion of children who were black or of other ethnic origins varied from 0 to 17%. A study on screening of immigrants reported a yield of active cases of 0 · 6 5 % . Studies on the effect of imported cases of tuberculosis on the increase in tuberculosis notification have indicated that socioeconomic factors play a major part with a small contribution from immigration, particularly from endemic areas. A balance needs to be struck between the concern over public health and safety, and the protection of individual rights and civil liberties. A way forward would be to institute specialised medical consultation before departure and investigate children who have symptoms of tuberculosis on their return.