The Home office has announced that those travelling to the UK could be screened for tuberculosis (TB) before being granted a visa. The new rules will apply to those who wish to spend over six months in the UK and come from a country deemed to have a high incidence of TB – 40 cases per 100,000. The new policy will cover over 60 countries including China, South Africa and Russia.

The Health Protection Agency (HPA) have welcomed the announcement from the Home Office and noted that they had been concerned for a number of years that the current policy of chest x-rays at Heathrow and Gatwick is not an cost effective or appropriate way of dealing with TB.

Why have the Home Office made this change?

The policy change has been driven by a review by the UK Border Agency (UKBA) with support from the HPA and Department of Health of the current arrangements for screening migrants from high incidence countries for active pulmonary TB to better protect UK public health and to use public resources more effectively. The scheme, which is employed in the USA, Australia and Canada, has already been piloted in 15 countries by the UKBA and will be introduced in three phases over an 18 month period – beginning in the summer of 2012.

Will this have a significant impact on rates of TB in the UK?

The Home Office rightly note that TB is a complex disease and that screening of migrants as part of immigration clearance can only make a limited contribution to TB control in the UK. This measure is targeted at active forms of the disease and it is important to remember that one third of the world’s population are estimated to have latent TB – that’s around 2bn people.

A minority will develop the disease in its active form at some point in their lives, but it is currently impossible to establish through screening if this is likely to occur in any individual case. Also, crucially most foreign-born TB patients only develop the disease in its active form years after arrival in the UK.

It is essential that the UK Government explore ways to improve the sharing of information between the UKBA and the HPA about individuals coming to live in the UK for more than six months from high incidence countries. This will complement the systems that are already in place at a local level for connecting individuals with healthcare services.

The global picture of TB

TB is a global public health issue, with the active form of the disease affecting almost 9 million people each year and killing over 1.4 million, despite being curable. While TB rates in this country are stable, at around 8500, HPA data indicates higher rates of infection concentrated in particular metropolitan areas like London, which is estimated to have the highest rates of TB of any western European capital. Overall the UK’s TB rate compares extremely unfavourably when compared to other developed nations.

Take London for example. It has relatively high rates of TB and accounts for almost 40% of all cases in the UK. Other cities in Europe have faced similar difficulties addressing TB, but have been more successful reducing the rates of the disease. In order for it to be effectively tackled it needs to have appropriate focus, attention and resources.  In essence it needs a fully thought through and funded plan.

There is a plan in place to further improve current interventions for TB in the capital and the Vice-Chair of the All-Part Parliamentary Group on Global Tuberculosis Virendra Sharma MP (Lab, Ealing Southall) and 16 other MP’s have thrown their support behind a London TB Model of Care (EDM 3002), which could reduce the current number of people affected by the disease in the London – if implemented fully.  However, current changes in the NHS mean it is unclear if the model will receive the support and attention required to instigate the step change that is really needed.