'Frightening' TB screening gaps in those most at risk

Chest x-ray
Image caption Some areas are failing to prioritise TB screening.

Those most at risk of developing tuberculosis are not being screened in some parts of the UK, experts say.

A national programme for high-risk groups in the UK is not being implemented in areas with the highest rates of the disease, the BBC has been told.

The latest annual TB statistics revealed a 7% rise in new cases.

A Health Protection Agency representative acknowledged some areas are "failing to prioritise screening".

Steadily increasing

In 2011 there were 9,000 new cases of tuberculosis, with 70% occurring among recent migrants to Britain from countries where the disease remains prevalent.

The condition, which can affect the lung or any part of the body, was largely eradicated in the 1980s, but rates have been steadily increasing over the last 20 years.

Last year the National Institute for Health and Clinical Excellence (NICE) recommended a co-ordinated screening programme to detect latent TB among the most at risk migrant groups.

The screening aims to ensure that latent disease, undetectable during immigration checks, is picked up and treated by the NHS once migrants settle in the UK.

But a recent survey of all primary care providers in the UK has revealed that around 40% are failing to implement the screening.

'Vast reservoir'

According to Professor Ajit Lalvani of Imperial College London, there is "wide deviation" from national guidance.

"The parts of the UK with the highest burden of TB were exactly those parts doing the least screening for latent TB, so the opposite of what should be the case.

"Those areas with the highest rates are devoting all their resources to the daily burden of treating active TB disease, but what that leaves below the surface is the vast reservoir of latent TB.

"It is frightening and it is part of the reason why TB has been progressively increasing for the last two decades in Britain."

It is thought that around 80% of active cases of TB are reactivated cases of latent bacteria.

Identifying patients with latent TB could halt the rising spread of the disease. A short course of antibiotics can successfully treat latent infection and prevent onward transmission.

'Too difficult'

Birmingham is the city with the highest TB rates in the UK after London and Dr Martin Dedicoat, a consultant at the city's chest clinic, admits to feeling overwhelmed by the task of trying to stop the disease.

He says: "Our rates of TB have gone up for multifactorial reasons, some are due to the make up of the city. So 70% of new cases are among people who are born overseas, and certainly there are very, very large numbers of people with what is known as latent TB.

"We would love to be accessing those patients to prevent there being a problem in the future."

Nicola Benge, the city's director of public health, admitted that despite Birmingham's high rates of the disease they do not screen for latent TB.

But she says: "In terms of targeted screening, we are not looking for latent TB, we are looking for TB.

"We do screen groups locally but what we are not able to do is identify all new immigrants at risk, it's just too difficult."

She adds that the city is currently re-commissioning its TB services and looking for a way to include latent screening.

Professor Ibrahim Abubakar, head of the TB section at the Health Protection Agency, was on the group that drew up the NICE guidance and says screening for latent infection requires urgent attention.

"The guidelines should be implemented, TB is a very important condition and we should do more to tackle it," he says.

Prof Abubakar adds: "If you deliver a screening programme you have a chance of reversing the tide of TB."

Listen to the full report on File on 4 on BBC Radio 4 on Tuesday, 31 July at 20:00 BST and Sunday 5 August at 17:00 BST. Listen again via the Radio 4 website or download the File on 4 podcast.

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