System to detect tuberculosis in new arrivals to UK must be improved

Editor—The news item on the global spread of drug resistant tuberculosis raised the issue of screening new arrivals to the United Kingdom who come from countries with a high incidence of tuberculosis.¹ One group of new arrivals in which such communicable diseases are an issue are refugees and asylum seekers.²

These people may have arrived from areas of war or famine, where medical systems have broken down, and may be incompletely immunised. Last year thousands of people arrived from tuberculosis hotspots at port health units (mainly Gatwick and Heathrow airports) claiming political asylum.³ Regulations state that these people, and indeed anyone planning to live in the United Kingdom for over six months who arrive from areas where tuberculosis is common (40 cases/100 000 population), should be screened by chest radiography at the port of entry as part of the tuberculosis screening programme.⁴ But port health units no longer have the resources to deal with the many asylum seekers and other immigrants arriving every day.

According to the regulations, the consultant in communicable disease control in the health authority in which the asylum seeker plans to live is contacted. It is up to him or her to contact the asylum seeker and carry out follow up tests to find people positive on skin testing and those requiring vaccination, and to initiate chest radiography for those who did not have it at port health units. Most health authorities, however, have insufficient resources to offer comprehensive contact tracing and screening of newly arrived asylum seekers.

In the absence of a national reception policy, and with a tuberculosis screening programme that is not detecting all people at risk, general practitioners have to deal with the health concerns of these new arrivals. General practitioners, however, do not seem to be initiating screening either. In a recent study of 58 general practitioners in Ealing, Hammersmith, and Hounslow Health Authority, most of whom had refugees on their lists, only four referred asylum seekers to a chest clinic for tuberculosis screening; 48 were unaware of the tuberculosis screening programme.⁵ Most thought that some screening should take place.

Although screening for tuberculosis at ports of entry is limited in detecting active cases, follow up in the community or reception centre needs to be organised. Tuberculosis and drug resistant tuberculosis are not only personal concerns but, potentially, major public health issues. The number of asylum seekers coming to the United Kingdom has sharply increased in the past few years; the system to tackle the spread of tuberculosis in the United Kingdom therefore requires attention.