NICE has suggested that one situation where TB screening for new entrants** should occur is when a patient becomes a new registration to a general practice. NICE has suggested that assessment for, and management of, TB in new entrants** should consist of the following:
- a chest X-ray for those who have not had one recently taken, unless they are younger than 11 or are possibly pregnant
- clinical assessment for those with an abnormal chest Xray.
- risk assessment for HIV, including HIV prevalence rates in the country of origin, which is then taken into account for Mantoux testing and BCG vaccination
- a Mantoux test for people with normal recent chest X-ray who are:
- younger than 16, or
- aged 16-35, from sub-Saharan Africa or a country with a TB incidence greater than 500 per 100,000
- a Mantoux test for
- children younger than 11 years
- pregnant women
- interferon-gamma test (if available) if Mantoux test is positive (6 mm or greater) in someone who has not had BCG vaccination, or strongly positive (15 mm or greater) in someone who has been vaccinated
- assessment for active TB if interferon-gamma test is positive; interpret chest X-ray first if it is not contraindicated
- treatment for latent TB infection for people aged 35 or younger in whom active TB has been excluded, with a positive Mantoux test inconsistent with their BCG history, and a positive interferon-gamma test (if this test was available)
- consideration of BCG for unvaccinated people who are Mantoux negative
For detailed guidance then consult the full NICE guideline (1).
** new entrants are defined as people who have recently arrived in or returned to the UK from high-incidence countries, with an incidence of more than 40 per 100,000 per year, as listed by the Health Protection Agency (go to www.hpa.org.uk and search for 'WHO country data TB').
- NICE (March 2011). Tuberculosis Clinical diagnosis and management of tuberculosis, and measures for its prevention and control
- MeReC bulletin (2003); 14(3):9-12.