Evaluating 17 years of latent tuberculosis infection screening in north-west England: a retrospective cohort study of reactivation

Approximately 72% of tuberculosis (TB) cases in England occur among non-UK born individuals, mostly as a result of reactivation of latent TB infection (LTBI). Programmatic LTBI screening is a key intervention of the TB strategy for England. This article reviews the results of a long-standing LTBI sc...

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Bibliographic Details
Published in:The European respiratory journal Vol. 50; no. 1
Main Authors: Zenner, Dominik, Loutet, Miranda G, Harris, Ross, Wilson, Stephen, Ormerod, L Peter
Format: Journal Article
Language:English
Published: England 01.07.2017
Subjects:
Adult
Databases, Factual
England - epidemiology
Female
Humans
Interferon-gamma - blood
Latent Tuberculosis - blood
Latent Tuberculosis - diagnosis
Latent Tuberculosis - epidemiology
Male
Mass Screening
Multivariate Analysis
Regression Analysis
Retrospective Studies
Tuberculin Test
Young Adult
ISSN:1399-3003, 1399-3003
Online Access:Get more information
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Summary:Approximately 72% of tuberculosis (TB) cases in England occur among non-UK born individuals, mostly as a result of reactivation of latent TB infection (LTBI). Programmatic LTBI screening is a key intervention of the TB strategy for England. This article reviews the results of a long-standing LTBI screening initiative in England.A retrospective cohort was created through probabilistic linkage between LTBI screening data and national TB case notifications. Screened persons were followed until they died, became a case, emigrated or until cohort-end. TB incidence rates and rate ratios (IRR) were calculated.97 out of 1820 individuals screened for LTBI were reported to have active TB. Crude incidence rates among LTBI-positive, treatment-naïve individuals were 4.1 and 2.3 per 100 person-years in the QuantiFERON and tuberculin skin test cohorts, respectively. Among the QuantiFERON cohort, Poisson regression showed that LTBI positivity (IRR 22.6, 95% CI 6.8-74.6) and no chemoprophylaxis increased the probability of becoming a TB case (IRR 0.17, 95% CI 0.05-0.6).We found high TB rates in LTBI-positive, treatment-naïve individuals and a strong association between no treatment and becoming a TB case, demonstrating feasibility and effectiveness of LTBI screening and providing important policy lessons for LTBI screening in England and beyond.
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ISSN:1399-3003
1399-3003
DOI:10.1183/13993003.02505-2016