Volume 199 - Issue 10
Immigration screening for latent tuberculosis infection
Author: Justin T Denholm
Med J Aust 2013; 199 (10): 654. || doi: 10.5694/mja13.11007
Published online: 18 November 2013
Published online: 18 November 2013
In reply: I thank Griffin and Kelly for elaborating on some practical elements of immigration screening for latent tuberculosis infection (LTBI) in light of their experience with isoniazid prophylactic therapy in a high-risk context.
Any screening program must strike a balance between costs (both the financial costs and the risks associated with screening) and benefits in a specific setting. Accumulating evidence suggests that higher levels of ...
In reply: I thank Griffin and Kelly for elaborating on some practical elements of immigration screening for latent tuberculosis infection (LTBI) in light of their experience with isoniazid prophylactic therapy in a high-risk context.
Any screening program must strike a balance between costs (both the financial costs and the risks associated with screening) and benefits in a specific setting. Accumulating evidence suggests that higher levels of risk are associated with LTBI than previously appreciated, which prompts consideration of a correspondingly larger group who would benefit from treatment. For instance, the estimates of 2%–7% lifetime risk that Griffin and Kelly refer to are based on patients with positive tuberculin skin test results, whereas a considerably higher risk of TB reactivation has been shown by more recent research and analysis based on the results of more specific interferon-γ release assays.1,2 Nonetheless, many individuals with LTBI (as currently diagnosed) will not develop active disease. While effective screening in appropriately selected populations is possible now, advances in LTBI testing and treatment could be used to further optimise screening programs. In particular, improved ability to predict which individuals are at high risk of reactivation would be welcome, as would treatment regimens that are shorter and better tolerated.
Competing interests
No relevant disclosures
References
- McBryde E, Denholm JT. Risk of active tuberculosis in immigrants: effects of age, region of origin and time since arrival in a low-exposure setting. Med J Aust 2012; 197: 458-461.
- Diel R, Loddenkemper R, Niemann S, et al. Negative and positive predictive value of a whole-blood interferon- release assay for developing active tuberculosis: an update. Am J Respir Crit Care Med 2011; 183: 88-95.
Costs of Delivering the Hep B PAST Model of Care in Remote Australia: A Retrospective Pre–Post Study
Hoa Nguyen, Anh Le Tuan Nguyen, Paula Binks, Melita McKinnon, Emily Vintour-Cesar, Karen Wills, Nicola Stephens, Benjamin Cowie, Joshua S. Davis, Yuejen Zhao, Peter Nihill, Julie A. Campbell, Andrew J. Palmer, Jane Davies, Barbara de Graaff
Buruli Ulcer Acquired From Ringtail Possum Rescue
Daniel P. O'Brien, Naomi Clarke, Sara Bonnici, Mohammad A. Hussain
Q Fever Visceral Abscesses After Contact With Native Australian Marsupials
Samantha J. Laws, Enzo Binotto, James Stewart, Jennifer Ho, Trent Yarwood, Josh Hanson, Simon Smith
Hospital-Admitted Injection-Related Infections Among Incarcerated People Who Inject Drugs in Australia: A Retrospective Cohort Study
Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark
The Live Attenuated Influenza Vaccine in Australia: An Additional Tool for Influenza Prevention
Cyra Patel, Alexis Pillsbury, Tran Nguyen, Xia Wang, Helen E. Quinn, Clayton K. Chiu, Allen C. Cheng, Katie L. Flanagan, Zhicheng Wang
Reflex Testing for Hepatitis D Infection: A Unique Opportunity to Reduce Hepatitis D-Related Chronic Liver Disease Deaths in Australia
Jessica Howell, Lauren Andersson, Miriam T. Levy, James O'Beirne, Leon Adams, Katharine Irvine, Avik Majumdar, Golo Ahlenstiel, Kathy Jackson, Krispin Hajkowicz, Joseph Doyle, Jane Davies, Sarah Cherian, Wayne Dimech, Alexander J. Thompson