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.