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

Dominik Zenner, Miranda G. Loutet, Ross Harris, Stephen Wilson, L. Peter Ormerod

Research output: Contribution to journalReview articlepeer-review

14 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number1602505
JournalEuropean Respiratory Journal
Volume50
Issue number1
DOIs
Publication statusPublished - 1 Jul 2017

Bibliographical note

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Copyright ©ERS 2017.

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