TB monitoring of refugees 'must improve'

Doctors have warned that the monitoring of asylum seekers and refugees for tuberculosis must be improved.

They say that thousands of people have been arriving from TB hotspots but that health units at Britain's ports, whose job includes screening for the disease, don't have the resources to deal with the number of people involved. The warning comes in the wake of growing concern about the global spread of drug-resistant TB, and the increase in the numbers of TB cases generally.

Dr Sally Hargeaves, of the Department of Infectious Diseases at Imperial College London, says that regulations require that people planning to live in the UK for longer than six months and who come from TB hotspots - where there are more than 40 cases for every 100,000 people - should be screened with chest radiography at the port of entry.

"But port health units no longer have the resources to deal with the many asylum-seekers and other immigrants arriving every day,'' she says in a letter in the current issue of the British Medical Journal.

The doctor for communicable diseases in the area where the asylum-seeker plans to live is also required to be contacted and should carry out further tests, she says. "Most health authorities have insufficient resources to offer comprehensive contact tracing and screening of newly arrived asylum seekers,'' she says. "In the absence of a national reception policy and with a TB screening programme that is not detecting all people at risk, GPs have to deal with the health concerns of these new arrivals.''

But Dr Hargreaves says one survey in London has shown that out of 58 GPs in the Ealing, Hammersmith and Hounslow health areas, most of whom have refugees on their lists, only four referred asylum-seekers for TB screening. All but 10 of the GPs were unaware of the screening programme. Many asylum-seekers and refugees may have arrived from areas of war or famine where medical systems have broken down, she says. "The number of asylum-seekers coming to the UK has sharply increased in the past few years. The system to tackle the spread of TB in the UK therefore requires attention.''

TB that is resistant to first- and second-line drugs has been found in 104 countries. Hot spots for the multi-drug-resistant strain include the former Soviet Union, India, China and the Ivory Coast. A Harvard university report says every year Russia releases from its prisons around 30,000 people who have TB. Around 12,000 have the resistant version.

Many specialists link the spread of the resistant strain to the dismantling of public health controls for a disease that many considered to have all but disappeared and the socio-economic crisis in the former Soviet Union.