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Tuberculosis (TB) screening and early detection methods, for professionals working with at-risk populations in the UK.

Tuberculosis (TB)Ìýis an infectious disease which can have a slow onset of symptoms and cause poor outcomes for individuals if left untreated. Despite almost all forms ofÌýTBÌýbeing curable, difficulties in detectingÌýTBÌýmake screening forÌýTBÌýan important action in the UK. Globally, the estimated that 10.7 million people fell ill with TB in 2024 withÌý 1.23 million deaths globally, the top cause of death by an infectious disease.

Screening a population forÌýTBÌýinvolves identifying otherwise healthy people who are at an increased risk of developingÌýTB. TheÌýÌýthat people who are at increased risk ofÌýTBÌýare screened in the UK.

Screening forÌýTBÌýcan focus on detecting activeÌýTBÌýdisease and latentÌýTBÌýinfection (LTBI). People withÌýLTBIÌýhave no symptoms of disease but are at risk of their latent infection activating into activeÌýTB »å¾±²õ±ð²¹²õ±ð.ÌýLTBIÌýcan be detected using tuberculin skin tests (TST) or interferon gamma release assays blood test (IGRA). Screening for activeÌýTBÌýdisease of the lungs usually involves a symptom check and chest X-rays.

The incidence ofÌýTBÌýin England isÌýhigher than most other Western European countries. It is important that awareness is raised aboutÌýTBÌýamongst professionals and the public. TheÌýTuberculosis (TB) Action Plan for England, 2021 to 2026Ìýrecognises that screening for latent and active forms ofÌýTB, alongside awareness raising activities will contribute to lowering the incidence ofÌýTBÌýin England.

TBÌýactive case finding

Active case finding (ACF) is a strategy used to identify and treat people withÌýTBÌýwho would otherwise not seek prompt medical careÌý.ÌýACFÌýusually focuses on detecting pulmonaryÌýTBÌýusing chest X-rays or performing a symptom check.

Abnormal results may lead to the collection of patient sputum for further tests. Early detection ofÌýTBÌýimproves treatment outcomes and prevents the spread of the disease.

In low incidence countries,ÌýACFÌýis most commonly targeted at high-risk groupsÌý;Ìý. In the UK,ÌýACFÌýis performed on:

• close contacts of patients withÌýactive TBÌý
• people with social risk factors such as:
  • homeless people
  • people with drug and/or alcohol problems
  • prisoners
• migrants from countries whereÌýTBÌýis common
• professionals at risk ofÌýTBÌý(for example healthcare workers)

In some groups, especially the homeless,Ìýmobile digital x-ray units are sometimes used forÌýACF. This can offer enhanced services including detection, diagnosis and care as well as screening for other relevant conditions.

TBÌýawareness raising

Raising awareness makes healthcare professionals and members of the public more alert of the risk and the various clinical manifestations ofÌýTB. This is important because:

• TBÌýÌýcan be vague
• TBÌýcan occur in many different sites in the body
• The onset ofÌýTBÌýcan be slow and is not always clear

Maintaining increased awareness ofÌýTBÌýcan be done through activities such as:

• Community group outreach events
• Training sessions
• Production and promotion of information and educational materials in various formats and languages

See below for further information:

• Ìýand with educational material onÌýTBÌý(available in different languages)
• and information for those affected byÌýTB
• for professionals working with the general population andÌýhigh-risk groups
• international awareness raising forÌý (24th March)

Educational materials should be in a format and language that target groups can understand. In the UK, several organisations are involved with awareness raising activities includingÌý.

LatentÌýTBÌýinfection (LTBI)

People withÌýLTBIÌýare asymptomatic and well but can become unwell as a result of reactivation of the latent TB infection. This can occur months, years or even decades after initial infection. It is likely thatÌýLTBIÌýreactivation causes most of the active cases in the UK.

Individuals who were born or spend considerable time in a country whereÌýTBÌýis very common are more likely to haveÌýLTBI. More information aboutÌýTBÌýin migrants can be found in theÌýTBÌýmigrant health guide.

It is not feasible or cost-effective to screen an entire population forÌýLTBIÌýbutÌýÌýscreening for specific high-risk groups in the UK. These groups include:

• close contacts of patients withÌýTB
• healthcare workers
• immunosuppressed patients (for example those withÌýHIV)
• migrants from countries whereÌýTBÌýis common

TheÌýTuberculosis (TB) Action Plan for England, 2021 to 2026Ìýrecommends systematicÌýLTBIÌýtesting and treatment for 16 to 35 year olds who recently arrived in the UK from high incidence countries as a key strategy.

Pre-entry TB screening for migrants

The tuberculosis (TB) pre-entry screening programme has been operational in 101 countries since replacing on-entry screening at UK airports in March 2014. The programme screens for active pulmonary TB (infectious form) using chest X-ray (CXR) and symptom review, with sputum testing conducted for individuals whose CXR is considered consistent with TB.

Applicants who apply for a long-term UK visa (6 months or more) and have recently lived in a country with high TB incidence (over 40/100,000), must be screened for pulmonary TB. Visa applications can only be processed once the applicant has been issued with a certificate of clearance to show they’re free from active pulmonary TB. The TBÌýscreening for the UK leaflet explains the processes and requirements for pre-entry screening.

Screening can only be performed by a UK-recognised and quality assured provider. UKHSA works closely with the Home Office to support the development of quality assurance systems to ensure that the pre-entry TB screening programme is ‘fit for purpose’ in providing its stated objectives. The UK tuberculosis technical instructions explain the pre-departure screening programme for applicants to the UK and provide guidance for those who conduct TB screening.

The UK is one of 5 countries (alongside Australia, Canada, New Zealand and USA) that have adopted a pre‑entry TB screening programme.

Pre-entry TB screening contributes to reduction of TB in the UK . However, pre-entry screening can only detect TB among people with active pulmonary disease at the time of screening. Therefore, it is important that migrants arriving in the UK and the professionals working with them are made aware of the issues surrounding TB and opt into latent TB screening if eligible.

For more information view Tuberculosis in England, 2025 report - °Ç¸ç³Ô¹Ï