TB - curable but a long way to go.

[Doc Alan]

There are still about 9 million new cases, and nearly 2 million deaths, from tuberculosis in the world. It's estimated that 75 filipinos die every day from TB, and only 3/4 cases are detected, but up to 4/5 of those are cured. Many provinces are below target because people with TB still don't seek treatment (through ignorance, shame, or poverty). If they can afford "over-the-counter" drugs, and self-medicate, this can lead to multi-drug resistance. There is a National TB Control Programme, but better collaboration with the private sector is needed.

TB is a continuing problem in the UK ! While 3/4 are seen in people born abroad, it's the conditions they live in here that may allow TB to become active years afterwards. Homeless drug users, alcoholics, and people with HIV/AIDS are also at high risk. There are over 9000 cases, and 300 deaths each year. London has the highest TB rate of any major city in Western Europe and all newborns are to be vaccinated with BCG, with screening for patients registering with GPs. Other "hotspots" for TB are Birmingham, Leeds, and Leicester. There's a risk of under diagnosis because patients ( and doctors ) are not always aware that cases are once again increasing in the UK.

TB mainly affects the lungs. Typical symptoms are:
* weight loss
* persistent cough
* night sweats
With most people infected with the TB "bug", their immune system kills it. In some the immune system manages to build a barrier round the infection ("latent" TB). Latent TB can become "active" TB ( sometimes taking years ), or it may be active from the start. Treatment needs 6 months of the right antibiotics, usually resulting in cure. Drug resistance is also a problem in the UK.
BCG vaccine protects in less than 8/10, but it's now only routinely given to babies at higher than normal risk, health workers, and children ( under 16 ) arriving in the UK from countries such as the Philippines with high levels of TB. Many adults in the UK will already have had BCG.

Members need to know that TB is still around. You should all be registered with a GP ( don't wait until you're ill ). If you have "typical" symptoms, ask your GP. A chest X Ray is just one test which can help diagnose or rule it out :xxgrinning--00xx3:

[Dedworth]

It woulkd appear that our inadequate screening procedures aren't picking up this

While very few immigrants have active TB on arrival, many of them are carriers of the latent disease, which often progresses to active TB within a few years of their arrival in Britain.

http://uk.reuters.com/article/2011/04/21/uk-tuberculosis-screening-idUKTRE73K6P420110421

I'd hazard a guess that many of the so called "asylum seekers" arriving illegally in the back of trucks etc are bringing this disease into the UK

[Doc Alan]

I'd hazard a guess that many of the so called "asylum seekers" arriving illegally in the back of trucks etc are bringing this disease into the UK
That is an informed guess which is very likely to be true. These are the very people who will not register with a GP, have a medical examination including chest X Ray, and agree to BCG vaccination. Even if they should be diagnosed and treated, they're likely to default on the full 6 months required, leading to the increasing problem of multi-drug resistant TB in the UK.
50 years ago there were around 50,000 new cases of TB in the UK. It's a bacterial infection spread by coughs and sneezes from an infected person. It can take many months or years before symptoms appear, and it need not be confined to the lungs. My father, a GP, acquired it from a patient, eventually recovering after weeks in a hospital for infectious diseases. It's the Dickensian image of TB - "consumption" - belonging to the 19th century, which needs to change. The infection is a major public health problem of THIS century.

[Rosie1958]

................ It's the Dickensian image of TB - "consumption" - belonging to the 19th century, which needs to change. The infection is a major public health problem of THIS century.

Thanks Doc Alan for an interesting post, I certainly wasn’t aware that TB is increasing here in the UK today. My own 2 x great grandmother died of "consumption" aged 29 in 1867 and as a result of her death, my great grandfather who was only 4 years old was brought up by my 3 x great grandparents. I had a TB inoculation when I was at school many moons ago and still have the scar to prove it. This awful disease has been about far too long.

[Doc Alan]

I had a TB inoculation when I was at school many moons ago and still have the scar to prove it.
Most of us in the UK will have had BCG ( Bacille Calmette-Guerin) vaccination around the age of 13. It was national policy between 1953 - 2005. In the Philippines the current policy is for BCG vaccination of infants. Immunity is normally thought to last for about 15 years, although it may be lifelong. It's best given while young, not being as effective in adults.
The Mantoux skin test ( to tuberculin protein) should be positive in immune people, and a "booster" dose of BCG is not necessary - only one dose is ever needed. New immigrants under the age of 16 from the Philippines should have BCG, if they have not previously been immunised. Unfortunately it's illegal immigrants from countries where TB is even commoner who are likely to be a source for TB ( and who should have BCG even if over 16) :NoNo:.
Most of us are still NOT at risk of TB, whether or not we're still immune :xxgrinning--00xx3: Those at increased risk include : HIV/AIDS, alcoholics, drug addicts, poorly controlled diabetics, and people on steroids / immunosuppression. ( 50 years ago my father acquired it from a patient through being overworked, underweight, and - it has to be said - he had lung disease already from smoking ).

[Rosie1958]

Most of us in the UK will have had BCG ( Bacille Calmette-Guerin) vaccination around the age of 13. It was national policy between 1953 - 2005. The Mantoux skin test ( to tuberculin protein) should be positive in immune people, and a "booster" dose of BCG is not necessary - only one dose is ever needed.......

I remember having the skin test t school which consisted of several “pin pricks” and how some silly boys were trying to prick their skin daily to avoid having to have the inoculation. :doh Of course it didn’t work and they had to have the injection anyway!

One of the first tests that my brother had on admittance to hospital last year was for TB but I knew that he had already had the BCG vaccine when he was a young teenager so there was already a strong possibility that he didn’t have it. However, since he was in contact with numerous people in different continents and particularly India, it couldn't be ruled out until tested. :NoNo:

[grahamw48]

My mother developed TB (lungs) when we were living in Malaya in the 1950s.

She spent many months in hospital, both out there and back in an isolation hospital in Leeds upon our return.

My brother, sister and I (aged 5, 6 and 7 years) probably didn't see her for 6 months or more, and my mother was also pregnant with my youngest sister throughout her illness, so she was a pretty tough lady. She is now a fit and healthy 84 year-old.

Because dad was away in the Navy, my brother and I had to live with his (dad's) parents for 7 months, and my sister went to live with my mother's parents.

Naturally we were given BCGs and checked on a few occasions for signs of infection. No problems there, but around that time my sister became so ill with Measles that she was close to death.

We should all be thankful for the advances in medicine during the past 50 years, and the fact that we live in a country with such a fantastic National Health Service. :)

[joebloggs]

British tuberculosis screening for new immigrants fails to detect most imported cases of latent disease and screening should be widened to include more people from the Indian subcontinent,

Britain has recently been dubbed "the tuberculosis (TB) capital of Europe" and is the only country in Western Europe with rising rates of disease.

Current British border policies require immigrants from countries with a TB incidence higher than 40 per 100,000 people to have a chest X-ray on arrival to check for active TB.

http://www.reuters.com/article/2011/04/21/us-immigrants-tb-idUSTRE73K78B20110421

[Dedworth]

Joe I posted similar a few days ago here

http://filipinaroses.com/showthread.php/31919-TB-curable-but-a-long-way-to-go.?p=295820&highlight=#post295820

"It would appear that our inadequate screening procedures aren't picking up this

While very few immigrants have active TB on arrival, many of them are carriers of the latent disease, which often progresses to active TB within a few years of their arrival in Britain.

http://uk.reuters.com/article/2011/0...73K6P420110421

I'd hazard a guess that many of the so called "asylum seekers" arriving illegally in the back of trucks etc are bringing this disease into the UK"

[joebloggs]

:yikes: double posting :doh

sorry dedworth, yes i saw your post to :cwm24:

[Dedworth]

Great anti uncontrolled immigration minds think alike Joe :D

[Doc Alan]

:yikes: double posting :doh

sorry dedworth, yes i saw your post to :cwm24:
I started it :doh. Can't you merge the two threads ?
I don't mind, but my thread took several hours to prepare ! It's vital to get the facts right for members. As always, I try to give the situation in the Philippines as well as the UK. It also gives some insight into why chest X rays may be helpful.
Both the Philippines and the UK have a long way to go before TB is eradicated. It's among the top causes of disease and death in the Philippines, and the UK is unprepared for the recent increase in cases. Multidrug resistance is a major worry. The other worry is that many people here think it's no longer relevant whereas in fact it's a global public health problem killing nearly 2 million a year.

[grahamw48]

They appear to be spending more money on X-raying trucks for contraband than they are on the detection of diseased people. :NoNo:

[joebloggs]

:icon_lol: it's all about the pera :REGamblMoney01HL1:, and I'm sure the Phils is on the list of 67 countries.

Foreign travellers coming to the UK from countries with a high incidence of tuberculosis will have to be screened for the potentially fatal infection before being granted a visa under new rules, the Immigration Minister said today.

Damian Green said the scheme for migrants coming from countries including China, India, Morocco, Nepal, and South Africa, will help save lives and will also save more than £40 million over 10 years.

TB is at its highest level in the UK for more than 30 years, with 9,000 new cases last year alone, up 5% from 2010, he added.

Under the new visa rules, which will be brought in in three stages over 18 months, infectious TB sufferers and those diagnosed with active TB will be denied entry to the UK.

The pre-entry screening will replace screening at UK airports after a pilot scheme in 15 countries found 300 active cases among 400,000 migrants.

Mr Green said: "Tuberculosis is currently at its highest level in the UK for 30 years and it's essential that we take action to tackle its continued rise.

"Pre-entry screening, followed by treatment where necessary, will help to prevent the risk of TB in the UK and will also save lives."

He added: "Removing screening facilities at airports will save the taxpayer £25 million over 10 years and further NHS savings will be made by preventing the importation and spread of TB in the UK."

TB kills 1.8 million people worldwide each year.

Under the scheme, all migrants coming to the UK for more than six months from 67 countries identified as having a high incidence of TB by the World Health Organisation will need to be screened for the airborne infection before being granted a visa.

The costs of screening and subsequent treatment will be met by those people applying to come into the UK, the Home Office said

http://www.thisislondon.co.uk/news/uk/migrants-from-countries-with-high-risk-of-tuberculosis-to-be-screened-7770632.html

[lastlid]

I see.

[Doc Alan]

What a shame my thread on tuberculosis - prepared less than a year ago - was closed. If it had been made " sticky " members would be aware of the facts about TB both in UK and Philippines.
http://filipinaroses.com/showthread.php/31919-TB-curable-but-a-long-way-to-go.

[joebloggs]

What a shame my thread on tuberculosis - prepared less than a year ago - was closed. If it had been made " sticky " members would be aware of the facts about TB both in UK and Philippines.
http://filipinaroses.com/showthread.php/31919-TB-curable-but-a-long-way-to-go.

with the changes going on i've made it a sticky and opened it again Doc Alan :xxgrinning--00xx3:

[Doc Alan]

with the changes going on i've made it a sticky and opened it again Doc Alan :xxgrinning--00xx3:
Thanks Joe :xxgrinning--00xx3:

[joebloggs]

its had more than 4,000 views so its an important topic DocAlan, even more so, as soon you could be refused a visa if you have active TB .

[Doc Alan]

TB screening
The new measures announced by the UK Home Office – to replace airport-based screening ( where it exists ) with a pre – entry screening programme – WILL apply to the Philippines. This means migrants wanting to enter the UK for more than 6 months will need to be screened before they are granted a visa. The UK government claims this will save the taxpayer, by not screening here and also requiring treatment – if needed - in the country of origin.
Pre – entry screening usually applies to active lung TB, since it poses the greatest risk of infecting others. It’s already been piloted in several countries ( not the Philippines ). The intention is to “ roll out “ screening to countries such as the Philippines over the next 18 months. Public health action at airports to protect against people with infectious TB will remain.
Screening for TB may include – in addition to a chest X Ray – a Mantoux skin test, a blood test ( IGRA or interferon gamma release assay ), sputum ( spit ) sample if you have a cough, and other clinical tests depending on symptoms. A new test ( Xpert MTB/RIF ) shows promise. The cost - effectively added to that of the visa – will depend on where, and what, tests are available and treatment needed.
TB – as this thread has shown – is still a major global public health problem. Drug resistance – and its diagnosis - is a challenge. The wrong ( inappropriate ) treatment aggravates this. The right combined drugs are needed for 6 months or more. New drugs are in the pipeline ( bedaquiline and delamanid ). Work is progressing with vaccine research. Early detection is vital – although it’s been reported that over half with TB may not have a chronic cough, and up to a quarter have no symptoms. People with HIV, children and women ( especially pregnant ) tend to have less “ classic “ symptoms of TB.
Despite all this, the actual chances of an intending migrant ( partner, fiancée or spouse ) forum member having TB are slight. Those at risk are people with HIV/AIDS, homeless, slum dwellers, refugees, illegal migrants, alcoholics, people who misuse substances, prisoners, miners, people on immunosuppressives, those with cancer and malnutrition, and health workers ( who are aware of the risk ).


http://www.homeoffice.gov.uk/media-centre/press-releases/screening-tuberculosis-UK
http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120522TBscreening/
http://www.ukba.homeoffice.gov.uk/sitecontent/newsarticles/2012/may/42-tb-test

[CBM]

An English friend of mine, a long term resident of the Philippines, has just been diagnosed with TB. He does not fit into any of the classic high risk categories. He is in the age group where he would have had a BCG as a child.

The risk looks pretty real to me - and "common sense" would suggest taking the test.

[Doc Alan]

Unfortunately BCG only gives up to 80% protection against TB, and the chances of being in close contact with someone who has TB are greater in the Philippines than UK. BCG is normally only given once and immunity should last at least 15 years. TB is most commonly passed on through coughing or sneezing. It is, however, a “ classic “ disease where the risk of acquiring it is much reduced if general health is good. That’s why the categories I have listed are at greatest risk. More general risk factors include “ non-communicable diseases “ like smoking-related and occupational lung disease and diet-related diabetes.
There should be no stigma or shame attached to a diagnosis of TB. “CBM “ - your English friend may indeed have had no risk factors apart from close contact with someone having active TB. My father ( a GP ) acquired TB by this route.
Clinical diagnosis of TB does not just rely on one test. Interpretation of a Mantoux test is not necessarily straightforward. If it’s positive it can mean past BCG vaccination, natural acquired immunity to TB, or current TB. Negative could mean no previous BCG or natural exposure, or current active TB to which the body is not responding. Mantoux status should be considered as part of a general health check up for anyone thinking of a long stay or living in the Philippines. Parents of young people embarking on travel to countries with high incidence of TB may not realise that routine BCG vaccination is no longer given at schools.
If TB is diagnosed it is worth repeating that correct treatment - with the right drugs obtained from a trustworthy source and taken for the full course - is vital ! Inappropriate treatment is increasing drug resistance – development of total drug resistance is a constant threat. This is not a topic to be taken lightly.

[CBM]

Thank you; I certainly had not "taken on board" the point that my children, who are half Filipino and who sometimes visit, will not have had the BCG vaccination.

[Doc Alan]

BCG is not now routinely given as part of the childhood vaccination schedule in the UK, unless a baby is thought to be at higher than usual risk of coming into contact with TB ( such as inner city London and other cities ). Similarly vaccination may be recommended for health workers or children who have recently come to the UK from countries with high levels of TB. Routine vaccination of schoolchildren in the UK was discontinued in 2005.
There IS a standard routine immunization schedule for infants in the Philippines, to be given by their first birthdays. This includes DPT ( Diphtheria-Pertussis-Tetanus ), oral polio vaccine, hepatitis B vaccine and measles vaccine - in addition to BCG. However, not all children have had BCG ( no scar present ) and, in any case, it only protects against TB in 8 out of 10 cases

[Steve.r]

Our little bundle of joy had his BCG quite soon after he was born. When we were talking to the doctor she told us that her daughter had been given the BCG also, but because she was a girl, who would in the future want to wear strapless tops, injected her in her buttock. She asked s if we wanted our Vincent injected there too, so we said yes. Luckily, he never reacted and there is no visable scar.
I don't know if this is you don't see so many Filipinos with scars Alan :Erm: or of course, it could be they never got the innoculation.

[gWaPito]

There are still about 9 million new cases, and nearly 2 million deaths, from tuberculosis in the world. It's estimated that 75 filipinos die every day from TB, and only 3/4 cases are detected, but up to 4/5 of those are cured. Many provinces are below target because people with TB still don't seek treatment (through ignorance, shame, or poverty). If they can afford "over-the-counter" drugs, and self-medicate, this can lead to multi-drug resistance. There is a National TB Control Programme, but better collaboration with the private sector is needed.

TB is a continuing problem in the UK ! While 3/4 are seen in people born abroad, it's the conditions they live in here that may allow TB to become active years afterwards. Homeless drug users, alcoholics, and people with HIV/AIDS are also at high risk. There are over 9000 cases, and 300 deaths each year. London has the highest TB rate of any major city in Western Europe and all newborns are to be vaccinated with BCG, with screening for patients registering with GPs. Other "hotspots" for TB are Birmingham, Leeds, and Leicester. There's a risk of under diagnosis because patients ( and doctors ) are not always aware that cases are once again increasing in the UK.

TB mainly affects the lungs. Typical symptoms are:
* weight loss
* persistent cough
* night sweats
With most people infected with the TB "bug", their immune system kills it. In some the immune system manages to build a barrier round the infection ("latent" TB). Latent TB can become "active" TB ( sometimes taking years ), or it may be active from the start. Treatment needs 6 months of the right antibiotics, usually resulting in cure. Drug resistance is also a problem in the UK.
BCG vaccine protects in less than 8/10, but it's now only routinely given to babies at higher than normal risk, health workers, and children ( under 16 ) arriving in the UK from countries such as the Philippines with high levels of TB. Many adults in the UK will already have had BCG.

Members need to know that TB is still around. You should all be registered with a GP ( don't wait until you're ill ). If you have "typical" symptoms, ask your GP. A chest X Ray is just one test which can help diagnose or rule it out :xxgrinning--00xx3:

Nice one Alan :xxgrinning--00xx3:....as you know, we just had a baby in May..he was born at home..our first was born in hospital....both, due to my wife's ethnicity were given TB injections.

How fortunate are we living here in the UK....many take so much for granted, health care being one of them.

[Doc Alan]

Thanks Steve.r and Gwapito for your support and interesting comments :xxgrinning--00xx3:. I don't know how frequently BCG vaccination is NOT given in the upper arm. It’s the normal site in both UK and Philippines. The only study I’m aware of from the Philippines was 15 years ago, where BCG scars were found in 2/3 of the childhood population, but they only examined the upper arms. ( http://www.psmid.org.ph/vol29/vol29num2topic5.pdf ). I’m sure the proportion having had BCG in the Philippines is now higher. My caution remains – there’s a chance they haven’t been vaccinated in the Philippines, and a much higher chance for this situation in the UK.

[-sillybilly-]

This is one issues that worries me so much. We are bringing our kids over in the UK soon but our daughter has had a Primary Complex when she was about 2 years old and i guess she had it from a second hand smoke?
I thought she has been treated but when i came back to Philippines she wasnt developing. I mean she was underweight, pale and coughing all the time specially at night. So i thought i' d take her to the doctor. She had chest xray done and yes i was right her TB was still there and she has to take these medications for about 6 to 8 months, get her xrayed again after, carried on with the medications for 3 months. And the doctor told me that even if she gets treated from her Primary Complex the scar is gonna stay in her lungs for God knows how long.
So when she comes over here would she need to show and an xray film and whats gonna happen after?

[grahamw48]

A friend of mine had Xrays as part of a medical for employment....at age 50+.

He was told that there were old TB scars on his lungs. He'd never been aware of having had TB in the past. :cwm24:

My stepdaughter, when I first met her aged around 2 years had a cough and was diagnosed with 'mild' TB.

I therefore paid for a course of treatment (antibiotics ?) which was for 6 months.

It cleared up, and she's enjoyed perfect health since then, even winning the sprint races at school sports days here. :)

[Doc Alan]

Here are the facts to the best of my knowledge :-

• A TB Primary Complex is the result,within 5 years, of primary ( first time ) infection with TB, typically in a child who has not had BCG vaccination. It’s caused by inhaling the TB “ bugs “ from someone ( adult ) coughing who has “ open “ TB, not by second hand smoke. There may be no symptoms ( clinically “ silent “ ), vague illness with cough or wheeze, or occasionally the infection may spread within the lungs. The Complex is a small area of lung and local lymph node scarring – which can be seen on X Ray because it’s calcified. The scarring does remain for ever, but if the TB has been adequately treated then it’s only a marker of past infection. TB is curable in most cases – with correct antibiotic treatment.
• “ Post-primary “ or “ secondary “ TB may be due to “ reactivation “ of pre-existing infection, or more commonly reinfection. The second “ dose “ of TB causes a different reaction and it depends on the patient’s general health. It may heal by more scarring if immunity is good, and with the right treatment.
• We’ve known for a long time that individuals vary in their resistance to TB – with or without BCG vaccination. Good general health protects. “ Non-communicable diseases “ such as smoking-related lung disease, diet-related diabetes, alcohol and drug abuse affect vulnerability – to which we now know HIV infection can be added.
The following are my opinion, again to the best of my knowledge :-
• Hopefully SillyBilly’s daughter will be cured of TB when she has completed her treatment. Just like any future migrant from Philippines if/when the “ pre-entry TB screening programme “ takes effect – she will need her X Rays and medical history ( the antibiotics taken ) when she comes to the UK.
• Graham’s friend with old TB scars is one of many who has had primary TB in childhood with no symptoms. He may not have had BCG if his skin test ( previously Heaf, now Mantoux ) showed “ natural immunity “.
• Graham’s stepdaughter must have been treated with the correct antibiotics and – since her general health is good – she’s effectively cured.

[Doc Alan]

Hope my last post was helpful :xxgrinning--00xx3:.

[CBM]

Very much so. Most of us in Britain have a horror of "TB" - in our childhoods it was a "disease of the slums"- caught by the poorest in society - and there was very definitely a social stigma attached to it as well as the problem of a debilitating and often fatal disease.

In looking at the disease in the Philippines, I have to force myself to be rational about it.

[Doc Alan]

I’m sure most members are now aware of the continuing importance of TB ( “ every Filipino’s business " – (http://www.gmanetwork.com/news/story/228567/news/specialreports/tuberculosis-is-every-filipino-s-business ). If you do want more information, there is a report highlighting TB screening gaps in those most at risk
( File on 4 on BBC Radio 4 on Tuesday, 31 July at 20:00 BST and Sunday 5 August at 17:00 BST; listen again via the Radio 4 website or download the File on 4 podcast ).
The link for this report ( http://www.bbc.co.uk/news/health-18969099
reminds us there were 9000 new cases of TB in the UK last year, 70% in recent migrants from countries where the disease remains prevalent.
It’s stated in that link “ around 80% of active cases of TB are reactivated cases of latent bacteria “. Latent means “ hidden “ , because the TB bug remains within cells, with a defensive barrier ( scar tissue ) round the infection. I have said that people with healed primary TB may reactivate in later life – if the immune system is weakened through ill health, but more commonly they are ( re)infected with a new bug. The exact proportions do vary according to circumstances. It's now thought that about 1 in 10 cases of latent TB will develop active TB at some point. Identifying latent TB - by Mantoux skin test and / or a blood test ( IGRA ) - is recommended by NICE ( National Institute for Health and Clinical Excellence ) for at risk migrant groups. This is not foolproof and, as the report tells us, not even attempted everywhere in the UK.

[CBM]

I just listened to that very sobering BBC Radio 4 "File on 4" documentary.


There#s a link to the "Listen again" facility here:

http://www.bbc.co.uk/programmes/b01l7sq4

[Doc Alan]

I just listened to that very sobering BBC Radio 4 "File on 4" documentary.



Not only sobering but also quite hard to follow. I'm well aware this is not a medical forum, and TB is not an easy condition to explain. It's hard for me to believe that most cases of active TB are reactivation of latent infections, rather than new infections. Identifying latent TB for treatment is definitely one of the challenges in tackling this illness.
I only hope that my posts " interpret " all the recent publications on TB as clearly as possible !

[CBM]

They do indeed; thank you Alan. As a parent of half Filipino children I am getting quite worried whenever they cough!

[Doc Alan]

Tuberculosis testing will form part of the visa application process for people planning to come to the UK from the Philippines for more than six months.
http://www.ukba.homeoffice.gov.uk/sitecontent/newsarticles/2013/february/30-tb-philippines
• The testing must be done at a clinic approved by UKBA.

• All children over 11 years old must be tested. The parent / guardian of children under 11 must complete a health questionnaire; the clinician will decide whether or not to test them, and issue a certificate.


• The test includes a chest x-ray, and possibly sputum ( phlegm ) sample. The fee will be P 3200 ( more for a sputum test ) in addition to the visa application fee.

• X-ray result and certificate should be available in 24 hours. If a sputum test is necessary processing could take up to 2 months ( but should be less if more rapid tests are available – they should be requested !! ).


• No certificate will be issued if TB is diagnosed, until treatment has been completed. This takes 6 months and genuine correct drugs must be taken. Multi-drug resistance and self-medication by over-the-counter fake drugs are recognised problems.

http://www.ukba.homeoffice.gov.uk/countries/philippines/applying/tb-test/?langname=null

• Applicants could save the extra costs of testing and treatment by submitting an online visa application form and paying the fee before 28 February.

• That is not a course which I would recommend.

• As the posts in this thread show, TB is a very serious illness, much commoner in the Philippines than the UK, also – if undiagnosed / inadequately treated - placing contacts at risk from coughing.


• Of course this is also an attempt by the UK Government to transfer costs of screening – and treatment if needed – to those people applying to come to the UK.

• It’s actually unlikely that an applicant in good general health will have TB. But clinical examination and chest x-ray to confirm this – and rule out other conditions which could be treated are surely worthwhile. The cost is a fraction of the visa fee.

• Early diagnosis and treatment always cost less – whatever the illness - in financial and health terms.

[Doc Alan]

This is not an easy topic, but important - not just because pre-entry TB testing is about to start in the Philippines but also to understand the reasoning behind this decision.

• Around 9000 cases of TB are reported each year in the UK ( 14 / 100,000 population ). Most are young adults in cities ( especially London ); from countries with high TB rates ; with one or more “ social risk factors “ ( drugs / alcohol misuse, homelessness, history of imprisonment ). Over half have lung TB ( the type infectious to others ).

• Three quarters of all these cases are non-UK born. Most of these are from South Asia ( especially India and Pakistan ) and sub-Saharan Africa. Unfortunately the Philippines is one of the countries known to have a high incidence of TB ( estimated 300 / 100,000 ) .

• Pre-entry screening allows more extensive / effective testing than an X-ray alone ( as with on-entry screening ) – including sputum sampling and culture – to detect active TB. It’s vital to identify drug-resistant TB and treat accordingly ( possibly for much longer than the usual 6 months ).


• The pre-entry screening programme is being extended to all 67 countries identified as high incidence for TB. It’s not - in my opinion – a cynical way of extracting more money from genuine immigrants and may not in fact save our NHS much, although it should reduce the numbers of TB in this country.


• It doesn’t apply to those making visits of less than 6 months ( they’re less of a risk even if they do have TB ), or EEA nationals ( not in the “ top 67 countries “ for TB incidence ). However, TB is a global public health issue, killing an estimated 1.8 million people worldwide every year. The European region is not exempt, and has a particular problem with drug resistant TB.

• Romania is thought to account for almost a third of all TB cases in this region. Underfunding , drug resistance, and lack of compliance by patients are problems in the region and especially Romania. It’s to be hoped prevention, diagnosis, and the right treatment - together with pre-entry screening - will also eventually apply to this region.



• Finally, while TB is a serious health problem, as I’ve said before, a Filipino ( or any other intending immigrant ) in good general health, previously BCG vaccinated, probably will NOT have active TB. Screening should therefore give reassurance, with relatively little cost or delay, in obtaining a visa.

http://www.who.int/tb/publications/global_report/en/

http://blogs.bmj.com/bmj/2012/10/10/caroline-robinson-curing-tb-in-europe-is-more-about-politics-than-science/

[Speedyman52]

Where does a child under 11 complete there health questionaire?

[Doc Alan]

If you are a parent or guardian of children under 11 years old you must bring your children to the approved clinic and complete a health questionnaire for them. The clinician will then decide, based on your answers, whether your child needs to be tested for tuberculosis. If the clinician decides not to test your child they will give you a certificate to say your child was not tested. This certificate must be submitted with your child's UK visa application.


So far, this is the only clinic approved by the UK Border Agency. They will not accept a tuberculosis test certificate from a clinic they have not approved.
International Organisation for Migration Health Centre,
15th Floor, Units A&B Trafalgar Plaza,
105 H.V. dela Costa Street,
Salcedo Village, Makati City 1227,
Metro Manila.

http://www.ukba.homeoffice.gov.uk/sitecontent/newsarticles/2013/february/30-tb-philippines

[Doc Alan]

By far the commonest way of acquiring TB is by droplet spread in the air from someone with active lung TB.


• Diagnosis of active TB is the reason for pre-entry screening, with treatment of positive cases.


• TB can be passed on from an infected pregnant woman to her child, and rarely acquired from handling infected meat, or from infected birds/fish – there are over 100 different types of TB “ bug “.



• There is a very low risk of TB from “ raw “ milk – depending on the source. This would NOT cause lung TB. It would cause ulcers in the bowel ( and rarely peritonitis ).


• TB can in fact involve almost any organ in the body – with a range of consequences from very serious ( meningitis ) to serious ( kidney / liver infection, infertility ), or relatively trivial ( skin ). Spread to internal organs is by the blood stream. This only occurs if the patient is ill, perhaps not on correct treatment, and - while serious for them - is NOT infectious to others. TB can cause symptoms or be latent ( as described elsewhere in this thread ).


• It’s important for doctors ( and patients ) to remember that TB can be a multisystem disease; but also that it tends only to cause illness in susceptible people – not those whose general health is good.


• Work is progressing on more effective TB vaccines than BCG, which does not give complete immunity.

[Doc Alan]

Last year World Health Organization / WHO estimates 9 million people fell ill – and 1.5 million died – with TB. Numbers ARE slowly declining. There were around 8,000 new cases in the UK ( still high compared to other Western European countries ) and a quarter of a million in the Philippines.


• The UK moved completely to pre-entry screening for TB in 67 high incidence countries about 8 months ago ( testing started in the Philippines on 28 February 2013 ).


• Most – about ¾ - of TB cases in the UK occurred among people born outside this country. It remains concentrated in " deprived " populations ( unemployed, alcohol / drug abuse, homelessness, imprisonment ).


• For non-UK born cases ( around 5,400 ) about a third were from India ; a fifth from Pakistan ; and 2.5 % ( 136 ) from the Philippines. The time between entry to the UK and TB diagnosis was within 5 years in over 2/5 ; for the Philippines the median time was 8 years. Why :doh ? These were either latent TB ( not active or infectious ), or not detected for other reasons on entering the UK. The lifetime risk of people from countries where TB is common ( such as the Philippines ) is higher than average.


• Is screening helpful ? As for any condition, there are advantages ( more chance of successful treatment ) and disadvantages ( cost, possible over-treatment, and worry to the individual and relatives ). We do know of the experience in countries which have pre-entry screening ( North America, Australia and others ).

A study of about 680,000 applicants to UK screened from 2005 – 2013 found 541 cases of TB – less than 0.1 %.


• It’s early days since full pre-entry screening here - but the number of cases detected by such screening is thought to have increased to 130.


• Pre-entry screening is only ONE part of improving TB care and prevention for migrants. Obviously a test result confirming no active TB is not only reassuring, but also essential for long term visa applicants from the Philippines or elsewhere. It may be that an expired negative test certificate is still acceptable for entry to the UK – that’s not within my area of expertise.


• What is vital to know is that latent ( hidden ) TB may " flare up " for some time ( months to years ) AFTER a negative screening result. This should not cause undue worry – but as a minimum, a first priority is to register with a GP in the UK, together with looking after your health. TB is a classic condition where good general health reduces – and poor health increases - the chances of active infection.



http://www.who.int/tb/publications/global_report/en/



http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)70998-3/fulltext


https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/360335/TB_Annual_report__4_0_300914.pdf


https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328468/TB_preentry_screening_brief_report_2013.pdf

[Steve.r]

Interesting statistics Alan, thanks :smile:

[Doc Alan]

Interesting statistics Alan, thanks :smile:


Thanks in turn for your response :xxgrinning--00xx3:


I sincerely hope that as many members as possible read such posts. At least they will then be informed, without necessarily reading all the evidence in the links !


" Flaring up " ( reactivation ) of a previous infection - or ( less commonly ) a completely new infection from someone with active TB - are the alternative ways for getting this serious disease.


As some members may know, my father ( a GP ) was infected by a patient. Anecdotes are one thing - many years diagnosing TB in other patients is another. Both influence my wish to explain it to members as best I can.


May all members and their loved ones have the best possible health :smile:.

[Doc Alan]

TB remains a global health problem. Around a quarter of the world’s population may be infected with the TB " bug " ( Mycobacterium tuberculosis ). Many are " latent " infections - not active disease, although the lifetime risk of progression to active TB may be 5-15%.


Diagnosis of active TB is relatively straightforward, by clinical history, X-ray and sputum testing. The Philippines still has a high incidence of the disease, and screening pre-entry to the UK has been in place for 4 years. An increasing concern is patients with extensive drug resistance, who have a very poor outlook.


Current tests for latent TB ( tuberculin skin test and a blood test ) detect an " immune memory " response to the bug, and they can’t reliably predict disease progression to active TB.


We now recognize there isn’t such a clear division between ACTIVE disease ( with symptoms and infectious ) and LATENT disease ( without symptoms or risk of spreading infection ). It’s probably a spectrum.


Several factors are known to increase the risk of progression. These include young age, low body mass index, diabetes, smoking, and HIV infection. Other, unknown factors, may well lead to activation. We need tests to show persistent infection and incipient / developing TB.



Preventive treatment for individuals with latent TB infection ( with one or two drugs ) is effective - but cost and toxic effects mean those treated do need to be accurately selected.


There is a new skin test - " C-Tb " - which appears promising. It avoids the " false positives " seen in people who have been vaccinated with BCG. The aim of any such test is to identify and treat those people with persistent infection who are otherwise most likely to progress to active disease. C-Tb seems to be an improvement. Searching for test(s) to more accurately diagnose and predict progression from latent to active TB is ongoing.


The aim of screening tests for ALL other conditions is to identify those without symptoms who would benefit from treatment. Tuberculosis ( TB ) is the ONLY disease where screening aims to diagnose active disease. All other screening ( such as for breast, cervical, or bowel cancer ) attempts to diagnose conditions BEFORE signs / symptoms have appeared. People who are ill or have symptoms should of course be diagnosed and treated by a healthcare professional - if possible / affordable.

[Michael Parnham]

Nice article and interesting, I had TB in my left lung when I was 11 years old, was in hospital 2 years bedridden and had to learn to walk again after I was cured, I remember having two Streptomycin injections each day also will never forget Matron Starr who was a true blue Catholic also very very strict a wonderful lady, every Sunday morning she used to have us all singing 'Ava Maria' and we sounded great, even though I was in hospital for two years I enjoyed my time there never to be forgotten, nice memories:xxgrinning--00xx3: