Hope my last post was helpful.
Hope my last post was helpful
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.
I’m sure most members are now aware of the continuing importance of TB ( “ every Filipino’s business " – (http://www.gmanetwork.com/news/story...ino-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.
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
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.Originally Posted by CBM
I only hope that my posts " interpret " all the recent publications on TB as clearly as possible !
They do indeed; thank you Alan. As a parent of half Filipino children I am getting quite worried whenever they cough!
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/si...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/co...?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.
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/...-than-science/
Where does a child under 11 complete there health questionaire?
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/si...tb-philippines
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.
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 Ύ - 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? 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 %.
Its 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 thats 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/la...998-3/fulltext
https://www.gov.uk/government/upload...4_0_300914.pdf
https://www.gov.uk/government/upload...eport_2013.pdf
Interesting statistics Alan, thanks
If you want your dreams to come true ...... first you have to wake up
Interesting statistics Alan, thanks
Thanks in turn for your response
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
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.
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
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