In the UK, clinical management of TB is generally conducted according to NICE guidelines [external link] by secondary care specialist teams, which may be based in dedicated TB services or in general respiratory disease services depending on local arrangements. These teams consist of physicians, nurses and social outreach workers with expertise in the treatment of TB. Any patients with suspected TB should be referred to your local team for diagnosis.
Pre-entry TB screening
In 2012 the UK Government announced a new pre-entry screening programme for TB. Following a pilot scheme, pre-entry screening is currently being introduced in countries with a high incidence of TB for migrants applying for a UK visa for over 6 months. The screening includes a chest x-ray and symptom assessment and can include a sputum examination. Individuals who are found to have active TB of the lungs must complete treatment before their visa is granted. Children under 11 years old do not undergo chest x-ray screening unless a clinician deems it necessary, but a medical questionnaire must be completed by their parent(s)/guardian(s). Further details on exemptions are available from the gov.uk website. This programme will replace the chest x-ray TB screening programme at Heathrow and Gatwick airports.
Pre-entry screening does not test for latent tuberculosis infection (LTBI) or for extra-pulmonary disease. Migrants from high incidence countries remain at a higher risk for TB many years after arrival in the UK and extra-pulmonary TB is more common in non-UK born, than UK-born, individuals . It is therefore vital that primary care practitioners remain alert to the signs and symptoms of TB among migrants and offer LTBI screening in accordance with the NICE TB guidelines.
Screening guidelines for new entrants
Any person known to be HIV positive should be referred to HIV services for further risk assessment. If not known to be HIV positive, screening for TB should be arranged according to the NICE guidelines screening for latent tuberculosis in new entrants from a high-incidence country [external link] and in accordance with local service arrangements.
Anyone who has TB diagnosed should also be offered HIV testing [external link].
Treatment of active disease in the UK is done according to NICE guidelines [external link] by secondary care specialist teams. It involves a combination of antibiotics for a minimum of six months with monitoring of treatment by the specialist team. Completion of treatment is vitally important to ensure that the patient is cured and to prevent the development of antibiotic resistance. Treatment of latent disease may be for three to six months depending on the antibiotic regimen used.
Advice for secondary care specialist teams about treatment of Multi Drug Resistant TB (MDR-TB) is available from the MDR-TB Clinical Advice Service [external link].
The role of the primary care practitioner in the treatment of TB is to:
The most important aspects of preventing and controlling TB in the population are prompt recognition of cases and adequate treatment, followed by investigation of the contacts of cases. TB is a notifiable disease and when cases are identified contacts will be traced, screened and treated as appropriate. Who does this will vary depending on local circumstances but contact tracing is usually carried out by local TB services. Where clusters or outbreaks are identified the local health protection team will become involved in investigation and control. Screening of at risk groups such as new entrants is the third element of prevention and control of TB, and BCG vaccination is the fourth.
The role of the primary care practitioner in the prevention and control of TB is to:
Tuberculosis is a notifiable disease in the UK. If a case is diagnosed it should be notified to your local Health Protection Team.
For further information on treatment and prevention please see the NICE guidelines [external link].
Patient UK tuberculosis clinical information leaflets [external link] developed by TB Alert in partnership with the North West London TB Network to provide a useful overview of key issues in tuberculosis. They support the advice given to TB patients by TB nurses and other health care specialists.
The Truth About TB website from TB Alert [external link]
TB, BCG vaccine and your baby [external link] (Department of Health information leaflet). Available in English, Arabic, Polish, Latvian, Punjabi, Bengali, Estonian, Lithuanian, Turkish, Chinese, Gujarati, Urdu and Portuguese.
TB information cards for patients [external link] to provide information on the tests that will be conducted in TB clinics. Available in English, Bengali, Farsi, French, Gujarati, Hindi, Polish, Punjabi, Somali, Tamil, Turkish, Urdu.
Tuberculosis - the disease, its treatment and prevention [external link] (Department of Health information leaflet). Available in English, Albanian, Bengali, Chinese, Farsi, French, Greek, Gujarati, Italian, Kurdish, Pashto, Polish, Portuguese, Punjabi, Romanian, Somali, Spanish, Tamil, Turkish, Urdu, and Vietnamese.
TB Alert clinical information leaflets [external link] available in English, Albanian, Bengali, Chinese, Farsi, French, Greek, Gujarati, Italian, Pashto, Polish, Portuguese, Punjabi, Romanian, Somali, Sorani, Spanish, Tamil, Turkish, Urdu, Vietnamese
TB in primary care [external link] training video from HPA migrant health event 12 November 2012
BCG Atlas [external link] a database of global BCG Policies and Practices produced by McGill University and the Public Health Agency of Canada.
National Knowledge Service - TB [external link] a collaborative project, co-ordinated by the HPA working with the NHS and various voluntary organisations which brings together sources of information and knowledge on tuberculosis for healthcare professionals and patients.
TB Alert [external link] TB Alert is the UK's national tuberculosis charity, working to address tuberculosis both in the UK and overseas.
NaTHNaC TB factsheet for health professionals [external link]
Tuberculosis case management and cohort review [external link] - guidance for health professionals published by the Royal College of Nursing
Identifying and managing tuberculosis among hard-to-reach groups [external link] - NICE guidance issued March 2012
MDR-TB Clinical Advice Service [external link]