Severi Ettore, Maguire Helen, Ihekweazu Chikwe, Bickler Graham, Abubakar Ibrahim
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, 17183, Sweden.
Health Protection Agency (HPA), London, SW1W 9SZ, UK.
BMC Infect Dis. 2016 Apr 22;16:178. doi: 10.1186/s12879-016-1506-2.
In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry.
We designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry.
We identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively).
Airport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening.
2012年，英国政府宣布将停止在希思罗机场和盖特威克机场对活动性肺结核（TB）进行的新入境者筛查。我们的研究目的是评估筛查的检出率和诊断准确性，并确定入境后有活动性肺结核风险的人群。
我们设计了一项回顾性队列研究，并通过与英国强化结核病监测（ETS）数据（2009年6月至2010年12月）进行概率匹配，将2009年6月至2010年9月期间接受筛查的新入境者进行关联。检出率是指在筛查人群中，机场筛查后三个月内报告给ETS的病例比例。为了评估筛查诊断的准确性，我们评估了敏感性、特异性、阳性预测值和阴性预测值。通过泊松回归，我们确定了入境后结核病诊断风险增加的人群。
我们确定了200199名接受筛查的入境者，其中59人在筛查时有疑似结核病，并在三个月内报告给了ETS（检出率=0.03%）。敏感性为26%；特异性为99.7%；阳性预测值为13.2%；阴性预测值为99.9%。总体而言，ETS报告了350名入境者。来自结核病年发病率高于每10万人口150例的国家的人员以及难民和寻求庇护者入境后结核病诊断风险增加（人群归因风险分别为77%和3%）。
机场筛查的检出率、敏感性和阳性预测值非常低。来自结核病年发病率高于每10万人口150例的国家的新入境者、难民和寻求庇护者应在入境前或入境后筛查中被列为优先对象。
