Current guide lines, in press, for screening of immigrants advises that those coming from a country where case rates exceed 40/100,000 p.a. should be screened (Control and prevention of tuberculosis in the UK: code of practice 2000). Screening takes the form of a Heaf test for all arrivals and a Chest x-ray for those with a grade IV result. Children with a negative result and no evidence of previous BCG are given the vaccine. The recent influx of immigrants and political asylum seekers to the UK and their dispersion to provincial cities has considerably increased the workload of those involved in the screening process. In the full year 1999 fewer than 200 immigrants and asylum seekers were screened for tuberculosis, in the city of Liverpool, of whom one was found to have active tuberculosis and 11 put on preventive therapy. The majority of these individuals were from Kosova. In the first six months of 2000 a total of 1,370 individuals have been screened with the majority coming from the Russian Republic, Afghanistan and Eastern Europe. A further one case of active tuberculosis has been identified and 20 more individuals put on preventive therapy. No extra resources have been provided at governmental or local level for carrying out the considerable increase in workload. All immigrants require 2 home visits, first to perform the Heaf test and a second for the reading. Those with a grade IV Heaf must then be seen at the Chest Clinic for interview and Chest X-ray. Those who default require a further home visit to ensure that proper screening is carried out. It is important that sufficient resources are provided for effective screening of immigrants and asylum seekers, as the routine tuberculosis control services are becoming dangerously overstretched.

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