Background: Over 50% of cases of tuberculosis (TB) in the UK occur in people born overseas, and new entrants to the country are screened for TB. We sought to determine the prevalence and disease characteristics of pulmonary TB in new entrants to the UK seeking political asylum Methods: We performed a retrospective analysis of the results of screening 53,911 political asylum seekers (PAs) arriving at Heathrow Airport, London between 1995 and 1999 by studying Airport Health Control Unit (HCU) records and hospital medical records. Outcome measures were chest radiograph (CXR) abnormalities, sputum smear, culture and drug resistance data for Mycobacterium tuberculosis. Results: Of the 53,911 PAs seen at Heathrow Airport HCU, 41,470 had screening CXRs performed of which 564 were considered to be suggestive of pulmonary TB. 256 of these patients were referred immediately to hospital for further investigation, with the remainder being followed up in their region of destination within the UK. Following hospital investigations, 100 of the 256 referred were found to have active disease, equating to an overall prevalence of active TB in PAs of 241 per 100,000. There were large variations in disease prevalence between PAs from different regions, with low rates (per 100,000) from Eastern Europe (187), the Balkans (174) and the Middle East (32). The highest prevalence rates per 100,000 were in PAs from the Indian Subcontintent and sub-Saharan Africa (Somalia - 1,047, Central Africa - 565, India - 472, Afghanistan - 355). Home Office data corresponding to our study period recorded 152,120 persons claiming political asylum in the UK. We used the prevalence in each region of our screened population, extrapolated to all PAs in the UK as a whole, to estimate that 406 PAs with active pulmonary disease would have entered the country during the four year period, of whom 99 would have smear-positive disease.The frequency of drug resistance was high (22.6% of culture positive cases were isoniazid resistant, and 7.5% were multi-drug resistant TB - resistant to both isoniazid and rifampicin). Conclusions: The prevalence rate of TB in PAs entering the UK through Heathrow Airport is 22 times higher man the incidence rate in the UK. The true burden of TB among PAs is almost certainly higher, as non-respiratory TB is not detected by CXR, and because follow-up information was only available for 256 of the 564 cases identified by CXR abnormalities. Far more isolates of Mycobacterium Tuberculosis from PAs are drug resistant compared to the UK population. Transmission of TB is by prolonged close contact and PAs with TB pose a risk primarily to other asylum seekers and those in the new entrant community. When considered with the significantly higher risk of drug resistant disease in PAs with TB, this underlines the importance of primary screening in this setting in order to ensure that PAs receive appropriate treatment and that others in the immigrant community are protected.

[No Keywords available]

[No Keywords available]