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Medicine & Healthcare, Wiley-Blackwell

Active TB and Latent TB – should immigrants be screened for both?

Testing of immigrants could reduce TB in Australia, but raises ethical questions.

In a paper published in the August issue of the Australian and New Zealand Journal of Public Health, Justin Denholm and colleagues from the University of Melbourne examined the ethical issues surrounding possible introduction of mandatory screening for latent TB.

“Latent TB does not present an immediate risk to individuals or the community, merely a potential future risk,” Dr Denholm said.

“Therefore any attempt to exclude or defer potential immigrants on the basis of latent infection would be disproportionate and unjustified.

 “After people have been exposed to tuberculosis they may remain in a state known as latent tuberculosis. During this phase they pose no risk of transmitting tuberculosis to others, but may go on to develop active tuberculosis at a later date,” said Dr Denholm.

“Mandatory testing for latent TB poses little risk. However, treatment involves risk of adverse effects depending on the individual circumstance, age and pre-existing medical conditions.

“While testing and medical review could be mandated, a decision to be treated for latent infection should be voluntary, just as is the case for citizens of Australia and New Zealand.

 “Another issue to consider is whether screening should be applied to all potential immigrants, or limited to groups from high-prevalence countries.

“Such limitations could be discriminatory, but could also be argued as justifiable.

“Further ethical questions include the accuracy of testing and the monitoring and evaluation of any screening program.”