Active case-finding of tuberculosis in Europe. A TBNET (Tuberculosis Network European Trials Group) survey

¹ NE London TB Network, Homerton University Hospital, London E9 6SR, UK
² Tuberculosis Control, WHO Regional Office for Europe, Scherfigsvei 8, DK-2100 Copenhagen, Denmark
³ WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy
⁴ Division of Clinical Infectious Diseases, Research Center Borstel, Parkallee 35, 23845 Borstel, Germany

^* To whom correspondence should be addressed. E-mail: graham.bothamley{at}homerton.nhs.uk.

	Abstract

Tuberculosis control depends on successful case-finding and treatment of individuals infected with Mycobacterium tuberculosis. Passive case-finding is widely practised: we wanted to ascertain the consensus and possible improvements in active case-finding across Europe.

Recommendations from national guidelines were collected from 50 countries of the WHO-European Region using a standard questionnaire.

Contacts are universally screened for active tuberculosis and latent tuberculosis infection (LTBI). Most countries (>70%) screen those with HIV-infection, prisoners and inpatient contacts. Screening of immigrants is related to their contribution to national rates of tuberculosis. Only 25/50 (50%) advise a request for symptoms in their guidelines. 36/50 (72%) countries recommend sputum examination for those with a persistent cough; 13 countries do not, even if the chest radiograph suggests tuberculosis. Nearly all countries (49/50) use tuberculin skin testing (TST); 27/50 (54%) countries also perform chest radiography irrespective of the TST result. Interpretation of the TST varies widely. All countries use 6–9 months of isoniazid as treatment of LTBI, with an estimated median uptake of 55% (range 5–92.5%).

Symptoms and sputum examination could be used more widely when screening for active tuberculosis. Treatment of LTBI might be better focused by targeted use of interferon- release assays.

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