Ethical evaluation of immigration screening policy for latent tuberculosis infection

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 325 © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia After individuals have been exposed to tuberculosis (TB), tubercle bacilli may cause disease or remain quiescent but viable for many decades; this latter state is known as latent tuberculosis infection (LTBI). During this phase, individuals are asymptomatic and pose no risk of transmitting tuberculosis to others. While some infected people will never progress, a proportion will later go on to develop active tuberculosis disease, with resultant risk of morbidity and mortality as well as the possibility of transmission of infection to others. Preventative therapy is available, and may be given to eradicate LTBI and prevent future active disease. In low prevalence countries such as Australia and New Zealand (NZ), the considerable majority of new diagnoses of active tuberculosis (approximately 1,5001,600 a year) arise from reactivation of previously latent infection in those born in high-prevalence regions. The potential therefore exists to reduce tuberculosis incidence through new public health policy aimed at the detection and treatment of LTBI in immigrants, thereby preventing reactivation. Recently, there has been increasing interest in expanding immigration screening for TB in such ways. Expanded screening programs Ethical evaluation of immigration screening policy for latent tuberculosis infection