Tuberculosis screening

Tuberculosis (TB) screening and early detection methods, for professionals working with at-risk populations in the UK.

Tuberculosis (TB) is an infectious disease which can have a slow onset of symptoms and cause poor outcomes for individuals if left untreated. Despite almost all forms of TB being curable, difficulties in detecting TB make screening for TB an important action in the UK. Globally, the World Health Organization (WHO) estimated that 10.7 million people fell ill with TB in 2024 with  1.23 million deaths globally, the top cause of death by an infectious disease.

Screening a population for TB involves identifying otherwise healthy people who are at an increased risk of developing TB. The National Institute for Health and Care Excellence (NICE) currently recommends that people who are at increased risk of TB are screened in the UK.

Screening for TB can focus on detecting active TB disease and latent TB infection (LTBI). People with LTBI have no symptoms of disease but are at risk of their latent infection activating into active TB disease. LTBI can be detected using tuberculin skin tests (TST) or interferon gamma release assays blood test (IGRA). Screening for active TB disease of the lungs usually involves a symptom check and chest X-rays.

The incidence of TB in England is higher than most other Western European countries. It is important that awareness is raised about TB amongst professionals and the public. The Tuberculosis (TB) Action Plan for England, 2021 to 2026 recognises that screening for latent and active forms of TB, alongside awareness raising activities will contribute to lowering the incidence of TB in England.

TB active case finding

Active case finding (ACF) is a strategy used to identify and treat people with TB who would otherwise not seek prompt medical care (Golub and others, 2005). ACF usually focuses on detecting pulmonary TB using chest X-rays or performing a symptom check.

Abnormal results may lead to the collection of patient sputum for further tests. Early detection of TB improves treatment outcomes and prevents the spread of the disease.

In low incidence countries, ACF is most commonly targeted at high-risk groups (Zenner and others, 2013); (Pareek and others, 2016). In the UK, ACF is performed on:

• close contacts of patients with active TB 
• people with social risk factors such as:
  • homeless people
  • people with drug and/or alcohol problems
  • prisoners
• migrants from countries where TB is common
• professionals at risk of TB (for example healthcare workers)

In some groups, especially the homeless, mobile digital x-ray units are sometimes used for ACF. This type of service can offer enhanced services including detection, diagnosis and care as well as screening for other relevant conditions.

TB awareness raising

Raising awareness makes healthcare professionals and members of the public more alert of the risk and the various clinical manifestations of TB. This is important because:

• TB symptoms can be vague
• TB can occur in many different sites in the body
• The onset of TB can be slow and is not always clear

Maintaining increased awareness of TB can be done through activities such as:

• Community group outreach events
• Training sessions
• Production and promotion of information and educational materials in various formats and languages

See below for further information:

• leaflets and videos with educational material on TB (available in different languages)
• support and information for those affected by TB
• training for professionals working with the general population and high-risk groups
• international awareness raising for World TB Day (24th March)

Educational materials should be in a format and language that target groups can understand. In the UK, several organisations are involved with awareness raising activities including TB Alert.

Latent TB infection (LTBI)

People with LTBI are asymptomatic and well but can become unwell as a result of reactivation of the latent TB infection. This can occur months, years or even decades after initial infection. It is likely that LTBI reactivation causes most of the active cases in the UK.

Individuals who were born or spend considerable time in a country where TB is very common are more likely to have LTBI. More information about TB in migrants can be found in the TB migrant health guide.

It is not feasible or cost-effective to screen an entire population for LTBI but NICE recommends screening for specific high-risk groups in the UK. These groups include:

• close contacts of patients with TB
• healthcare workers
• immunosuppressed patients (for example those with HIV)
• migrants from countries where TB is common

The Tuberculosis (TB) Action Plan for England, 2021 to 2026 recommends systematic LTBI testing and treatment for 16 to 35 year olds who recently arrived in the UK from high incidence countries as a key strategy.

Pre-entry TB screening for migrants

The tuberculosis (TB) pre-entry screening programme has been operational in 101 countries since replacing on-entry screening at UK airports in March 2014. The programme screens for active pulmonary TB (infectious form) using chest X-ray (CXR) and symptom review, with sputum testing conducted for individuals whose CXR is considered consistent with TB.

Applicants who apply for a long-term UK visa (6 months or more) and have recently lived in a country with high TB incidence (over 40/100,000), must be screened for pulmonary TB. Visa applications can only be processed once the applicant has been issued with a certificate of clearance to show they’re free from active pulmonary TB. The TB screening for the UK leaflet explains the processes and requirements for pre-entry screening.

Screening can only be performed by a UK-recognised and quality assured provider. UKHSA works closely with the Home Office to support the development of quality assurance systems to ensure that the pre-entry TB screening programme is ‘fit for purpose’ in providing its stated objectives. The UK tuberculosis technical instructions explain the pre-departure screening programme for applicants to the UK and provide guidance for those who conduct TB screening.

The UK is one of 5 countries (alongside Australia, Canada, New Zealand and USA) that have adopted a pre‑entry TB screening programme.

Pre-entry TB screening contributes to reduction of TB in the UK Berrocal-Almanza and others, 2019. However, pre-entry screening can only detect TB among people with active pulmonary disease at the time of screening. Therefore, it is important that migrants arriving in the UK and the professionals working with them are made aware of the issues surrounding TB and opt into latent TB screening if eligible.

For more information view Tuberculosis in England, 2025 report - GOV.UK