Missed opportunities for prevention of tuberculosis in Victoria, Australia

SETTING: Victoria, Australia. OBJECTIVE: To ascertain missed opportunities for prevention in all persons notified in 1991 to the state registry with active tuberculosis (TB), and to examine aspects of case management relevant to prevention. DESIGN: A descriptive study. Records were reviewed for 231/236 cases of TB notified in the state of Victoria in 1991. Documentation of past screening for TB, preventive therapy, treatment of active disease and follow up was sought for all cases. Past screening was defined as past contact screening, migrant screening, refugee screening and health undertakings for TB. RESULTS: Of the 231 cases, 13 were not confirmed to have TB. Of the remaining 218 cases, 78% were foreign born, and of these, nearly half were diagnosed within 3 years of arriving in Australia. Nearly half of all cases (97/218) had some form of past screening for TB. The most common type of screening was refugee and migrant screening (45/218, 21%) followed by tuberculosis health undertakings (25/218, 12%) and contact screening (15/218, 7%). Of those with past screening, 70% (68/97) had a positive screening result at the time. Among these, the first screening episode resulted in the diagnosis of active TB in 5/68, and TB infection in 63/68. In the latter group only 5% (3/63) received preventive therapy. CONCLUSION: There are significant missed opportunities for prevention in Victoria, particularly in the foreign born cases who receive screening on entry into the country. For screening to be a meaningful exercise, preventive therapy should be used where medically indicated.