1. Helen Green Public Health Registrar (ST3) West Midlands
Tackling Tuberculosis The contribution of a public health registrar in different settings within the West Midlands
Helen Green
Public Health Registrar (ST3)
West Midlands

2. Tuberculosis in the West Midlands
1. Second highest regional rate of TB behind London
2. Highest regional rate in non UK born in England
3. Highest regional proportion with multiple social risk factors in England
4. Significant reduction during the past few years
5. Considerable variation within the region
PHE 2016 Tuberculosis annual report (presenting data to end of 2015)

3. How to tackle TB
 Tackling TB requires the coordinated action of many partners

4. A registrar’s perspective
 Unique opportunity to experience the perspective of different organisations and how they can contribute to addressing this public health issue
Registrar

5. Local incidents requiring contact tracing in high TB incidence areas
An infectious case of TB working in a large factory for several months
Risk assessment carried out
Infectiousness, duration of contact, population vulnerability
Workplace contacts identified
A considerable number with different employment and shift patterns
<8hrs contact
Inform and advise
8+hrs contact
Screen
Individual
On treatment
Remaining off work while infectious
High background prevalence of latent TB in workforce
Extension of screening required?
National PHE expert guidance
Whole Genome Sequencing

6. Designing a pathway for latent TB testing for unaccompanied asylum seeking children
UASC at an increased risk of TB infection
Responsibility of care lies with assigned local authority
Coventry and Warwickshire situation
Informal arrangements in place for the management of latent TB screening in this vulnerable group
Overlap between areas accepting UASC and areas placed
Variation in who carries out screening according to which GP registered with

7. Designing a pathway for latent TB testing for unaccompanied asylum seeking children (2)
A range of health and social care professionals consulted
Complex exercise to reconcile processes across Coventry and Warwickshire

8. Reviewing neonatal BCG vaccine policies in place across the West Midlands
BCG immunisation programme is risk-based
Neonatal programme a key component
Targeted at protecting children most at risk of exposure
Responsibility of Trust of birth
Selective strategy in the West Midlands
Requires identification of eligible neonates
 Clear pathways need to be in place
Restricted supply in 2015 and a change in vaccine highlighted variation in policy and practice by Trust in the region

9. Reviewing neonatal BCG vaccine policies in place across the West Midlands (2)
1. Infant eligibility and assessment
2. Informed choice and provision of consent
3. Vaccine storage and administration
When identified?
Training
Data collection
Documentation?
Tricky to look at data collection when CHIS only report vaccines that
Where vaccinated?

10. Implementing neonatal BCG vaccine policies in low incidence areas
Need to ensure standard recommended pathways appropriate to level of demand
Facilitates maximum uptake
Minimise vaccine wastage
Confirm contract arrangements between Trusts where necessary
Minimise impact of DNAs
 Use of data available on the number of eligible neonates helps to engage the Trusts

11. Registrar benefits of experience in a range of settings
Working in different settings afforded the opportunity to:
1. Explore different aspects of TB control, focusing on the following TB Strategy key areas:
2. Address the issue at different levels and through a range of perspectives
3. Observe the challenges faced when implementing best practice and when the level of need can vary markedly

12. Key learning opportunities
Focusing on a common aim across training placements helps to:
Strengthen understanding of how organisations can work together to address key public health issues
Enable long term follow up of implementation of the work done and how it can result in change which can be difficult in time- limited placements
TB incident management
UASC pathway development
BCG policy review
BCG policy implementation
August 2015
August 2016
June 2017

13. Acknowledgements
Nicola Benge (Consultant Lead Screening and Immunisation, PHE/NHS England West Midlands)
Nicky Bennett (Screening and Immunisation Coordinator, PHE)
Nadia Inglis (Consultant in Public Health, Warwickshire County Council and Coventry City Council)
Bharat Sibal (Lead CCDC, WME Health Protection Team, PHE)
Annette Wood (formerly Consultant Screening and Immunisation Lead, PHE/NHS England West Midlands)