Collapse of the denialist camp

The Canadian TB control program has been used as a model by other bodies, such as those within Australia. Regarding the use of IGRA the then South Australian Minister for Health, John Hill, did advise me that

Expert opinion in South Australia is that the NTAC recommendations are in keeping with Canadian guidelines, which are probably the most balanced given the current level of knowledge.

The NTAC that Minister Hill referred to is the National Tuberculosis Advisory Committee. The Australian Medical Association also report similar views

We are advised that the Australian Tuberculosis Advisory Council does not recommend these tests at this stage due to issues of validation. Their position is similar to that of the Canadian TB Advisory Committee

The National guidance has permeated its way through the various health bodies; here is the view held in Queensland

Tuberculin skin test readings are interpreted after considering the clinical and epidemiological setting rather than defining a specific positive or negative cut-off. Skin testing by trained staff is done in conjunction with patient education, counselling, and screening for symptoms of tuberculosis.

..With trained staff, tuberculin skin testing lends itself to community screening and in populations at high risk for tuberculosis and it may be more sensitive for detecting remote (rather than recent) tuberculosis infections.

It is worth reviewing the effectiveness of these much quoted guidelines - and according to a recent report TB control in Canada has failed in a spectacular fashion

Manitoba's former tuberculosis control director will testify in front of a federal health committee to push for action to eliminate a disease critics call a national embarrassment.

Longtime TB control director Dr. Earl Hershfield will appear alongside other TB experts and First Nations representatives at a health committee hearing in Ottawa on April 20. Recommendations stemming from the testimony will be debated in Parliament, raising hopes the Harper government will address the poverty, poor housing and lack of access to medical care that help TB spread.

Hershfield spent 37 years at the helm of Manitoba's TB control program and recently blasted provincial health officials for losing track of sick TB patients, saying the system is "falling apart."

Let the facts speak for themselves

Some northern First Nations communities have recorded more than 600 cases of TB per 100,000 people...the rate in Bangladesh is slightly below 400 cases per 100,000.

Whatever Health Canada are doing they are doing it wrong

Health Canada Advisory Statement Recommendations
IGRAs are not currently recommended :
1. For the diagnosis of active TB in adults (Sensitivity=rule out, specificity = rule in)
2. For serial testing such as in health care workers or prison staff and inmates.
3. In an immunocompromised person, TST is the preferred test.

The time for change is now

The Canadian Tuberculosis Committee (CTC) recommends that all provincial and territorial governments fund the use of IGRAs for use according to the current CTC recommendation

Australia should take their advice.

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