Screening of migrants for tuberculosis identifies patients with multidrug-resistant tuberculosis but is not sufficient (original) (raw)
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Tuberculosis screening in migrants in selected European countries shows wide disparities
European Respiratory Journal, 2006
Well-established tuberculosis screening units in Western Europe were selectively sampled. Three screening units in Norway, two in the UK, one in the Netherlands and one in Switzerland were evaluated. The aim of this study was to describe a range of service models used at a number of individual tuberculosis units for the screening of new entrants into Europe. Semi-structured interviews were conducted with clinicians, nurses and administrators from a selected sample of European tuberculosis screening units. An outline of key themes to be addressed was forwarded to units ahead of scheduled interviews. Themes included the history of the unit, structure, processes and outputs involved in screening new entrants for tuberculosis. Considerable variation in screening services exists in the approaches studied. Units are sited in transit camps or as units within hospital facilities. Staff capacity and administration varies from one clinic per week with few dedicated staff to fully dedicated units. Only one site recorded symptoms; tuberculin testing was universal in children, but varied in adults; chest radiograph screening was universal except at one site where a positive tuberculin skin test or symptoms were required in those ,35 yrs of age before ordering a radiograph. Few output data are routinely and systematically collected, which hinders comparison and determination of effectiveness and efficiency. Service models for screening new immigrants for tuberculosis appear to vary in Western Europe. The systematic collection of data would make international comparisons between units easier and help draw conclusions that might usefully inform service development.
BMC Infectious Diseases - BMC INFECT DIS, 2011
Background: Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates.
BMC Public Health | Full text | The role of entry screening in
2010
Background: Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods: All asylum seekers who arrived at the National Reception Centre between January 2005-June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results: Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion: In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
Eurosurveillance, 2022
Background Migrants in low tuberculosis (TB) incidence countries in the European Union (EU)/European Economic Area (EEA) are an at-risk group for latent tuberculosis infection (LTBI) and are increasingly included in LTBI screening programmes. Aim To investigate current approaches and implement LTBI screening in recently arrived migrants in the EU/EEA and Switzerland. Methods At least one TB expert working at a national level from the EU/EEA and one TB expert from Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results Experts from 32 countries were invited to participate (30 countries responded): 15 experts reported an LTBI screening programme targeting migrants in their country; five reported plans to implement one in the near future; and 10 reported having no programme. LTBI screening was predominantly for asylum seekers (n = 12) and refugees (n = 11). Twelve countri...
European Respiratory Journal, 2022
In the consolidated guidelines for tuberculosis (TB) prevention and systematic screening for TB disease, the World Health Organization (WHO) recommends countries with a low TB incidence to consider systematic screening for TB disease as well as testing for TB infection (TBI) and preventive TB treatment (TPT) for migrants from high TB burden countries . Many low TB burden countries, including the Netherlands, perform TB screening among those migrants . In the Netherlands, migrants are mandatorily screened for TB by chest radiography (CXR) within 3 months after entry; migrants from countries with an estimated WHO TB incidence of >200 per 100 000 are also offered voluntary biannual follow-up screening for 2 years. As part of the Dutch TB ENDPoint project, three implementation studies showed practical feasibility of TBI screening and treatment among newly arriving immigrants of all ages [4], asylum seekers aged ⩾12 years [5], and settled (Eritrean) migrants of all ages . The TBI screening algorithm consisted of TB symptom screening and TBI testing (tuberculin skin test (TST) and/or interferon-γ release assay (IGRA)), with an additional CXR to exclude TB disease among persons with TB symptoms or positive TBI test [7]. To consider the replacement of CXR screening with this TBI screening algorithm, evidence is needed on the effectiveness of the TBI screening, including the assessment of the risk of missing persons with TB disease at the time of screening. To identify individuals with prevalent TB disease (i.e. TB diagnosis within 6 months of TBI screening) and individuals with incident TB disease (i.e. TB diagnosis at least 6 months post TBI screening), we used cohort data from the three implementation studies (TB ENDPoint dataset) and matched it (by author H. Schimmel) to records (2016)(2017)(2018)(2019) notified to the Netherlands Tuberculosis Register (Osiris-NTR) through identical Osiris-NTR numbers or patient registration numbers of public health services . For remaining potential matching records, public health services were approached for verification of the person-identifiable data. Data on TB diagnosis of the verified matched records were added to the pseudonymised TB ENDPoint dataset for descriptive data analysis.
The European respiratory journal, 2018
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country application for a long-stay visa, as well as asylum seeker...
Evaluation of Immigrant Tuberculosis Screening in Industrialized Countries
Emerging Infectious Diseases, 2012
In industrialized countries, tuberculosis (TB) cases are concentrated among immigrants and driven by reactivation of imported latent TB infection (LTBI). We examined mechanisms used to screen immigrants for TB and LTBI by sending an anonymous, 18-point questionnaire to 31 member countries of the Organisation for Economic Cooperation and Development. Twenty-nine (93.5%) of 31 responded; 25 (86.2%) screened immigrants for active TB. Fewer countries (16/29, 55.2%) screened for LTBI. Marked variations were observed in targeted populations for age (range <5 years of age to all age groups) and TB incidence in countries of origin of immigrants (>20 cases/100,000 population to >500 cases/100,000). LTBI screening was conducted in 11/16 countries by using the tuberculin skin test. Six countries used interferon-γ release assays, primarily to confi rm positive tuberculin skin test results. Industrialized countries performed LTBI screening infrequently and policies varied widely. There is an urgent need to defi ne the cost-effectiveness of LTBI screening strategies for immigrants.
Public Health, 2019
Objective: To compare predeparture tuberculosis (TB) screening policies, including screening criteria and screening tests, and visa requirements for prospective migrants to high-income countries that have low to intermediate TB incidence and high immigration. Study design: Systematic review of policy documents. Methods: We systematically identified high-income, high net-migration countries with an estimated TB incidence of <30 per 100,000. After initial selection, this yielded 15 countries which potentially had TB screening policies. We performed a systematic search of governmental and official visa services' websites for these countries to identify visa information and policy documents for prospective migrants. Results were summarized, tabulated, and compared. Results: Programs to screen for active TB were identified in all 15 countries, but screening criteria and screening tests varied substantially between countries. Prospective migrants' country of origin represented an initial assessment criterion which generally focused on elevated TB incidence based on World Health Organization data but also focused on the countries of origin that sent the most migrants, and this varied between destination countries. Specific categories of migrants represented a second assessment criterion that focused on duration of stay and reasons for migration; the focus of which showed variation between the destination countries. Specific screening tests including medical examination and chest X-rays were used as the final stage of assessment, and there were differences between which tests were used between the destination countries. Conclusions: Current approaches to migrant TB screening are inconsistent in their approach and implementation. While this variation might reflect adaptation to local public health situations, it could also indicate uncertainty concerning optimal strategies. Comparative research studies are needed to define the most effective and efficient methods for TB screening of migrants.