Active Tuberculosis Case Finding Interventions among Immigrants, Refugees and Asylum Seekers in Italy

Abstract

In Italy tuberculosis (TB) is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014) at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0%) reported TB history or symptoms suggestive of active TB and 546 (61.3%) were referred to the TB clinic. Of them, 254 (46.5%) did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population.

Spatial and Temporal Epidemiologic features analysis of pulmonary tuberculosis in Nanjing, China

“…Regional economy directly affects the prevalence and control of PTB [28]. At present, Nanjing is in the period of rapid economic development, and the economic development of each district is unbalanced.…”

Crisis-Affected Populations and Tuberculosis

“…Effective TB detection and care are unlikely except in the most stable of these situations, such as in established camp situations (11). This may explain the relatively high rates of active TB found on arrival in ports, where informal routes are more common, and the attractiveness of active case finding interventions for receiver countries (31). Screening for TB at ports is often limited to active case finding (32) and frequently faced with operational problems, including loss to follow-up for identified cases (31).…”

“…This may explain the relatively high rates of active TB found on arrival in ports, where informal routes are more common, and the attractiveness of active case finding interventions for receiver countries (31). Screening for TB at ports is often limited to active case finding (32) and frequently faced with operational problems, including loss to follow-up for identified cases (31). A number of countries have therefore implemented pre-entry screening procedures for migrants and refugees (33), although these are limited to recognized refugees following formal travel arrangements.…”

The Impact of Tuberculosis among Immigrants: Epidemiology and Strategies of Control in High-Income Countries—Current Data and Literature Review

“…2 Presence of cough, fever, fatigue, hemoptysis and weight loss. Although only a limited number of TB cases was detected, of those screened and evaluated, the study, based on its feasible cost approach and reduced burden of medical procedures, contributed to the diagnoses and control of TB, especially among subpopulations that have difficulties to access specialized healthcare centers [27].…”

“…An interesting and original active TB finding approach was recently investigated by Schepisi [27] in Italy, a country where there is no TB national screening policy for new entrants [28].…”