Low yield of screening asylum seekers from countries with a tuberculosis incidence of &lt;50 per 100 000 population

Vries, Gerard de; Rest, Job van; Meijer, Wieneke; Wolters, Bert; Hest, Rob van

doi:10.1183/13993003.00099-2016

Cited by 33 publications

(37 citation statements)

References 6 publications

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“…Important post-migration factors such as median length of stay in the host country and characteristics of the accommodation were not reported either by the primary studies in our review. It is known that the underlying incidence of TB in the countries of origin affects the yield of screening approaches in different settings [36,40]. Better reporting of country-stratified yields may therefore help to prioritise special risk groups among the heterogeneous population of asylum seekers.…”

Section: Discussionmentioning

confidence: 99%

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

et al. 2017

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All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45–1.10) to 6.41 (95% CI: 4.19–9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78–5.73; I2 = 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I2 = 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24–3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes.

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Section: Discussionmentioning

confidence: 99%

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

et al. 2017

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“…Our results support recommendations to target postlanding LTBI screening and treatment to adult refugees originating from countries with a high TB incidence. 2,4,27 Although the public health impact may not be high given the relatively small population, LTBI screening of adult refugees from countries with a high TB incidence should be a feasible first step to implement (e.g., in BC, this represents up to an estimated 600 people annually). Many WHO European-region countries screen for both TB and LTBI in refugee centres.…”

Section: Implications and Knowledge Gapsmentioning

confidence: 99%

Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study

Ronald¹,

Campbell²,

Balshaw³

et al. 2018

CMAJ

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A s tuberculosis (TB) transmission declines in regions of low TB incidence, TB is becoming concentrated in migrant populations.1 In Canada, a country with low TB incidence, most cases of TB (about 70%) are diagnosed in people born outside of Canada, with many arriving from countries with a high TB incidence. 2Preimmigration medical screening is a cornerstone of TB prevention in Canada. Prospective permanent residents and temporary residents who will be staying in Canada for more than 6 months undergo a preimmigration medical examination that includes a history, physical examination and chest radiograph, and when indicated by radiograph abnormalities, sputum samples for smear and culture. Applicants with a diagnosis of active TB must receive treatment before they can obtain residency status.2 Postimmigration surveillance of select individuals is also conducted, whereby people considered to be at high risk for TB (i.e., evidence of prior TB or abnormalities present on chest radiographs) are highlighted for follow-up surveillance by public health authorities in Canada.2 However, a recent study found that less than 3% of active cases of TB in people migrating to Canada were detected by postimmigration surveillance.3 Currently, no routine pre-or postimmigration screening and treatment programs for latent TB infection (LTBI) for people migrating to Canada are available. Scale-up of LTBI screening and treatment in high-risk populations postimmigration is a component strategy for achieving World Health Organization (WHO) targets for TB elimination in Canada.4,5 However, with about 250 000 new permanent residents migrating to Canada annually, the large population of people who may qualify for LTBI screening and treatment is a substantial barrier to implementation.6 National guidelines recommend targeting screening for LTBI in people migrating from high-incidence countries, particularly in adult refugees up to 50 years of age and those with other risk factors for increased TB reactivation.2,4 However, many of these recommendations are based on weak evidence.

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“…A recent survey performed by the European Respiratory Society and WHO among 31 European countries shows that only six countries were able to report LTBI treatment completion rates, which ranged between 40 and 88% [22]. The role and feasibility of LTBI management among asylum seekers has also been raised in the face of recent influx of migrants to Europe, presenting another programmatic challenge [23].…”

Section: Barriers For Programmatic Managementmentioning

confidence: 99%

Advancing global programmatic management of latent tuberculosis infection for at risk populations

et al. 2016

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@ERSpublicationsIntensification of #LTBI treatment for child #TB contacts and people living with #HIV and other at risk populations http://ow.ly/ZfzAvIn this issue of the European Respiratory Journal, ERKENS et al.[1] present experience and results of long-term data in the recording and reporting of latent tuberculosis (TB) infection (LTBI) management from the Netherlands. The authors report a high rate of initiation (77%) among the 37 729 eligible persons and a high rate of treatment completion (82%). Valid and complete data were available on almost all (96%) persons who started treatment, due to the use of a technically sound notification system supported by a legal framework and standardised indicators [1]. These findings are important additions to the renewed focus and call to address LTBI, which is considered as the reservoir for virtually all TB cases [2,3]. Other renewed efforts include the establishment of a World Health Organization (WHO) global task force to raise the profile of programmatic management of LTBI, including monitoring and evaluation of implemented activities, as well as promoting research. UNITAID has also identified LTBI as one of its areas of intervention.The management of LTBI is a key component of the WHO End TB Strategy [4], which is critical to the advancement of TB control, particularly when TB elimination efforts are pursued [5]. Modelling showed that protection of 8% of people with LTBI each year, from developing active TB disease, could result in a 14-fold decrease of the global incidence of TB in 2050 compared to the incidence in 2013 [6]. Two-pronged global approachWHO has issued global recommendations on the treatment of LTBI for people living with HIV [7] and for children aged <5 years who are close contacts of a pulmonary TB case [8]. Additionally, WHO recommends the management of LTBI among at risk populations in upper-middle and high-income countries with an estimated TB incidence rate of <100 per 100 000 population [9]. In these countries, systematic LTBI testing and treatment is strongly recommended for a wider range of clinical risk groups: patients with silicosis, patients initiating anti-tumour necrosis factor (TNF) treatment, patients on dialysis, and patients preparing for organ and haematological transplantation. This two-prong approach and the tailored recommendations on diagnosis and treatment are presented in table 1.

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Low yield of screening asylum seekers from countries with a tuberculosis incidence of <50 per 100 000 population

Cited by 33 publications

References 6 publications

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis

Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study

Advancing global programmatic management of latent tuberculosis infection for at risk populations

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