Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations

Abstract

A systematic literature review was performed with the objective of assessing the effectiveness of tuberculosis (TB) screening methods and strategies in migrants in European Union/European Economic Area (including Switzerland) countries.Extracted data on yield and coverage were used as indicators of effectiveness. Reported yields varied considerably between studies and countries. Considering only the 14 studies representative of national screening programmes, a median yield of TB disease of 0.18% (interquartile range 0.10-0.35%) was reported.The data did not indicate differences in effectiveness between the three main strategies: 1) screening at port of entry; 2) screening just after arrival in reception/holding centres; and 3) screening in the community following arrival in European Union countries. The variation seen probably reflects variation in risk factors for TB, in particular the composition of the migrants entering the country.Recommendations include the need for improved data for guiding the optimal frequency and duration of screening; assessment and improvement of cost-effectiveness; access to healthcare for migrants, including illegal migrants; ensuring a continuum of care for those screened; and consideration of screening for latent TB infection with caution. Finally, screening should be a component of a wider approach, rather than a stand-alone intervention.

Social determinants of tuberculosis in Europe: a prospective ecological study

“…Income inequality remained a strong predictor of both TB incidence and prevalence, supporting our speculation that the effect of net migration on TB is being picked up by income inequality. On the contrary, the effect of GDP became nonsignificant, a finding due to the tendency of affluent countries to receive a relatively high number of migrants from countries where TB is endemic [46]; this idea is supported by the high correlations (r.0.8) between GDP and the proportion of foreign born TB cases (unpublished data).…”

New times for migrants' health in Europe

“…Moreover, drug-resistant TB among cases of foreign origin is commonly higher than among native EU citizens , especially among those from the Former Soviet Union 36 . In the EU in 2007, the mean percentage of foreign-born reported cases was 20 (range 0-82) 37 . From the cases that reported country of origin, most of them were from Sub-Saharan Africa, Southeast Asia, specific areas of Latin America and former Eastern Europe 37 .…”

“…In the EU in 2007, the mean percentage of foreign-born reported cases was 20 (range 0-82) 37 . From the cases that reported country of origin, most of them were from Sub-Saharan Africa, Southeast Asia, specific areas of Latin America and former Eastern Europe 37 . TB infection in migrants tends to occur at younger ages, and those infected are more likely to default on treatment and have a poor outcome 35 .…”

“…Whereas, tuberculin skin testing or chest radiographs for latent infection, have showed a higher impact and cost-effectiveness when they have been used under coercive measures 43 . The only measure that appears to be more cost-efficient and less intrusive is contact tracing, particularly within common socio-demographic groups 37,43 . Also, studies do not indicate differences in effectiveness between the three main strategies of screening; screening at port of entry; screening just after arrival in reception/holding centres; or screening in the community following arrival in the EU countries 37 .…”

“…The only measure that appears to be more cost-efficient and less intrusive is contact tracing, particularly within common socio-demographic groups 37,43 . Also, studies do not indicate differences in effectiveness between the three main strategies of screening; screening at port of entry; screening just after arrival in reception/holding centres; or screening in the community following arrival in the EU countries 37 . Therefore, there is a need for improved data related with; assessment and improvement of cost-effectiveness.…”