Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis

Aldridge, Robert W; Yates, Tom A; Zenner, Dominik; White, Peter J; Abubakar, Ibrahim; Hayward, Andrew

doi:10.1016/s1473-3099(14)70966-1

Cited by 76 publications

(78 citation statements)

References 26 publications

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“…The detection of one active case among 299 screened contacts of patients with active EPTB also compares favourably to other screening strategies for active TB 8. By comparison, screening for abdominal aortic aneurysms over the age of 65 identified <1% of men eligible for yearly surveillance,9 cervical cancer screening identifies ∼7% of those with abnormal smears10 and bowel cancer screening identified ∼2% 11…”

Section: Screening Contacts Of Patients With Extrapulmonary Tb For Lamentioning

confidence: 99%

Screening contacts of patients with extrapulmonary TB for latent TB infection

Humphreys

Abbara

Williams

et al. 2017

Thorax

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2016 TB National Institute for Health and Care Excellence (NICE) guidelines imply that contacts of extrapulmonary TB do not require screening for latent TB infection. At our high TB prevalence site, we identified 189 active cases of TB for whom there were 698 close contacts. 29.1% of the contacts of pulmonary TB and 10.7% of the contacts of extrapulmonary TB had active or latent TB infection. This supports screening contacts of extrapulmonary TB at our site and presents a way to access high-risk individuals. We propose to continue to screen the contacts of our patients with extrapulmonary TB and recommend other TB units audit their local results.

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Section: Screening Contacts Of Patients With Extrapulmonary Tb For Lamentioning

confidence: 99%

Screening contacts of patients with extrapulmonary TB for latent TB infection

Humphreys

Abbara

Williams

et al. 2017

Thorax

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“…A systematic review 6 published in 2014 showed that, in pre-entry screening of migrants before travel to low-incidence countries, the largest number of cases was detected when screening was done in high-incidence countries. One-off pre-entry screening for active tuberculosis in migrants will detect only disease prevalent at the time of screening.…”

Section: Introductionmentioning

confidence: 99%

“…Few linked data are available for incident tuberculosis after migration to low-incidence countries in populations screened before entry, and even fewer data are available for risk factors for subsequent development of disease in this screened population. Investigators in previous studies focused on prevalent cases detected during pre-entry screening, 6 used national tuberculosis notification data alone with no linkage to pre-entry screening records, 7 or followed up a selected cohort of individuals from a few countries or subnationally after arrival 8, 9, 10. Thus, the most effective approach to reduction of the disease burden in migrants from high-incidence to low-incidence countries—including latent tuberculosis screening and treatment, active case finding, and improvement of health-care access—is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland

et al. 2016

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SummaryBackgroundTuberculosis elimination in countries with a low incidence of the disease necessitates multiple interventions, including innovations in migrant screening. We examined a cohort of migrants screened for tuberculosis before entry to England, Wales, and Northern Ireland and tracked the development of disease in this group after arrival.MethodsAs part of a pilot pre-entry screening programme for tuberculosis in 15 countries with a high incidence of the disease, the International Organization for Migration screened all applicants for UK visas aged 11 years or older who intended to stay for more than 6 months. Applicants underwent a chest radiograph, and any with results suggestive of tuberculosis underwent sputum testing and culture testing (when available). We tracked the development of tuberculosis in those who tested negative for the disease and subsequently migrated to England, Wales, and Northern Ireland with the Enhanced Tuberculosis Surveillance system. Primary outcomes were cases of all forms of tuberculosis (including clinically diagnosed cases), and bacteriologically confirmed pulmonary tuberculosis.FindingsOur study cohort was 519 955 migrants who were screened for tuberculosis before entry to the UK between Jan 1, 2006, and Dec 31, 2012. Cases notified on the Enhanced Tuberculosis Surveillance system between Jan 1, 2006, and Dec 31, 2013, were included. 1873 incident cases of all forms of tuberculosis were identified, and, on the basis of data for England, Wales, and Northern Ireland, the estimated incidence of all forms of tuberculosis in migrants screened before entry was 147 per 100 000 person-years (95% CI 140–154). The estimated incidence of bacteriologically confirmed pulmonary tuberculosis in migrants screened before entry was 49 per 100 000 person-years (95% CI 45–53). Migrants whose chest radiographs were compatible with active tuberculosis but with negative pre-entry microbiological results were at increased risk of tuberculosis compared with those with no radiographic abnormalities (incidence rate ratio 3·2, 95% CI 2·8–3·7; p<0·0001). Incidence of tuberculosis after migration increased significantly with increasing WHO-estimated prevalence of tuberculosis in migrants' countries of origin. 35 of 318 983 pre-entry screened migrants included in a secondary analysis with typing data were assumed index cases. Estimates of the rate of assumed reactivation tuberculosis ranged from 46 (95% CI 42–52) to 91 (82–102) per 100 000 population.InterpretationMigrants from countries with a high incidence of tuberculosis screened before being granted entry to low-incidence countries pose a negligible risk of onward transmission but are at increased risk of tuberculosis, which could potentially be prevented through identification and treatment of latent infection in close collaboration with a pre-entry screening programme.FundingWellcome Trust, UK National Institute for Health Research, UK Medical Research Council, Public Health England, and Department of Health Policy Research Programme.

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“…This requirement denies the right to enter the country and claim asylum in case of untreated, infectious TB. 51–54 Here, the firewall argument helps to argue for a separation in principle. An empirical investigation as to whether it functions would be the second step.…”

Section: Three Highlights From the Ethics And Justice Literaturementioning

confidence: 99%

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe

Wild

Jaff

Shah

et al. 2017

int j tuberc lung dis

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SUMMARY Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). When creating public health policies to address the complex challenges posed by TB and migration, countries should focus these policies on evidence, ethics, and human rights. This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. This illustration provides the basis for discussing TB and migration from the perspective of human rights, with a focus on the right to health. We then highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of ‘firewalls’ to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice. The paper closes by reflecting briefly on how TB programs can better incorporate human rights and ethical principles and values into public health practice.

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Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis

Abstract: Wellcome Trust, UK National Institute for Health Research, Medical Research Council, Public Health England.

Cited by 76 publications

References 26 publications

Screening contacts of patients with extrapulmonary TB for latent TB infection

Screening contacts of patients with extrapulmonary TB for latent TB infection

Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe

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