Pulmonary tuberculosis among political asylum seekers screened at Heathrow Airport, London, 1995-9

Abstract

Background: Over 50% of cases of tuberculosis (TB) in the UK occur in people born overseas, and new entrants to the country are screened for TB. A study was undertaken to determine the prevalence and disease characteristics of pulmonary TB in new entrants to the UK seeking political asylum. Methods: A retrospective analysis of the results of screening 53 911 political asylum seekers arriving at Heathrow Airport between 1995 and 1999 was performed by studying Airport Health Control Unit records and hospital medical records. Outcome measures were chest radiograph abnormalities, sputum smear, culture, and drug resistance data for Mycobacterium tuberculosis. Results: The overall prevalence of active TB in political asylum seekers was 241 per 100 000. There were large variations in prevalences of TB between asylum seekers from different regions, with low rates from the Middle East and high rates from the Indian subcontinent and sub-Saharan Africa. The frequency of drug resistance was high; 22.6% of culture positive cases were isoniazid resistant, 7.5% were multidrug resistant (resistant to both isoniazid and rifampicin), and 4% of cases diagnosed with active disease had multidrug resistant TB. Conclusions: The prevalence rate of TB in political asylum seekers entering the UK through Heathrow Airport is high and more M tuberculosis isolates from asylum seekers are drug resistant than in the UK population. Extrapolating these figures, it is estimated that 101 political asylum seekers with active pulmonary TB enter the UK every year, of whom about 25 would have smear positive disease.

Pre-immigration screening process and pulmonary tuberculosis among Ethiopian migrants in Israel

“…The PTB point prevalence on arrival in the present study was 270 per 100,000 immigrants, which is lower than documented among asylum seekers at Heathrow Airport, London, UK [13] and in Belgium [14], but is higher than in Somalis screened in Norway [15] or in Switzerland [16] (415, 252, 248 and 198 cases per 100,000 immigrants, respectively). The gap in TB prevalence between Ethiopia and Somalia may be related to the relatively higher TB prevalence in Ethiopia, the age composition and the basic health status of the immigrants to Israel, and the active case-finding process applied to all immigrants.…”

Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis

“…12 studies reported information about the geographic origin of the migrants [19-21, 26-31, 36, 38, 39], while only three studies reported a sex distribution of pulmonary tuberculosis cases [22,29,31]. Among the studies reporting the geographic origin of immigrants, six reported cases from Europe (median (interquartile range) number of cases: 10 (4-8); median number of immigrants: 2,950 (945-8,462)) [19-21, 26, 28, 29], six reported cases from Asia (median number of cases: 24 (13-71); median number of immigrants: 2,089 (1,863-9,328)) [20,27,30,31,36,38], three reported cases from Africa (median number of cases: 14 ; median number of immigrants: 1,732 (1,390-10,490)) [19][20][21], one reported cases from the Middle East [20] and, finally, one paper reported cases from Haiti [39]. Table 1 summarises the findings of the 22 studies that reported cases of active pulmonary tuberculosis among migrants and the prevalence of tuberculosis among the general population in the host countries.…”

“…The median (interquartile range) number of cases of pulmonary tuberculosis among immigrants was 31 , while the median number of immigrants screened in each study was 6,526 (945-19,912). Of the 22 studies, seven reported pulmonary tuberculosis cases among refugees [26][27][28][29][30][31]38], seven reported cases among regular immigrants [32][33][34][35][36][37]39], seven reported cases among asylum seekers [18][19][20][21][22][23][24] and one did not report any pulmonary tuberculosis case [25]. 12 studies reported information about the geographic origin of the migrants [19-21, 26-31, 36, 38, 39], while only three studies reported a sex distribution of pulmonary tuberculosis cases [22,29,31].…”

“…This could be explained by the fact that ,51% of immigrants from Asia were refugees, whereas all immigrants from Africa were asylum seekers. Furthermore, according to a restricted analysis, the pooled yield for asylum seekers from European countries [19][20][21] was 2.00 per 1,000 (95% CI 1.36-2.63; I 2 50.0%). This finding suggests that a more specific definition of the risk groups might result in a reduction of heterogeneity of the estimates, possibly supporting more specific indications about which immigrant groups should be targeted for screening.…”

Deciphering an Outbreak of Drug-Resistant Mycobacterium tuberculosis

“…The TB screening of other categories of immigrants could also be improved. These problems are not unique to Norway but are also experienced in other countries (2,8).…”