A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates

Abstract

BackgroundTuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates.MethodsDescriptive study of immigration TB screening programsResults16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted.ConclusionsIn spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved screening programs.

The challenge of establishing an evidence-based and migrant sensitive approach to tuberculosis screening of inbound migrants to Sri Lanka

“…37 TB screening for inbound migrants may take place in one of three locations: at pre-departure phase, on arrival or at a defined period during the post-arrival phase. 7 Pre-departure screening that occurs at the country of origin has several advantages. Since the immigrant receives screening before departure, if detected positive for TB, he/she will receive treatment in a familiar environment.…”

“…To overcome this limitation, standardization of interpretation is recommended and can be done by digital CXR facilities which allow centralized interpretation by experts with extensive TB experience. 7 To overcome the low predictive values of CXR in diagnosing active pulmonary TB, sputum smear examination for acid fast bacilli and culture when CXR is abnormal and/or the migrant is having other signs and symptoms suggestive of TB should be undertaken. Conventional TB culture in Lowenstein Jensen (LJ) media takes two to eight weeks on average to produce results and has no value in migrant screening programmes.…”

“…The existing TB screening models in other countries among migrants vary widely. 7 In the Netherlands, migrants from countries with high prevalence of TB who intend to stay longer than 3 months undergo obligatory screening by chest X-ray at entry. This is followed by a half yearly voluntary screening for 2 years.…”

“…17,18 Considerable variability exists between nations in the model used for immigration TB screening. 7 Some countries in the Middle-Eastern region such as Saudi Arabia, Kuwait, Bahrain and Jordan impose both pre-departure and upon-arrival health examinations for temporary migrant workers arriving to their country. 19 Differing country specific priorities on TB control, weak health systems, limited political support and technical capacity and financial constraints may be some of the reasons for non-establishment of immigrant health assessment systems in countries experiencing high volumes of migrants from high TB incidence countries, especially in the developing world.…”

“…The timing and location of the health assessment may vary where it can be undertaken at the pre-departure migration phase (warranting an 'off-shore' examination), or an 'on-shore' examination conducted upon arrival at destination country. 7 The screening for active TB is a universal requirement of all migration health assessments. 8 Despite the risk of transmission, there is limited evidence that imported tuberculosis actually leads to an increase in disease incidence of host countries.…”