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

Abstract

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.

Tuberculosis screening during the 2015 European refugee crisis

“…CXR examinations are obligatory for each person (except for children < 15 years of age and pregnant women) in order to screen for signs of potentially infectious pulmonary TB [14,15]. While notification of confirmed, active TB cases to official authorities is mandatory in Germany, no obligation to document the number of screening participants exists, resulting in sparse information about yields and effectiveness of TB screening programs [16,17].…”

“…TB-prevalence ranged from 0.26 to 0.05% in a study by Herzmann et al, including screening results from 4, both rural and metropolitan centers in Germany 2015 [19] but difficulties with the arrangement of follow up examinations were reported. The need for data collection and analysis in order to improve screening algorithms has been addressed by several authors [9,10,[16][17][18][19][20][21][22][23].…”

Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015

“…and intestinal parasites). Yields of the mandatory chest X-ray to rule out active TB were taken from a systematic review and meta-analysis of German studies [21] that found the yield of TB screening to be in line with a meta-analysis of international studies [22]. …”

Migration und Tuberkulose

“…Nach einem Review von Bozorgmehr et al zeigte sich nach dem Thorax-Röntgenscreening von Asylbewerbern in Deutschland eine Inzidenz von 3,47 Fällen auf 1000 Personen. Dies entsprach einer "number needed to screen" von 288 Personen, um einen Tuberkulosefall zu diagnostizieren [5]. Aufgrund der unterschiedlichen Inzidenzen der Tuberkulose in den Herkunftsländern der Migranten kommt es jedoch zu unterschiedlichen "numbers needed to screen".…”