Research article
A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates
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* Corresponding author: Gonzalo G Alvarez galvarez@ohri.ca
1 Divisions of Respirology and Infectious Diseases, University of Ottawa at The Ottawa Hospital, The Ottawa Health Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada
2 Migration Health Consultants, Inc., Singapore
3 National Tuberculosis Program, Jordan
4 Eidgenössisches Departement des Innern EDI, Bundesamt für Gesundheit BAG, Direktionsbereich Öffentliche Gesundheit, Schwarztorstrasse 96, CH-3007 Bern, Switzerland
5 National Tuberculosis Program, Department of Tuberculosis and AIDS, Public Health Services, Ministry of Health33 Pierre Koenig, P.O.B 1176, Jerusalem 91010, Israel
6 Department of Immigration & Citizenship Building C, Level 6, 300 Elizabeth St, Sydney, Australia
7 KNCV Tuberculosis Foundation, PO Box 146, 2501 CC The Hague, The Netherlands
8 Communicable Diseases, Population Health Protection Group, Population Health Directorate, Ministry of Health, New Zealand
9 Travel and Migrant Health Section, Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London, England
10 Istituto Malattie Infettive e Tropicali, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25123, Italy
11 Direction Générale de la Santé, Sous direction Prévention des risques infectieux, Bureau risque infectieux et politique vaccinale - RI 1, 14, avenue Duquesne, 75350 Paris, France
12 CDR, USPHS, Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, USA
13 Department for Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany
14 Socialstyrelsen, The National Board of Health and Welfare, Communicable Disease Prevention and Control, 10630 Stockholm, Sweden
15 Centro Nacional de Epidemiología, Instituto de Salud Carlos III C/Sinesio Delgado n° 6, 28029-Madrid, Spain
16 Norwegian Institute of Public Health Agency of Canada, 100 Eglantine Drive, AL 0603B Ottawa, Ontario K1A 0K9, Canada
17 Tuberculosis Prevention and Control, Public Health Agency of Canada, 100 Eglantine Drive, AL 0603B Ottawa, Ontario K1A 0K9, Canada
BMC Infectious Diseases 2011, 11:3 doi:10.1186/1471-2334-11-3
Published: 4 January 2011Abstract
Background
Tuberculosis (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.
Methods
Descriptive study of immigration TB screening programs
Results
16 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.
Conclusions
In 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.