Abstract
BackgroundIn Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015–2016.MethodsVoluntary screening conducted at reception centres included an interview and a chest X-ray. Data on TB screening and health status of asylum seekers was obtained from the reception centres’ national health register (HRS). To identify confirmed TB cases, the National Infectious Disease Register (NIDR) data of foreign-born cases during 2015–2016 were linked with HRS data. TB screening yield was defined as the percentage of TB cases identified among screened asylum seekers, stratified by country of origin.ResultsDuring 2015–2016, a total of 38,134 asylum applications were received (57% were from Iraq, 16% from Afghanistan and 6% from Somalia) and 25,048 chest x-rays were performed. A total of 96 TB cases were reported to the NIDR among asylum seekers in 2015–2016; 94 (98%) of them had been screened. Screening identified 48 (50%) cases: 83% were male, 56% aged 18–34 years, 42% from Somalia, 27% from Afghanistan and 13% from Iraq. Furthermore, 92% had pulmonary TB, 61% were culture-confirmed and 44% asymptomatic. TB screening yield was 0.19% (48/25048) (95%CI, 0.14–0.25%) and it varied between 0 and 0.83% stratified by country of origin. Number needed to screen was 522.ConclusionsTB screening yield was higher as compared with data reported from other European countries conducting active screening among asylum seekers. Half of the TB cases among asylum seekers were first suspected in screening; 44% were asymptomatic. TB yield varied widely between asylum seekers from different geographic areas.
Highlights
In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening
Data on foreignborn TB cases notified to National Infectious Disease Register (NIDR) during 2015–2016, were linked to the health register (HRS) data by name, date of birth and origin to identify asylum seekers who had arrived in Finland during 2015–2016
Data analysis and statistics Aggregated data of all asylum seekers by age group and country of origin who had arrived in Finland during 2015–2016 were obtained from the Finnish immigration service [15]
Summary
In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015–2016. Similar to other European countries, Finland has adopted active TB screening protocols for asylum seekers based on WHO recommendations [6]. EU/EEA countries use different screening strategies and settings: Belgium, Germany and Switzerland screen only asylum seekers and refugees, the Netherlands and Spain screen other migrants arriving from high incidence areas, and Italy and the United Kingdom do not conduct systematic TB screenings for asylum seekers. Screening prevalence rate (n/100000 individuals screened) is used in parallel with yield [7]
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