Migrant Screening Research Articles

Building a European database to gather multi-country evidence on active and latent TB screening for migrants

Background and aimScreening for active and latent TB among migrants in low TB incidence countries may constitute an important contribution to TB elimination. E-DETECT TB, a European multi-county collaboration, aims to address the present lack of evidence on effectiveness of migrant TB screening by collating data in an international database and perform cross-country pooled and comparative analyses of screening coverage, results and linkage to care. MethodA database was established using migrant TB screening data from participating countries’ national screening programs, national screening pilots and local research projects. All partner countries contributed to a common agreed protocol with standardized variables, pooling available numerator and denominator screening data from participating countries and sites. ResultsAll collaborating members drafted and agreed upon a data sharing accord as well as a protocol that clearly defined responsibilities and data governance principles. The database has been created and data transfer is ongoing. ConclusionBy persistence and focus the project has overcome considerable administrative, practical and legal challenges. This international collaboration provides greater power of analysis of harmonized data and thereby a unique opportunity to contribute migrant TB screening evidence. E-DETECT TB has started to invite other countries to contribute data to the database.

Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study

BackgroundAsylum seekers in Sweden are offered tuberculosis (TB) screening at a voluntary post-arrival health examination. The role of this screening in improving the TB diagnostic pathway has not been previously evaluated. The aim of this study was to determine diagnostic pathways for active TB cases and compare diagnostic delays between different pathways.MethodsRetrospective review of medical records of patients reported with active TB in Stockholm in 2015, using a structured and pre-coded form.ResultsSeventy-one percent of patients actively sought health care due to symptoms. As for source of referral to TB specialist clinic, 15% came from screening of eligible migrants, of whom the majority were asymptomatic. Among asylum seekers, 69% were identified through screening at a health examination (HE). The main sources of referral to TB clinics were emergency departments (27%) and primary health care centers (20%). Median health care provider delay was significantly longer in patients identified through migrant screening in health examination.ConclusionsScreening at a health examination was the main pathway of active TB detection among mainly asymptomatic and non-contagious asylum seekers but contributed modestly to total overall TB case detection. In these patients TB was diagnosed early in a non-contagious phase of the disease. Further research is required to assess the effectiveness and cost-effectiveness of HE TB screening as well as inclusion of other groups of migrants from high incidence countries in the screening program in terms of impact on delay, transmission and treatment outcomes.

Circles of Trust: A Proposal for Better Migrant Screening

Screening potential entrants is a major challenge to any system of immigration, and has become particularly salient in the Trump era. At bottom, the problem is one of information asymmetry, in which migrants hold private information as to their abilities and intentions. We propose a new approach that leverages information that refugees, migrants and guest workers have about each other. Potential applicants to enter the US from disfavored classes would have to apply as a small group, called a trust circle. Once inside the country, all members would be subject to periodic, onerous bureaucratic requirements, but these would be waived over time for trust circles that remain in good standing. However, if anyone within a trust circle became involved in hostile or criminal activities, every member of the trust group would summarily lose their privileges. Knowing this, potential migrants will only associate with others they know to be trustworthy, and would have incentives to expose others in the group who adopt bad behaviors post-entry.

Circles of Trust: A Proposal for Better Migrant Screening

AbstractScreening potential entrants is a major challenge to any system of immigration. At bottom, the problem is one of information asymmetry, in which migrants hold private information as to thei...

Tuberculosis and latent tuberculous infection screening of migrants in Europe: comparative analysis of policies, surveillance systems and results.

Migration patterns into and within Europe have changed over the last decade. In 2015, European Union (EU) countries received over 1.2 million asylum requests, more than double the number registered in the previous year. This review compares the published literature on policies for tuberculosis (TB) and latent tuberculous infection (LTBI) screening in EU and European Free Trade Association (EFTA) countries with the existing TB/LTBI screening programmes for migrants in 11 EU/EFTA countries based on a survey of policy and surveillance systems. In addition, we provide a systematic review of the literature on the yield of screening migrants for active TB and LTBI in Europe. Published studies provide limited information about screening coverage and the yield of screening evaluations in EU/EFTA countries. Furthermore, countries use different screening strategies and settings, and different definitions for coverage and yield of screening for active TB and LTBI. We recommend harmonising case definitions, reporting standards and policies for TB/LTBI screening. To achieve TB elimination targets, a European platform for multi-country data collection and analysis, sharing of countries' policies and practices, and harmonisation of migrant screening strategies is needed.

Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland

SummaryBackgroundTuberculosis elimination in countries with a low incidence of the disease necessitates multiple interventions, including innovations in migrant screening. We examined a cohort of migrants screened for tuberculosis before entry to England, Wales, and Northern Ireland and tracked the development of disease in this group after arrival.MethodsAs part of a pilot pre-entry screening programme for tuberculosis in 15 countries with a high incidence of the disease, the International Organization for Migration screened all applicants for UK visas aged 11 years or older who intended to stay for more than 6 months. Applicants underwent a chest radiograph, and any with results suggestive of tuberculosis underwent sputum testing and culture testing (when available). We tracked the development of tuberculosis in those who tested negative for the disease and subsequently migrated to England, Wales, and Northern Ireland with the Enhanced Tuberculosis Surveillance system. Primary outcomes were cases of all forms of tuberculosis (including clinically diagnosed cases), and bacteriologically confirmed pulmonary tuberculosis.FindingsOur study cohort was 519 955 migrants who were screened for tuberculosis before entry to the UK between Jan 1, 2006, and Dec 31, 2012. Cases notified on the Enhanced Tuberculosis Surveillance system between Jan 1, 2006, and Dec 31, 2013, were included. 1873 incident cases of all forms of tuberculosis were identified, and, on the basis of data for England, Wales, and Northern Ireland, the estimated incidence of all forms of tuberculosis in migrants screened before entry was 147 per 100 000 person-years (95% CI 140–154). The estimated incidence of bacteriologically confirmed pulmonary tuberculosis in migrants screened before entry was 49 per 100 000 person-years (95% CI 45–53). Migrants whose chest radiographs were compatible with active tuberculosis but with negative pre-entry microbiological results were at increased risk of tuberculosis compared with those with no radiographic abnormalities (incidence rate ratio 3·2, 95% CI 2·8–3·7; p<0·0001). Incidence of tuberculosis after migration increased significantly with increasing WHO-estimated prevalence of tuberculosis in migrants' countries of origin. 35 of 318 983 pre-entry screened migrants included in a secondary analysis with typing data were assumed index cases. Estimates of the rate of assumed reactivation tuberculosis ranged from 46 (95% CI 42–52) to 91 (82–102) per 100 000 population.InterpretationMigrants from countries with a high incidence of tuberculosis screened before being granted entry to low-incidence countries pose a negligible risk of onward transmission but are at increased risk of tuberculosis, which could potentially be prevented through identification and treatment of latent infection in close collaboration with a pre-entry screening programme.FundingWellcome Trust, UK National Institute for Health Research, UK Medical Research Council, Public Health England, and Department of Health Policy Research Programme.

Migrant screening: Lessons learned from the migrant holding level at the Greek-Turkish borders.

In March 2011, a migrant health project became operational that aimed to provide medical and psychosocial support to migrants at the Greek-Turkish border. The aim of this study is to describe common syndromes, the communicable disease profile and vaccination patterns in newly arrived migrants through a surveillance system that was based on medical records data as well as screening procedures. Data were collected prospectively using one standardized form per patient including demographic information, civil status, and medical and vaccination history. A tuberculin screening test (TST) and serological testing for HIV, hepatitis B and hepatitis C were performed after obtaining informed consent. A total of 6899 migrants were screened, the majority of whom were male (91%) and 18-31 years old (85%), with a mean age of 25.3 years. Of all patients, 2.5% received secondary care. Common complaints and diagnoses included respiratory infections (23%) and myalgia (18%). The tuberculin screening test (TST) was positive in 7.8% out of 1132 patients tested. Out of 632 migrants, 0.3%, 3.2% and 0.8% tested positive for HIV, hepatitis B and hepatitis C, respectively. Overall, 22.3% of adults were vaccinated against poliomyelitis. Irregular migrants that enter Greek borders are generally in good health. Nevertheless, the risk of spreading communicable diseases is an important issue to consider among migrants at the holding level due to severe overcrowding conditions. Therefore, there is a need to strengthen surveillance and implement harmonized screening procedures with the aim of providing sustainable and good quality services that are focused on prevention and early treatment.

CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines.

Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and sub-tropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal. To provide clinical guidance on the prevention, assessment and management of disseminated strongyloidiasis. A literature review was conducted to evaluate the current evidence and to identify any systematic reviews, case reports, guidelines and peer reviewed and non-peer reviewed medical literature. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a working group to develop this statement, which was then critically reviewed and approved by all CATMAT members. CATMAT recommends that screening for strongyloidiasis should be considered for individuals with epidemiologic risk and/or co-morbidities that place them at risk for Strongyloides hyperinfection and dissemination. Those at highest risk of hyperinfection and dissemination are individuals born in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool. Strongyloidiasis is relatively widespread in the global migrant population and screening for the disease should be based on an individual risk assessment. A practical tool for the clinician to use in the prevention, assessment and management of disseminated strongyloidiasis in Canada is now available.

Widening the net or streamlining the process? Migrant health screening and securitisation in Australia and beyond

This article critically examines the rise of forms of biometric health screening in relation to migrant bodies in Australia and beyond. It argues that whilst we should be cognisant of the opportunities presented by expedited health screening practices, we should also attend to the potential risks presented by the adoption of these practices. This includes concerns about stigma and privacy in an era of securitisation and information sharing across national borders.

Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis

Several high-income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes to inform evidence-based policy for migrant health screening. We searched six bibliographic databases for experimental or observational studies and systematic reviews, which reported data on migrant screening for active or latent tuberculosis by any method before migration to a low-incidence country. Primary outcomes were principal reported screening yield of active tuberculosis, yield of culture-confirmed cases, and yield of sputum smear for acid-fast bacilli cases. Where appropriate, fixed-effects models were used to summarise the yield of pre-entry screening across included studies. We identified 15 unique studies with data for 3 739 266 migrants screened pre-entry for tuberculosis between 1982 and 2010. Heterogeneity was high for all primary outcomes. After stratification by prevalence in country of origin, heterogeneity was reduced for culture-confirmed and smear-confirmed cases. Yield of culture-confirmed cases increased with prevalence in the country of origin, and summary estimates ranged from 19·7 (95% CI 10·3-31·5) cases identified per 100 000 individuals screened in countries with a prevalence of 50-149 cases per 100 000 population to 335·9 (283·0-393·2) per 100 000 in countries with a prevalence of greater than 350 per 100 000 population. Targeting high-prevalence countries could result in the highest yield for active disease. Pre-entry screening should be considered as part of a broad package of measures to ensure early diagnosis and effective management of migrants with active tuberculosis, and be integrated with initiatives that address the health needs of migrants. Wellcome Trust, UK National Institute for Health Research, Medical Research Council, Public Health England.

Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations

A systematic literature review was performed with the objective of assessing the effectiveness of tuberculosis (TB) screening methods and strategies in migrants in European Union/European Economic Area (including Switzerland) countries. Extracted data on yield and coverage were used as indicators of effectiveness. Reported yields varied considerably between studies and countries. Considering only the 14 studies representative of national screening programmes, a median yield of TB disease of 0.18% (interquartile range 0.10-0.35%) was reported. The data did not indicate differences in effectiveness between the three main strategies: 1) screening at port of entry; 2) screening just after arrival in reception/holding centres; and 3) screening in the community following arrival in European Union countries. The variation seen probably reflects variation in risk factors for TB, in particular the composition of the migrants entering the country. Recommendations include the need for improved data for guiding the optimal frequency and duration of screening; assessment and improvement of cost-effectiveness; access to healthcare for migrants, including illegal migrants; ensuring a continuum of care for those screened; and consideration of screening for latent TB infection with caution. Finally, screening should be a component of a wider approach, rather than a stand-alone intervention.

Immigration medical screening and HIV infection in Canada

HIV infection, particularly associated with AIDS, is often used by migrant screening nations to exclude entry into the country. The unique feature of the Canadian immigration HIV screening programme is that it was not primarily for determining inadmissibility of HIV-positive applicants, but for health promotion and disease prevention purposes. All applicants over 15 years of age for permanent residency or temporary residency from designated countries are HIV antibody tested. This includes persons seeking asylum from within Canada. The highest rates of HIV infection were found in migrant applicants from high prevalence areas of the world and reflected the demographic profile of the source region (predominately women). The majorities of HIV-positive persons are exempt from exclusion from Canada due to class of application (refugee, family) or are already in Canada (refugee claimant). Significant issues in notification, reporting and programme management have been identified as a consequence of this programme.

Improved Sensitivity of Sputum Smear Microscopy after Processing Specimens with C 18 -Carboxypropylbetaine To Detect Acid-Fast Bacilli: a Study of United States-Bound Immigrants from Vietnam

The goal of this study was to evaluate the effect of the specimen-processing method that uses the detergent C18-carboxypropylbetaine (CB-18) on the sensitivity of acid-fast bacillus (AFB) staining. Vietnamese immigrants with abnormal chest radiographs provided up to three sputum specimens, which were examined for acid-fast bacilli by use of direct auramine and Ziehl-Neelsen staining. The remaining sputum was split; half was cultured, and the other half was incubated with CB-18 for 24 h, centrifuged, and examined for AFB by both staining methods. CB-18 processing improved the sensitivity of AFB staining by 20 to 30% (only differences in auramine sensitivity were statistically significant) but reduced specificity by approximately 20% (P < 0.05). These findings have direct utility for overseas migrant tuberculosis screening programs, for which maximizing test sensitivity is a major objective.

Multi‐drug resistant tuberculosis in migrants

Between 1986 and 1989 three Vietnamese migrants presented at the Perth Chest Clinic with multiple-drug resistant tuberculosis of the lungs. This resistance was to both rifampicin and isoniazid in addition to other antituberculous drugs. Although all three had a long history of past intermittent treatment for tuberculosis and extensive active disease, they were not detected in spite of what should have been adequate premigration screening. This report is to alert those medical personnel concerned with the process of migrant health screening and surveillance. The implications of such multi-drug resistant disease on tuberculosis control in Australia is also briefly discussed.