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Volume 18, Number 9—September 2012

Research

Evaluation of Immigrant Tuberculosis Screening in Industrialized Countries

Manish Pareek, Iacopo Baussano, Ibrahim Abubakar, Christopher Dye, and Ajit LalvaniComments to Author 
Author affiliations: Imperial College London, London, UK (M. Pareek, A. Lalvani); University of Leicester, Leicester, UK (M. Pareek); Univeristà degli Studi del Piemonte Orientale, Novara, Italy (I. Baussano); University College London, London (I. Abubakar); University of East Anglia, Norwich, UK (I. Abubakar); and World Health Organization, Geneva, Switzerland (C. Dye)

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Table 2

Selection criteria for screening immigrants for active TB in selected OECD countries*

Country Timing of screening relative to arrival in host country
Active tuberculosis target groups and immigrants selected for screening
Prearrival At arrival Postarrival Age Threshold of TB incidence/100,000 population Target countries/regions Intended duration of residence that triggers screening, mo
Australia Yes No Yes† All NA All countries >3–12‡
Austria Yes No Yes† All NA All countries except United States, Canada, and EU N/U
Belgium No Yes§ Yes† All >50 NA N/U
Canada Yes No Yes† All >15¶ NA N/U
Czech Republic Yes No Yes All All (if refugee/asylum seekers); otherwise, Kenya, Congo, Moldova, Mongolia, Nigeria, Pakistan, Turkmenistan, Tajikistan, Uzbekistan, and Vietnam >3 and applying for long-term stay
Finland No No Yes All >50 NA N/U
France Yes¶ No Yes All NA All countries except those in EU and North America, and Japan, New Zealand. and Australia >2
Germany No No Yes All NA All high-incidence countries N/U
Greece No No Yes All NA All countries except those in EU N/U
Iceland No No Yes All NA All countries except those in EU (except Bulgaria and Romania),and Australia, New Zealand, Switzerland, United States, and Canada N/U
Ireland No No Yes All >40 NA >3
Israel Yes No No >6 mo NA Sub-Saharan Africa, Horn of Africa, and Southeast Asia N/U
South Korea No No Yes All NA North Korea N/U
Luxembourg No No Yes All NA All countries except those in EU >3
The Netherlands No No Yes** All NA All countries except those in EU, and Australia, Canada, Iceland, Israel, Japan, Monaco, New Zealand, Norway, Surinam, Switzerland, and United States >3
New Zealand Yes No Yes† ≥11 y NA All countries except those in North America and EU >6
New Zealand Yes No Yes† ≥11 y NA All countries >12
Norway No Yes Yes† All NA All countries except those in EU, and United States, Canada, Australia, Japan, and New Zealand >3
Poland No No Yes All NA All countries except those in EU N/U
Portugal No No Yes All NA All countries N/U
Slovakia No Yes Yes† All NA All countries except those in EU N/U
Slovenia No No Yes All NA Asia, Africa and eastern Europe N/U
Sweden No No Yes All >100 NA N/U
Switzerland No Yes No All NA All countries N/U
United Kingdom Yes†† Yes Yes All >40 NA >6
United States Yes‡‡ No Yes†,§§ All‡‡,§§ NA All countries‡‡,§§ Varies¶¶

*OECD, Organisation for Economic Co-operation and Development; TB, tuberculosis; NA, not applicable; EU, European Union; N/U, not known/unclear.
†Postarrival screening for asylum seekers/refugees.
‡Immigrants from low-risk countries (American Samoa, Andorra, Antigua and Barbuda, Australia, Austria, Barbados, Belgium, Bermuda, Canada, Chile, Costa Rica, Cuba, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Grenada, Iceland, Ireland, Israel, Italy, Jamaica, Jordan, Libyan Arab Jamahiriya, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Netherlands Antilles, New Zealand, Norway, Oman, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, San Marino, Slovakia, Slovenia, Sweden, Switzerland, Trinidad and Tobago, United Kingdom and Northern Ireland, United States, US Virgin Islands, Vatican City) require chest radiographs when applying for permanent stay; immigrants from medium-risk countries (Albania, Algeria, Anguilla, Argentina, Bahamas, Belize, Bosnia and Herzegovina, Brazil, Colombia, Cook Islands, Egypt, Fiji, French Polynesia, Guam, Hungary, Iran, Japan, Kuwait, Lebanon, Macedonia [the former Yugoslav Republic], Maldives, Mauritius, Mexico, Montenegro, New Caledonia, Panama, Poland, Portugal, Saint Vincent and the Grenadines, Samoa, Serbia, Seychelles, Singapore, Spain, Syria, Tahiti, Tonga, Tunisia, Turkey, United Arab Emirates, Uruguay, Venezuela, West Bank, and Gaza Strip.) are required to be screened for active TB if staying in Australia for >12 months or applying for permanent stay; immigrants from high-risk countries (all countries not listed above including China India, Indonesia, Malaysia, Pakistan, the Philippines, Russia, South Africa, South Korea, Thailand, and Vietnam) need to be screened for active TB if staying for >3 months or applying for permanent residence.
§Asylum seekers screened at arrival and then twice during the years after arrival (1 year in Flanders and 2 years in Brussels and Wallonia).
¶Countries with a 3-year average incidence of smear-positive TB >15 cases/100,000 population.
#Prearrival screening for Morocco, Tunisia, Turkey, and Poland; otherwise, postarrival in France.
**Immigrants/asylum seekers/refugees >12 years of age (>25 years in some regions) in the Netherlands from countries with TB incidence >200 cases/100,000 are screened after the initial entry chest radiograph with half-year chest radiographs for 2 years postentry.
††Prearrival screening for selected countries: Ghana, Burkina Faso, Côte d’Ivoire, Togo, Niger, Kenya, Eritrea, Somalia, Democratic Republic of the Congo, Rwanda, Uganda (visitor applications), Tanzania, Pakistan, Bangladesh, Sudan, Thailand, Cambodia, and Laos.
‡‡Prearrival screening conducted by a panel of physicians outside the United States; in countries with a TB incidence ≥20 cases/100,000, immigrants >15 years of age are screened by medical examination and chest radiograph, immigrants 2–14 years of age are screened by medical examination and tuberculin skin test (TST)/interferon-γ release assay (IGRA) (and chest radiograph if TST/IGRA results were positive) and those <2 years of age who have been screened by medical examination, which if suggestive of active TB, is followed by TST/IGRA with or with or without chest radiograph. In countries with a TB incidence <20 cases/100,000, immigrants >15 years of age undergo chest radiograph and those <15 years of age undergo medical examination which, if suggestive of active TB, is followed by TST/IGRA with or without chest radiograph.
§§Postarrival screening is either a repeat chest radiograph for an immigrant who was previously screened overseas or screening for active TB by medical examination or TST/IGRA with or without chest radiograph (if TST/IGRA results were positive) in immigrants >2 years of age who originated from all countries, are already resident in the United States, and are applying for adjustment of their visa status (undertaken by civil surgeons).
¶¶Any duration of stay or persons applying for long-term visa status.

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