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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 4

Location of and selection criteria for screening immigrants for latent tuberculosis in selected OECD countries*

Country Timing of screening
Criteria by which migrants are selected for latent tuberculosis screening
Screening tools used
Prearrival At arrival Postarrival Type of immigrants
Age TB incidence/ 100,000 population Target regions Intended duration of residence that triggers screening
Legal Refugees/ asylum seekers
Belgium No Yes Yes Yes (selected) Yes <5 y† >50 NA N/U TST
Czech Republic No No Yes No Yes <15 y NA All N/U TST
France No No Yes Yes Yes <15 y All countries except those in EU and North America, and Japan, New Zealand, and Australia >2 mo TST
Greece No No Yes Yes Yes All NA All N/U TST‡
Iceland No No Yes Yes Yes <35 y NA All countries except those in EU (except Bulgaria and Romania), and Australia, New Zealand, Switzerland, United States, and Canada >1 y TST
Ireland No No Yes Yes Yes <35 y >40§; >500/sub-Saharan Africa§ >500/sub-Saharan Africa§ >3 mo TST
Israel Yes¶ No Yes¶ Yes No >6 mo NA Ethiopia TST
Luxembourg No No Yes Yes Yes All NA All >3 mo TST
The Netherlands No No Yes Yes Yes <12 y# NA All countries except those in EU, and Australia, Canada, Iceland, Israel, Japan, Monaco, New Zealand, Norway, Surinam, Switzerland, and United States >3 mo TST‡
Norway No Yes Yes Yes Yes <40 y NA All countries except those in EU, and United States, Canada, Australia, Japan, and New Zealand >3 mo TST and confirmatory IGRA
Portugal No No Yes No Yes All NA All N/U TST and confirmatory IGRA
Slovak Republic No No Yes Yes Yes All NA All countries except those in EU N/U TST and confirmatory IGRA
Slovenia No No Yes Yes (selected) Yes All NA Asia, Africa, and eastern Europe N/U IGRA
Sweden No No Yes No Yes All >100 NA N/U TST
United Kingdom No No Yes Yes Yes <35 y >40** NA >6 mo TST and confirmatory IGRA or IGRA alone
United States Yes†† No Yes Yes‡‡ Yes 2–14 y†† or >2 y§§ ≥20† All§§ N/U TST or IGRA

*OECD, Organisation for Economic Co-operation and Development; TB, tuberculosis; NA, not applicable; N/U, not known/unclear; TST, tuberculin skin test; EU, European Union; IGRA, IGRA, interferon-γ release assay.
†In general, children <5 years of age are screened for latent TB although pregnant women of any age can also be screened.
‡TST is mainly used although IGRA can be used optionally if diagnosis is unclear in confirming the TST result.
§If <16 years of age; screening adults (16–35 years of age) from >500 cases/100,000 or from sub-Saharan Africa.
¶First step for TST for Jewish immigrants from Ethiopia is performed in Addis Ababa (i.e., prearrival) and the second step is performed postarrival in Israel.
#Applies to persons who were not vaccinated with Mycobacterium bovis BCG; in some centers in the Netherlands, immigrants <25 years of age are screened for latent TB infection.
**Previous threshold for United Kingdom was >40 cases/100,000 if <16 years of age and 500 cases/100,000 for sub-Saharan Africa if 16–35 years of age.
††In the US system, immigrants 2–14 years of age from countries with a TB incidence ≥20 cases/100,000 are screened with TST or IGRA prearrival in their country of origin. Some persons are therefore identified as having latent TB and are advised to seek medical attention on arrival in the United States.
‡‡In the US system, immigrants can be screened postarrival if their initial screening test results suggest that they have inactive TB.
§§All immigrants >2 years of age who apply to have their visa status adjusted (status adjusters) are screened by TST or IGRA.

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