Volume 18, Number 9—September 2012
Evaluation of Immigrant Tuberculosis Screening in Industrialized 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|
|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|
|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|
|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.