Volume 18, Number 9—September 2012
Evaluation of Immigrant Tuberculosis Screening in Industrialized 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|
|Austria||Yes||No||Yes†||All||NA||All countries except United States, Canada, and EU||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|
|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|
|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|
|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|
|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.
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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