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Coverage and yield of entry and follow-up screening for tuberculosis among new immigrants

¹ KNCV Tuberculosis Foundation, The Hague, ² Municipal Health Service Rotterdam, Rotterdam, ³ Municipal Health Service Amsterdam, and ⁵ Dept of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Amsterdam, and ⁴ Municipal Health Service Hart voor Brabant, Tilburg, The Netherlands.

CORRESPONDENCE: C. Erkens, KNCV Tuberculosis Foundation, P.O. Box 146, 2501 CC The Hague, The Netherlands. Fax: 31 703584004. E-mail: erkensc{at}kncvtbc.nl

Keywords: Chest radiograph, incidence, migrants, prevalence, screening, tuberculosis

Received: October 19, 2007
Accepted February 7, 2008

The aim of the present study was to determine the effectiveness of entry screening for tuberculosis and biannual follow-up screening among new immigrants in the Netherlands.

To achieve this, the present authors analysed screening, prevalence and incidence data of 68,122 immigrants, who were followed for 29 months. Patients diagnosed within 5 months and 6–29 months after entry screening were considered to be detected at entry and during the follow-up period, respectively.

Coverage of the second to fifth screening rounds was 59, 46, 36 and 34%, respectively. Yield of entry screening was 119 per 100,000 individuals, and prevalence at entry was 131 per 100,000. Average yield of follow-up screening was highest among immigrants with abnormalities on chest radiography (CXR) at entry (902 per 100,000 individuals). When excluding these, yield of follow-up screening was 9, 37 and 97 per 100,000 screenings for immigrants from countries with tuberculosis incidences of <100, 100–200 and >200 per 100,000, respectively. The incidence during follow-up in individuals with a normal CXR was 11, 58 and 145 per 100,000 person-yrs follow-up in these groups. The proportion of cases detected through screening declined per screening round from 91 to 31%.

Yield of entry screening was high. Overall coverage and yield of follow-up screening was low. Follow-up screening of immigrants with a normal chest radiograph from countries with an incidence of <200 per 100,000 individuals was therefore discontinued.