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Tuberculosis screening in migrants in selected European countries shows wide disparities

¹ ECOHOST, Dept of Public Health and Policy, London School of Hygiene and Tropical Medicine, ² Centre for Infections, Health Protection Agency, ⁵ UCL Centre for Infectious Disease Epidemiology, Dept of Primary Care and Population Sciences, Royal Free and University College Medical School, ⁷ North East London TB Network, Dept of Respiratory Medicine, Homerton University Hospital, London and ⁸ Mayday University Hospital, Croydon, UK, ³ Swiss Lung Association, Berne, Switzerland, ⁴ Norwegian Institute of Public Health, and ⁶ Correctional Services Dept, Ministry of Justice and the Police, Oslo, Norway, ⁹ Dept of Tuberculosis Control, Municipal Health Service Rotterdam, Rotterdam, The Netherlands.

CORRESPONDENCE: R. Coker, ECOHOST, Dept of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fax: 44 2076127812. E-mail: richard.coker{at}lshtm.ac.uk

Keywords: Europe, screening, tuberculosis

Received: September 6, 2006
Accepted November 11, 2005

Well-established tuberculosis screening units in Western Europe were selectively sampled. Three screening units in Norway, two in the UK, one in the Netherlands and one in Switzerland were evaluated. The aim of this study was to describe a range of service models used at a number of individual tuberculosis units for the screening of new entrants into Europe.

Semi-structured interviews were conducted with clinicians, nurses and administrators from a selected sample of European tuberculosis screening units. An outline of key themes to be addressed was forwarded to units ahead of scheduled interviews. Themes included the history of the unit, structure, processes and outputs involved in screening new entrants for tuberculosis.

Considerable variation in screening services exists in the approaches studied. Units are sited in transit camps or as units within hospital facilities. Staff capacity and administration varies from one clinic per week with few dedicated staff to fully dedicated units. Only one site recorded symptoms; tuberculin testing was universal in children, but varied in adults; chest radiograph screening was universal except at one site where a positive tuberculin skin test or symptoms were required in those <35 yrs of age before ordering a radiograph. Few output data are routinely and systematically collected, which hinders comparison and determination of effectiveness and efficiency.

Service models for screening new immigrants for tuberculosis appear to vary in Western Europe. The systematic collection of data would make international comparisons between units easier and help draw conclusions that might usefully inform service development.

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