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Pre-immigration screening process and pulmonary tuberculosis among Ethiopian migrants in Israel

¹ Public Health Services, Ministry of Health, ⁴ Brown School of Public Health of Hadassah and the Hebrew University, Jerusalem, ² Preventive Medicine Dept, Clalit Health Services, and ³ School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

CORRESPONDENCE: Z. Mor, Public Health Services, 20 King David St., P.O. Box 1176, Jerusalem 91010, Israel. Fax: 972 26233058. E-mail: zohar.mor{at}moh.health.gov.il

Keywords: Cost-effectiveness, immigration, Israel, latent tuberculosis infection, screening, tuberculosis

Received: November 3, 2007
Accepted March 10, 2008

More than 75,000 displaced Ethiopians have moved to Israel. Tuberculosis (TB) incidence in Ethiopia is 44 times higher than in Israel (344 versus 8 cases per 100,000 inhabitants, respectively). The aims of the present retrospective cohort study were to evaluate the pre-immigration screening process initiated in 2001 on pulmonary TB (PTB) morbidity and to assess its cost-effectiveness.

Ethiopian immigrants who were screened before departure (study group) were compared with those who were screened after arrival (comparison group).

Between 1998 and 2005, 24,051 Ethiopian immigrants arrived in Israel. PTB was diagnosed in 332 (1.4%) immigrants, an incidence density of 325 patients per 100,000 person-yrs. PTB cumulative incidence was lower in the study group than in the comparison group: 711 compared with 1,746 patients per 100,000 immigrants, respectively (rate ratio 0.4). PTB was detected significantly earlier in the study group than in the comparison group: 193 versus 487 days after entry, respectively. Disease incidence declined significantly during the first 2 yrs following immigration. A 5-yr predictive model indicated that 98 individuals would be free of PTB, saving US$91,055 on annual treatment cost, due to screening.

The pre-immigration screening process reduced pulmonary tuberculosis incidence in subsequent years following immigration. Pulmonary tuberculosis was diagnosed earlier in the screened group than in the comparison group and the process was found to be both cost-beneficial and cost-effective.