Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis

Robert W Aldridge; Tom A Yates; Dominik Zenner; Peter J White; Ibrahim Abubakar; Andrew C Hayward

doi:10.1016/S1473-3099(14)70966-1

Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis

Lancet Infect Dis. 2014 Dec;14(12):1240-9. doi: 10.1016/S1473-3099(14)70966-1. Epub 2014 Nov 7.

Authors

Robert W Aldridge¹, Tom A Yates², Dominik Zenner³, Peter J White⁴, Ibrahim Abubakar³, Andrew C Hayward²

Affiliations

¹ Research Department of Infection and Population Health, University College London, London, UK. Electronic address: rob.aldridge@gmail.com.
² Research Department of Infection and Population Health, University College London, London, UK.
³ Research Department of Infection and Population Health, University College London, London, UK; TB Section, Public Health England, London, UK.
⁴ Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.

PMID: 25455991
DOI: 10.1016/S1473-3099(14)70966-1

Abstract

Background: Several high-income countries have pre-entry screening programmes for tuberculosis. We aimed to establish the yield of pre-entry screening programmes to inform evidence-based policy for migrant health screening.

Methods: We searched six bibliographic databases for experimental or observational studies and systematic reviews, which reported data on migrant screening for active or latent tuberculosis by any method before migration to a low-incidence country. Primary outcomes were principal reported screening yield of active tuberculosis, yield of culture-confirmed cases, and yield of sputum smear for acid-fast bacilli cases. Where appropriate, fixed-effects models were used to summarise the yield of pre-entry screening across included studies.

Findings: We identified 15 unique studies with data for 3 739 266 migrants screened pre-entry for tuberculosis between 1982 and 2010. Heterogeneity was high for all primary outcomes. After stratification by prevalence in country of origin, heterogeneity was reduced for culture-confirmed and smear-confirmed cases. Yield of culture-confirmed cases increased with prevalence in the country of origin, and summary estimates ranged from 19·7 (95% CI 10·3-31·5) cases identified per 100 000 individuals screened in countries with a prevalence of 50-149 cases per 100 000 population to 335·9 (283·0-393·2) per 100 000 in countries with a prevalence of greater than 350 per 100 000 population.

Interpretation: Targeting high-prevalence countries could result in the highest yield for active disease. Pre-entry screening should be considered as part of a broad package of measures to ensure early diagnosis and effective management of migrants with active tuberculosis, and be integrated with initiatives that address the health needs of migrants.

Funding: Wellcome Trust, UK National Institute for Health Research, Medical Research Council, Public Health England.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Humans
Incidence
Mass Screening / methods*
Transients and Migrants*
Tuberculosis / diagnosis*

Abstract

Publication types

MeSH terms

Grants and funding