Tuberculosis screening among newly arrived asylum seekers in Denmark

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Migration Health

Background:

• Tuberculosis (TB) screening in asylum seekers often prioritizes chest radiography (CXR), with limited focus on sputum examination.
• This study evaluated active TB screening methods, including CXR and sputum culture, for newly arrived asylum seekers in Denmark.
• The study also assessed the reach of a voluntary general health assessment program.

Purpose of the Study:

• To evaluate the effectiveness of active tuberculosis screening using chest radiography (CXR) and sputum culture in asylum seekers.
• To determine the yield of TB cases identified through these screening methods.
• To assess the coverage of voluntary general health assessments for asylum seekers.

Main Methods:

• A prospective study was conducted from February 2017 to March 2019, including asylum seekers aged 18 years and older from high-incidence TB countries or at-risk groups.
• Participants were offered active TB screening with CXR and spot sputum examination (culture and smear microscopy).
• Coverage of the general health assessment was also evaluated.

Main Results:

• The general health assessment coverage was 65.1%. Among 1,154 referred for TB screening, 923 (80.0%) attended.
• Chest radiography (CXR) screened 854 individuals, identifying one active TB case (0.12% yield).
• Sputum culture identified one *M. tuberculosis*-positive case (0.13% yield), which was also detected by CXR. No cases were solely identified by sputum culture. Three malignant diseases were also found.

Conclusions:

• Tuberculosis screening efforts should prioritize asylum seekers from high-incidence countries.
• Implementing early health assessments is essential for ensuring the health of migrants.
• Combining CXR and sputum culture may improve TB detection yield in this population.