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

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

^* To whom correspondence should be addressed. E-mail: zohar.mor{at}moh.health.gov.il.

	Abstract

Israel absorbs displaced immigrants from Ethiopia, in which tuberculosis incidence is 44 times higher than in Israel (344 vs. 8 per 100,000, respectively). The aims of this retrospective cohort study were to evaluate the pre-immigration screening process initiated in 2001 on pulmonary tuberculosis (PTB) morbidity and to assess its cost-effectiveness.

Ethiopian immigrants who were screened before departure (study group) were compared to 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%), demonstrating incidence density of 325 patients: 100,000 persons-years. PTB cumulative incidence was lower in the study than in the comparison group, demonstrating 711 and 1,746 patients: 100,000 immigrants, respectively (RR=0.4). PTB was detected earlier in the study than in the comparison group (193 vs. 487 days from entry, respectively, p<0.01). Disease incidence declined significantly during the first two years following immigration. A five-year predictive model indicated that 98 individuals would be free of PTB, saving US $91,055 annual treatment cost, due to screening.

Pre-immigration screening process reduced PTB incidence in subsequent years following immigration. PTB was diagnosed earlier in the screened group than in the comparison group and the process was found cost-benefit and cost-effective.