Coverage and yield of entry and follow-up screening for tuberculosis among new immigrants

¹ KNCV Tuberculosis Foundation, the Hague, The Netherlands
² Municipal Health Service Rotterdam, the Netherlands
³ Municipal Health Service Amsterdam and Haarlem, the Netherlands
⁴ previously KNCV Tuberculosis Foundation
⁵ Municipal Health Service Hart voor Brabant, the Netherlands
⁶ KNCV Tuberculosis Foundation, the Hague, The Netherlands; and Dept of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, the Netherlands

^* To whom correspondence should be addressed. E-mail: erkensc{at}kncvtbc.nl.

	Abstract

Determine the effectiveness of entry screening for tuberculosis and bi-annual follow-up screening among new immigrants in the Netherlands.

Analysis of screening, prevalence and incidence data on 68,122 immigrants, followed-up for 29 months. Patients diagnosed within 5 months and 6–29 months after entry screening were considered to be detected at entry and follow-up period, respectively.

Coverage of the second to fifth screening round was 59, 46, 36 and 34%, respectively. Yield of entry screening was 119 /100,000 persons, and prevalence at entry 131/100,000. Average yield of follow-up screening was highest among immigrants with abnormalities on the chest X-ray (CXR) at entry (902/100,000). When excluding these, yield of follow-up screening was 9/100,000, 37/100,000 and 97/100,000 screenings, for immigrants from countries with TB incidences of <100, 100–200, and >200 /100,000 respectively. The incidence during follow-up in persons with a normal CXR was 11, 58 and 145/100,000 persons years follow-up in these groups. The proportion of cases detected through screening declined per screening round from 91% to 31%.

Yield of entry screening was high. Overall coverage and yield of follow-up screening was low. Follow-up screening of immigrants with a normal CXR from countries with an incidence of <200/100,000 was therefore discontinued.

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