BMJ  2004;328:897 (10 April), doi:10.1136/bmj.328.7444.897-a

Letter

Compulsory screening of immigrants for TB and HIV

Screening could detect latent infection

EDITOR—The enormous problem of tuberculosis in many parts of the world and the emergence of drug resistant strains are important matters to consider when revising control programmes for tuberculosis. In many countries a high incidence of the disease among immigrants has led to calls for improvements in detecting and treating latent infection.

Coker questions the suggestion that screening for tuberculosis in immigrants should be compulsory.¹ He says that most active disease develops after immigration and that early diagnosis has not been shown to convey public health benefits. However, screening can also detect latent infection with Mycobacterium tuberculosis.²

In Norway in 2001 the incidence of tuberculosis was 550/100 000 in African immigrants and 1.9/100 000 in natives.³ Immigrants represent over 70% of cases of tuberculosis in Norway.³ The rate of transmission is, however, low, indicating that most immigrants with tuberculosis arrive with latent infection that could be detected by screening on arrival. Similar numbers have been shown in other countries.

Entry screening of immigrants is cost effective and results in public health benefits.^{2 4} Also, an imported drug resistant strain of M tuberculosis caused an outbreak which could have been avoided if latent infection had been detected and treated in the index case on arrival.⁵ Screening immigrants from high-burden countries for latent infection is well grounded in individual and public health interests. People with latent infection can be offered preventive treatment or close follow up.^{3 5}

Division of Infectious Disease Control, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway ulf.dahle{at}fhi.no

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Competing interests: URD is a scientist working with tuberculosis and has previously advocated the need to improve the screening of immigrants for tuberculosis.

References

1. Coker R. Compulsory screening of immigrants for tuberculosis and HIV. BMJ 2004;328: 298-300. (7 February.)[Free Full Text]
2. Khan K, Muennig P, Behta M, Zivin JG. Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. N Engl J Med 2002;347: 1850-9.[Abstract/Free Full Text]
3. Dahle UR, Sandven P, Heldal E, Caugant DA. Continued low rates of transmission of Mycobacterium tuberculosis in Norway. J Clin Microbiol 2003;41: 2968-73.[Abstract/Free Full Text]
4. Verver S, van Soolingen D, Borgdorff MW. Effect of screening of immigrants on tuberculosis transmission. Int J Tuberc Lung Dis 2002;6: 121-9.[ISI][Medline]
5. Dahle UR, Sandven P, Heldal E, Mannsaaker T, Caugant DA. Deciphering an outbreak of drug resistant Mycobacterium tuberculosis. J Clin Microbiol 2003;41: 67-72.[Abstract/Free Full Text]

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Compulsory screening of immigrants for tuberculosis and HIV

Richard Coker
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