Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis

Although there is no evidence that imported tuberculosis increases the incidence of the disease in host countries, the rise in migration worldwide raises concerns regarding the adequacy of surveillance and control of immigrant-associated tuberculosis in low incidence countries. Assessing the performance of screening of immigrants for tuberculosis is key to rationalising control policies for the detection and management of immigrant-associated tuberculosis. We performed a systematic review and meta-analysis to determine the yield of active screening for tuberculosis among new immigrants at the point of entry. The yield for pulmonary tuberculosis was 3.5 cases per 1,000 screened (95% CI 2.9-4.1; I-2=94%); for refugees, asylum seekers and regular immigrants the estimates were 11.9 (95% CI 6.7-17.2; I-2=92%), 2.8 (95% CI 2.0-3.7; I-2=96%) and 2.7 (95% CI 2.0-3.4; I-2=81%), respectively. The yield estimates for immigrants from Europe, Africa and Asia were 2.4 (95% CI 1.3-3.4; I-2=51.5%), 6.5 (95% CI 3.2-10.0; I-2=62%) and 11.2 (95% CI 6.2-16.1; I-2=95%), respectively. These results provide useful data to inform the development of coherent policies and rational screening services for the detection of immigrant-associated tuberculosis.