ArticleBMC infectious diseases2019
Using country of origin to inform targeted tuberculosis screening in asylum seekers: a modelling study of screening data in a German federal state, 2002-2015.
Article in BMC infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Prevalence of Tuberculosis among migrants under national screening programs: a systematic review and meta-analysis.Global health research and policy · 2025Pooled it
- Mandatory, voluntary, repetitive, or one-off post-migration follow-up for tuberculosis prevention and control: A systematic review.PLoS medicine · 2023Pooled it
- Tuberculosis Disease and Infection in US-Bound International Adoptees: 2016 to 2023.Pediatrics · 2026Article
- Tuberculosis in United States-Bound Follow-to-Join Asylees, 2014-2019.The American journal of tropical medicine and hygiene · 2024Article
- Overcoming denominator problems in refugee settings with fragmented electronic records for health and immigration data: a prediction-based approach.BMC medical research methodology · 2024Article
- Tuberculosis screening in migrants to the EU/EEA and UK.The European respiratory journal · 2023Article
- German Health Update Fokus (GEDA Fokus) among Residents with Croatian, Italian, Polish, Syrian, or Turkish Citizenship in Germany: Protocol for a Multilingual Mixed-Mode Interview Survey.JMIR research protocols · 2023Article
- Active and latent TB screening in recently arrived persons from Afghanistan: feasibility and lessons learned.Clinical medicine (London, England) · 2023Article
- Health status of recently arrived asylum seekers in their host country: results of a cross-sectional observational study.BMC public health · 2022Observational
- Tuberculosis in migrants - screening, surveillance and ethics.Pneumonia (Nathan Qld.) · 2020Review
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundScreening programmes for tuberculosis (TB) among immigrants rarely consider the heterogeneity of risk related to migrants' country of origin. We assess the performance of a large screening programme in asylum seekers by analysing (i) the difference in yield and numbers needed to screen (NNS) by country and WHO-reported TB burden, (ii) the possible impact of screening thresholds on sensitivity, and (iii) the value of WHO-estimated TB burden to improve the prediction accuracy of screening yield.
methodsWe combined individual data of 119,037 asylum seekers screened for TB in Germany (2002-2015) with TB estimates of the World Health Organization (WHO) (1990-2014) for their 81 countries of origin. Adjusted rate ratios (aRR) and 95% credible intervals (CrI) of the observed yield of screening were calculated in Bayesian Poisson regression models by categories of WHO-estimated TB incidence. We assessed changes in sensitivity depending on screening thresholds, used WHO TB estimates as prior information to predict TB in asylum seekers, and modelled country-specific probabilities of numbers needed to screen (NNS) conditional on different screening thresholds.
resultsThe overall yield was 82 per 100,000 and the annual yield ranged from 44.1 to 279.7 per 100,000. Country-specific yields ranged from 10 (95%- CrI: 1-47) to 683 (95%-CrI: 306-1336) per 100,000 in Iraqi and Somali asylum seekers, respectively. The observed yield was higher in asylum seekers from countries with a WHO-estimated TB incidence > 50 relative to those from countries ≤50 per 100,000 (aRR: 4.17, 95%-CrI: 2.86-6.59). Introducing a threshold in the range of a WHO-estimated TB incidence of 50 and 100 per 100,000 resulted in the lowest "loss" in sensitivity. WHO's TB prevalence estimates improved prediction accuracy for eight of the 11 countries, and allowed modelling country-specific probabilities of NNS.
conclusionsWHO's TB data can inform the estimation of screening yield and thus be used to improve screening efficiency in asylum seekers. This may help to develop more targeted screening strategies by reducing uncertainty in estimates of expected country-specific yield, and identify thresholds with lowest loss in sensitivity. Further modelling studies are needed which combine clinical, diagnostic and country-specific parameters.
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