The identification of prevalent TB disease through TBI screening among high TB risk migrants in The Netherlands

In the consolidated guidelines for tuberculosis (TB) prevention and systematic screening for TB disease, WHO recommends countries with a low TB incidence to consider systematic screening for TB disease as well as testing for TB infection (TBI) and preventive TB treatment (TPT) for migrants from high TB burden countries [1, 2]. Many low TB burden countries, including the Netherlands, perform TB screening among those migrants [3]. In the Netherlands, migrants are mandatorily screened for TB by chest X-ray (CXR) within 3 months after entry; migrants from countries with an estimated WHO TB incidence of >200 per 100 000 are also offered voluntary biannual follow-up screening for two years. As part of the Dutch TB ENDPoint project, three implementation studies showed practical feasibility of TBI screening and treatment among newly arriving immigrants of all ages [4], asylum seekers age ≥12 years [5], and settled (Eritrean) migrants of all ages [6]. The TBI screening algorithm consisted of TB symptom screening and TBI testing (tuberculin skin test (TST) and/or interferon gamma release assay (IGRA)), with an additional CXR to exclude TB disease among persons with TB symptoms or positive TBI test [7]. To consider the replacement of CXR screening with this TBI screening algorithm, evidence is needed on the effectiveness of the TBI screening, including the assessment of the risk of missing persons with TB disease at the time of screening. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Spruijt has nothing to disclose. Conflict of interest: Dr. Joren has nothing to disclose. Conflict of interest: Dr. Schimmel has nothing to disclose. Conflict of interest: Dr. Procee has nothing to disclose. Conflict of interest: Dr. Alam has nothing to disclose. Conflict of interest: Dr. van den Hof has nothing to disclose. Conflict of interest: Dr. Erkens has nothing to disclose.