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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

BMC Infectious Diseases Apr 06, 2019

Bozorgmehr K, et al. - Among asylum seekers, the accuracy of a large screening program was assessed. For this purpose, researchers evaluated the difference in yield and numbers required to screen by country and World Health Organization (WHO)-reported tuberculosis (TB) burden, if screening thresholds influence sensitivity, and if WHO-estimated TB burden can improve the accuracy of predicting screening yield. Individual data from 119,037 asylum seekers screened for TB in Germany (2002–2015) was combined with TB estimates from WHO (1990–2014) for their 81 countries of origin. Analysis revealed the overall yield of 82 per 100,000 and the annual yield of 44.1 to 279.7 per 100,000. Country-specific yields ranged from 10 per 100,000 in Iraqi asylum seekers to 683 per 100,000 in Somali asylum seekers. Asylum seekers from countries with a WHO-estimated TB incidence > 50 per 100,000 had higher yield relative to those from countries that were ≤50 per 100,000. The lowest “loss” in sensitivity was observed with the introduction of a threshold in the range of a WHO-estimated TB incidence of 50 and 100 per 100,000. For eight of the 11 countries, WHO’s TB prevalence estimates led to improvement in prediction accuracy in addition to allowing modeling country-specific probabilities of NNS.

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