University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy; Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.
Travel Med Infect Dis. 2019 Jan-Feb;27:39-45. doi: 10.1016/j.tmaid.2018.10.015. Epub 2018 Oct 19.
The World Health Organization conditionally recommends systematic screening of tuberculosis (TB) and Latent Tuberculosis Infection (LTBI) among asylum seekers (AS) from high-burden countries, but the effectiveness of different screening approaches is controversial.
We report the results of a retrospective cohort analysis of TB and LTBI screening among consecutive AS in Brescia, Italy during 2015-2016. TB screening was based on symptoms, LTBI screening on the tuberculin skin test (TST). Logistic regression analysis was performed to identify factors associated with screening uptake.
Of 2904 registered AS 2567 (88.4%) were evaluated for TB, 62 (2.4%) had symptoms and active TB yield was 155/100,000. Prevalence and incidence TB rates were 545/100,000 persons and 220/100,000 person-years. Questionnaire screening identified 28.6% (4/14) prevalent cases. Of 2303 (89.7%) AS with TST result, the positivity rate was 36.6% (843/2303). Of the 843 candidates for LTBI treatment 413 (49.0%) completed the screening. LTBI treatment was prescribed to 190 (47.9%) of 397 eligible individuals, 10.8% (91) completed treatment.
TB prevalence and incidence rates were high in this AS population, but symptom-based screening performed poorly. LTBI cascade losses were significant and mainly attributable to the defragmentation of the health care system.
世界卫生组织有条件地建议对来自高负担国家的寻求庇护者（AS）进行结核病（TB）和潜伏性结核感染（LTBI）的系统筛查，但不同筛查方法的效果存在争议。
我们报告了 2015 年至 2016 年期间意大利布雷西亚连续 AS 中 TB 和 LTBI 筛查的回顾性队列分析结果。TB 筛查基于症状，LTBI 筛查基于结核菌素皮肤试验（TST）。进行逻辑回归分析以确定与筛查参与相关的因素。
在 2904 名登记的 AS 中，有 2567 名（88.4%）接受了 TB 评估，有 62 名（2.4%）有症状，活动性 TB 发生率为 155/100,000。TB 的患病率和发病率分别为 545/100,000 人和 220/100,000 人年。问卷调查筛查发现了 28.6%（4/14）的现患病例。在 2303 名（89.7%）有 TST 结果的 AS 中，阳性率为 36.6%（843/2303）。在 843 名 LTBI 治疗候选者中，有 413 名（49.0%）完成了筛查。LTBI 治疗方案被开给了 397 名符合条件的人中的 190 名（47.9%），有 10.8%（91 名）完成了治疗。
在这个 AS 人群中，TB 的患病率和发病率很高，但基于症状的筛查效果不佳。LTBI 级联损失很大，主要归因于卫生保健系统的碎片化。
