Nederby Öhd Joanna, Lindström Battle Tobias, Jonsson Jerker, Dahlgren Sara, Tomacha Supamon, Widerström Micael, Nordenstedt Helena, Winqvist Niclas, Hergens Maria-Pia, Lönnroth Knut
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Communicable Disease Prevention and Control, Stockholm Region, Stockholm, Sweden.
Infect Dis (Lond). 2025 Jul 23:1-10. doi: 10.1080/23744235.2025.2534166.
Strategies for tuberculosis (TB) elimination in low-incidence countries involve screening recent migrants from TB-endemic regions for TB infection (TBI) and providing TB preventive treatment (TPT) to individuals with an increased risk of reactivation. This study aimed to determine TB incidence and identify reactivation risk markers in a cohort of asylum seekers in Sweden after screening.
We conducted a registry-based retrospective cohort study with a three-year follow-up of asylum seekers receiving post-arrival Interferon Gamma Release Assay (IGRA) screening in three Swedish regions 2015-2019. Medical records, health-examination records, and the national TB disease registry were linked using identification numbers or probabilistic methods. The primary outcome was TB disease more than 90 days post-screening. Explanatory variables included age, sex, IGRA-result (positive/negative), TPT-initiation, and TB incidence in the country of origin. Poisson and Cox regression addressed incidence rates (IR), incidence rate ratios (IRR), and hazard ratios over a three-year follow-up.
The cohort included 21 739 individuals and 70 467 person-years. Incident TB disease was recorded in 41 cases (IR 58.2/100 000 person-years). The IR for those with a positive IGRA was 321.7/100 000 person-years ( = 34). The highest risk was in persons aged under 20 with no TPT (1 279.0/100 000 person-years). Positive IGRA result, age under 20 years, and origin from TB-endemic country predicted incident TB.
Risk markers for incident TB were similar to findings previously reported. However, the observed 0.3% annual reactivation risk found among all IGRA-positive individuals in this study was considerably lower compared to earlier findings.
在低发病率国家消除结核病的策略包括对来自结核病流行地区的新移民进行结核病感染（TBI）筛查，并为有再激活风险增加的个体提供结核病预防性治疗（TPT）。本研究旨在确定瑞典一组寻求庇护者筛查后的结核病发病率，并确定再激活风险标志物。
我们进行了一项基于登记的回顾性队列研究，对2015 - 2019年在瑞典三个地区接受入境后干扰素-γ释放试验（IGRA）筛查的寻求庇护者进行了为期三年的随访。使用身份证号码或概率方法将医疗记录、健康检查记录和国家结核病疾病登记册进行关联。主要结局是筛查后90天以上发生的结核病。解释变量包括年龄、性别、IGRA结果（阳性/阴性）、TPT启动情况以及原籍国的结核病发病率。泊松回归和Cox回归分析了三年随访期间的发病率（IR）、发病率比（IRR）和风险比。
该队列包括21739人，共70467人年。记录到41例结核病发病病例（发病率为58.2/100000人年）。IGRA阳性者的发病率为321.7/100000人年（n = 34）。风险最高的是20岁以下未接受TPT的人群（1279.0/100000人年）。IGRA结果阳性、年龄在20岁以下以及来自结核病流行国家是结核病发病的预测因素。
结核病发病的风险标志物与先前报道的结果相似。然而，本研究中所有IGRA阳性个体中观察到的每年0.3%的再激活风险与早期结果相比要低得多。
