Abstract
Objective
Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis.
Materials and methods
We evaluated data of all refugees who underwent CXR screening in a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health.
Results
A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% [95% confidence interval (CI) 30.8–78.5%) and a specificity 98.3% (CI 98.1–98.5%) to reveal one case of active TB.
Conclusion
Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees.
Key Points
• Prevalence of pulmonary tuberculosis (TB) among refugees in 2015 was low (0.103%).
• The number needed to screen to detect one case of active pulmonary TB was 1749.
• Tuberculosis X-ray screening resulted in a low sensitivity and high specificity.
• Tuberculosis X-ray screening during the European refugee crisis is of low yield.
• Improved screening algorithms are needed due to the overwhelming the number of refugees.
Similar content being viewed by others
References
World Health Organization (2015) Global tuberculosis report 2015
Arshad S, Bavan L, Gajari K et al (2010) Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J 35:1336–1345
Lillebaek T, Andersen AB, Dirksen A (2002) Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis 8:679–684
Blumberg HM, Migliori GB, Ponomarenko O, Heldal E (2010) Tuberculosis on the move. Lancet 375:2127–2129
Diel R, Loddenkemper R, Nienhaus A (2016) Consequences of tuberculosis among asylum seekers for health care workers in Germany. J Occup Med Toxicol 1–8. doi:10.1186/s12995-016-0093-x
Kranzer K, Afnan-Holmes H, Tomlin K et al (2013) The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis 17:432–446
Infektionsschutzgesetz I (2000) Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen. BGBl I
Sardanelli F, Di Leo G (2009) Biostatistics for Radiologists. doi:10.1007/978-88-470-1133-5
Rembold CM (1998) Number needed to screen: development of a statistic for disease screening. BMJ 317:307–312
Shapiro AE, Chakravorty R, Akande T, Lönnroth K (2013) A systematic review of the number needed to screen to detect a case of active tuberculosis in different risk groups. World Health Organization
Eisenberg RL, Pollock NR (2010) Low yield of chest radiography in a large tuberculosis screening program 1. Radiology 256:998–1004
Dasgupta K, Menzies D (2005) Cost-effectiveness of tuberculosis control strategies among immigrants and refugees. Eur Respir J 25:1107–1116
Mor Z, Leventhal A, Weiler-Ravell D et al (2012) Chest radiography validity in screening pulmonary tuberculosis in immigrants from a high-burden country. Respir Care 57:1137–1144
Hoog AV, Langendam MW, Mitchell E (2013) A systematic review of the sensitivity and specificity of symptom-and chest-radiography screening for active pulmonary tuberculosis in HIV-negative persons and persons with unknown HIV status. World Health Organization
Diel R, Loytved G, Nienhaus A et al (2011) Neue Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. Pneumologie 65:359–378
Arbeitsgruppe AWMF-Leitlinie Tuberkulose im Kindes- und Jugendalter: Diagnostik, Prävention und Therapie, Ritz N, Brinkmann F, et al (2015) Tuberculosis screening for children and adolescents ‹ 15 years seeking asylum in Germany. Monatsschrift Kinderheilkunde 163:1287–1292.
(2016) http://www.bmi.bund.de/SharedDocs/Pressemitteilungen/DE/2016/01/asylantraege-dezember-2015.html.
Meyer M, Clarke P, O'Regan AW (2003) Utility of the lateral chest radiograph in the evaluation of patients with a positive tuberculin skin test result. Chest 124:1824–1827
Jeong YJ, Lee KS (2008) Pulmonary tuberculosis: up-to-date imaging and management. Am J Roentgenol 191:834–844
RKI RK-I (2014) Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2013. 1–97
Marx FM, Fiebig L, Hauer B et al (2015) Higher rate of tuberculosis in second generation migrants compared to native residents in a metropolitan setting in Western Europe. PLoS ONE 10, e0119693
Erkens C, Slump E, Kamphorst M et al (2008) Coverage and yield of entry and follow-up screening for tuberculosis among new immigrants. Eur Respir J 32:153–161
Schoenfeld N, Haas W, Richter E et al (2016) Recommendations of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the diagnosis and treatment of non-tuberculous mycobacterioses. Pneumologie 70:250–276
Riley S (2007) Large-scale spatial-transmission models of infectious disease. Science 316:1298–1301
Pinto LM, Dheda K, Theron G et al (2013) Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. PLoS ONE 8, e54235
Klinkenberg E, Manissero D, Semenza JC, Verver S (2009) Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations. Eur Respir J 34:1180–1189
Pareek M, Baussano I, Abubakar I et al (2012) Evaluation of immigrant tuberculosis screening in industrialized countries. Emerg Infect Dis 18:1422–1429
Peto HM, Pratt RH, Harrington TA et al (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 49:1350–1357
Kruijshaar ME, Abubakar I (2009) Increase in extrapulmonary tuberculosis in England and Wales 1999-2006. Thorax 64:1090–1095
Yeh JJ, Chen SC-C, Teng W-B et al (2010) Identifying the most infectious lesions in pulmonary tuberculosis by high-resolution multi-detector computed tomography. Eur Radiol 20:2135–2145
Lee SW, Jang YS, Park CM et al (2010) The role of chest CT scanning in TB outbreak investigation. Chest 137:1057–1064
Acknowledgements
The scientific guarantor of this publication is Dr. Julius Matthias Weinrich. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Mr. Gerhard Schön kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weinrich, J.M., Diel, R., Sauer, M. et al. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. Eur Radiol 27, 3244–3248 (2017). https://doi.org/10.1007/s00330-016-4684-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-016-4684-9