Skip to main content
Top
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome

Authors: Monica Sañé Schepisi, Gina Gualano, Claudia Fellus, Nazario Bevilacqua, Marco Vecchi, Pierluca Piselli, Giuliana Battagin, Giulia Silvestrini, Andrea Attanasio, Alberto Vela, Giorgia Rocca, Alessandro Rinaldi, Pietro Benedetti, Salvatore Geraci, Francesco Nicola Lauria, Enrico Girardi

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers.

Methods

Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup.

Results

Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis.

Conclusion

The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.
Appendix
Available only for authorised users
Literature
1.
go back to reference Broekmans JF, Migliori GB, Rieder HL, et al: World Health Organization, International Union Against Tuberculosis and Lung Disease, and Royal Netherlands Tuberculosis Association Working Group. European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J. 2002, 19 (4): 765-775. 10.1183/09031936.02.00261402.CrossRefPubMed Broekmans JF, Migliori GB, Rieder HL, et al: World Health Organization, International Union Against Tuberculosis and Lung Disease, and Royal Netherlands Tuberculosis Association Working Group. European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J. 2002, 19 (4): 765-775. 10.1183/09031936.02.00261402.CrossRefPubMed
2.
go back to reference Abubakar I, Lipman M, Anderson C, et al: Tuberculosis in the UK-time to regain control. BMJ. 2011, 343: d4281-10.1136/bmj.d4281.CrossRefPubMed Abubakar I, Lipman M, Anderson C, et al: Tuberculosis in the UK-time to regain control. BMJ. 2011, 343: d4281-10.1136/bmj.d4281.CrossRefPubMed
3.
go back to reference Borgdorff MW, Van Den Hof S, Kremer K, et al: Progress towards tuberculosis elimination: secular trend, immigration and transmission. Eur Respir J. 2010, 36: 339-347. 10.1183/09031936.00155409.CrossRefPubMed Borgdorff MW, Van Den Hof S, Kremer K, et al: Progress towards tuberculosis elimination: secular trend, immigration and transmission. Eur Respir J. 2010, 36: 339-347. 10.1183/09031936.00155409.CrossRefPubMed
4.
go back to reference Alvarez GG, Gushulak B, Abu Rumman K, et al: A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Infect Dis. 2011, 11: 3-10.1186/1471-2334-11-3.CrossRefPubMedPubMedCentral Alvarez GG, Gushulak B, Abu Rumman K, et al: A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Infect Dis. 2011, 11: 3-10.1186/1471-2334-11-3.CrossRefPubMedPubMedCentral
5.
go back to reference Coker R, Bell A, Pitman R, et al: Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J. 2006, 27 (4): 801-807. 10.1183/09031936.06.00104305.CrossRefPubMed Coker R, Bell A, Pitman R, et al: Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J. 2006, 27 (4): 801-807. 10.1183/09031936.06.00104305.CrossRefPubMed
6.
go back to reference Mor Z, Lerman Y, Leventhal A: Pre-immigration screening for pulmonary tuberculosis. Eur Respir J. 2009, 33: 701-702. 10.1183/09031936.00149908.CrossRefPubMed Mor Z, Lerman Y, Leventhal A: Pre-immigration screening for pulmonary tuberculosis. Eur Respir J. 2009, 33: 701-702. 10.1183/09031936.00149908.CrossRefPubMed
7.
go back to reference Griffiths C, Sturdy P, Brewin P, et al: Educational outreach to promote screening for tuberculosis in primary care: a cluster randomised controlled trial. Lancet. 2007, 369 (9572): 1528-1534. 10.1016/S0140-6736(07)60707-7.CrossRefPubMed Griffiths C, Sturdy P, Brewin P, et al: Educational outreach to promote screening for tuberculosis in primary care: a cluster randomised controlled trial. Lancet. 2007, 369 (9572): 1528-1534. 10.1016/S0140-6736(07)60707-7.CrossRefPubMed
8.
go back to reference Getahun H, Kittikraisak W, Heilig CM, et al: Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011, 8 (1): e1000391-10.1371/journal.pmed.1000391.CrossRefPubMedPubMedCentral Getahun H, Kittikraisak W, Heilig CM, et al: Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011, 8 (1): e1000391-10.1371/journal.pmed.1000391.CrossRefPubMedPubMedCentral
11.
go back to reference IDOS - Centro Studi e Ricerche - Redazione Dossier Statistico Immigrazione Caritas/Migrantes: Caritas Italiana, Fondazione Migrantes, Caritas diocesana di Roma. Dossier statistico immigrazione. 2011, Idos Edizioni, Roma: XXI Rapporto IDOS - Centro Studi e Ricerche - Redazione Dossier Statistico Immigrazione Caritas/Migrantes: Caritas Italiana, Fondazione Migrantes, Caritas diocesana di Roma. Dossier statistico immigrazione. 2011, Idos Edizioni, Roma: XXI Rapporto
12.
go back to reference Scotto G, Fornabaio C, Prato R, et al: Italian Study Group for Infectious Diseases in Immigrants. Tuberculosis and immigrants: a SIMIT (Italian Society of Infectious Diseases) clinical, epidemiological multicentric research investigation. New Microbiol. 2009, 32 (1): 39-47.PubMed Scotto G, Fornabaio C, Prato R, et al: Italian Study Group for Infectious Diseases in Immigrants. Tuberculosis and immigrants: a SIMIT (Italian Society of Infectious Diseases) clinical, epidemiological multicentric research investigation. New Microbiol. 2009, 32 (1): 39-47.PubMed
13.
go back to reference Klinkenberg E, Manissero D, Semenza JC, et al: Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations. Eur Respir J. 2009, 34 (5): 1180-1189. 10.1183/09031936.00038009.CrossRefPubMed Klinkenberg E, Manissero D, Semenza JC, et al: Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations. Eur Respir J. 2009, 34 (5): 1180-1189. 10.1183/09031936.00038009.CrossRefPubMed
14.
go back to reference Migliori GB, Zellweger JP, Abubakar I, et al: European Union Standards for Tuberculosis Care. Eur Respir J. 2012, 39: 807-819. 10.1183/09031936.00203811.CrossRefPubMedPubMedCentral Migliori GB, Zellweger JP, Abubakar I, et al: European Union Standards for Tuberculosis Care. Eur Respir J. 2012, 39: 807-819. 10.1183/09031936.00203811.CrossRefPubMedPubMedCentral
16.
go back to reference El-Hamad I, Casalini C, Matteelli A, et al: Screening for tuberculosis and latent tuberculosis infection among undocumented immigrants at an unspecialised health service unit. Int J Tuberc Lung Dis. 2001, 5 (8): 712-716.PubMed El-Hamad I, Casalini C, Matteelli A, et al: Screening for tuberculosis and latent tuberculosis infection among undocumented immigrants at an unspecialised health service unit. Int J Tuberc Lung Dis. 2001, 5 (8): 712-716.PubMed
17.
go back to reference Carvalho ACC, Saleri N, El-Hamad I, et al: Completion of screening for latent tuberculosis infection among immigrants. Epidemiol Infect. 2005, 133 (1): 179-185. 10.1017/S0950268804003061.CrossRefPubMedPubMedCentral Carvalho ACC, Saleri N, El-Hamad I, et al: Completion of screening for latent tuberculosis infection among immigrants. Epidemiol Infect. 2005, 133 (1): 179-185. 10.1017/S0950268804003061.CrossRefPubMedPubMedCentral
20.
go back to reference Malotte CK, Rhodes F, Mais KE: Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998, 88 (5): 792-796. 10.2105/AJPH.88.5.792.CrossRefPubMedPubMedCentral Malotte CK, Rhodes F, Mais KE: Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998, 88 (5): 792-796. 10.2105/AJPH.88.5.792.CrossRefPubMedPubMedCentral
21.
go back to reference Malotte CK, Hollingshead JR, Rhodes F: Monetary versus nonmonetary incentives for TB skin test reading among drug users. Am J Prev Med. 1999, 16 (3): 182-188. 10.1016/S0749-3797(98)00093-2.CrossRefPubMed Malotte CK, Hollingshead JR, Rhodes F: Monetary versus nonmonetary incentives for TB skin test reading among drug users. Am J Prev Med. 1999, 16 (3): 182-188. 10.1016/S0749-3797(98)00093-2.CrossRefPubMed
22.
go back to reference Chaisson RE, Keruly JC, McAvinue S, Gallant JE, Moore RD: Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection. JAIDS. 1996, 11 (5): 455-459.PubMed Chaisson RE, Keruly JC, McAvinue S, Gallant JE, Moore RD: Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection. JAIDS. 1996, 11 (5): 455-459.PubMed
23.
go back to reference Pilote L, Tulsky JP, Zolopa AR, et al: Tuberculosis prophylaxis in the homeless. A trial to improve adherence to referral. Arch Intern Med. 1996, 156: 161-165. 10.1001/archinte.1996.00440020063008.CrossRefPubMed Pilote L, Tulsky JP, Zolopa AR, et al: Tuberculosis prophylaxis in the homeless. A trial to improve adherence to referral. Arch Intern Med. 1996, 156: 161-165. 10.1001/archinte.1996.00440020063008.CrossRefPubMed
25.
go back to reference Arshad S, Bavan L, Gajari K, et al: Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J. 2010, 35 (6): 1336-1345. 10.1183/09031936.00054709.CrossRefPubMed Arshad S, Bavan L, Gajari K, et al: Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J. 2010, 35 (6): 1336-1345. 10.1183/09031936.00054709.CrossRefPubMed
26.
go back to reference Schneeberger Geisler S, Helbling P, Zellweger JP, Altpeter ES: Screening for tuberculosis in asylum seekers: comparison of chest radiography with an interview-based system. Int J Tuberc Lung Dis. 2010, 14: 1388-1394.PubMed Schneeberger Geisler S, Helbling P, Zellweger JP, Altpeter ES: Screening for tuberculosis in asylum seekers: comparison of chest radiography with an interview-based system. Int J Tuberc Lung Dis. 2010, 14: 1388-1394.PubMed
27.
go back to reference Corbett EL, Bandason T, Duong T, et al: Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial. Lancet. 2010, 376 (9748): 1244-1253. 10.1016/S0140-6736(10)61425-0.CrossRefPubMedPubMedCentral Corbett EL, Bandason T, Duong T, et al: Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial. Lancet. 2010, 376 (9748): 1244-1253. 10.1016/S0140-6736(10)61425-0.CrossRefPubMedPubMedCentral
28.
go back to reference Monney M, Zellweger JP: Active and passive screening for tuberculosis in Vaud Canton, Switzerland. Swiss Med Wkly. 2005, 135: 469-474.PubMed Monney M, Zellweger JP: Active and passive screening for tuberculosis in Vaud Canton, Switzerland. Swiss Med Wkly. 2005, 135: 469-474.PubMed
29.
go back to reference Verver S, Bwire R, Borgdorff MW: Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness. Int J Tuberc Lung Dis. 2001, 5 (5): 419-425.PubMed Verver S, Bwire R, Borgdorff MW: Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness. Int J Tuberc Lung Dis. 2001, 5 (5): 419-425.PubMed
30.
go back to reference Laifer G, Widmer AF, Simcock M, Bassetti S, Trampuz A, Frei R, Tamm M, Battegay M, Fluckiger U: TB in a low-incidence country: differences between new immigrants, foreign-born residents and native residents. Am J Med. 2007, 120 (4): 350-356. 10.1016/j.amjmed.2006.10.025.CrossRefPubMed Laifer G, Widmer AF, Simcock M, Bassetti S, Trampuz A, Frei R, Tamm M, Battegay M, Fluckiger U: TB in a low-incidence country: differences between new immigrants, foreign-born residents and native residents. Am J Med. 2007, 120 (4): 350-356. 10.1016/j.amjmed.2006.10.025.CrossRefPubMed
31.
go back to reference Hopewell PC: Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and control of tuberculosis. Clin Infect Dis. 1992, 15 (3): 540-547. 10.1093/clind/15.3.540.CrossRefPubMed Hopewell PC: Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and control of tuberculosis. Clin Infect Dis. 1992, 15 (3): 540-547. 10.1093/clind/15.3.540.CrossRefPubMed
32.
go back to reference Corbett EL, Zezai A, Cheung YB, et al: Provider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status. Bull World Health Organ. 2010, 88 (1): 13-21. 10.2471/BLT.08.055467.CrossRefPubMedPubMedCentral Corbett EL, Zezai A, Cheung YB, et al: Provider-initiated symptom screening for tuberculosis in Zimbabwe: diagnostic value and the effect of HIV status. Bull World Health Organ. 2010, 88 (1): 13-21. 10.2471/BLT.08.055467.CrossRefPubMedPubMedCentral
33.
go back to reference Ayles H, Schaap A, Nota A, et al: ZAMSTAR Study Team. Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV. PLoS One. 2009, 4 (5): e5602-10.1371/journal.pone.0005602.CrossRefPubMedPubMedCentral Ayles H, Schaap A, Nota A, et al: ZAMSTAR Study Team. Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: implications for tuberculosis control in the era of HIV. PLoS One. 2009, 4 (5): e5602-10.1371/journal.pone.0005602.CrossRefPubMedPubMedCentral
34.
go back to reference Dara M, de Colombani P, Petrova-Benedict R, on behalf of the members of the Wolfheze Transborder Migration Task Force, et al: The Minimum Package for Cross-Border TB Control and Care in the WHO European Region: a Wolfheze Consensus Statement. Eur Respir J. 2012, 40 (5): 1081-1090. 10.1183/09031936.00053012.CrossRefPubMedPubMedCentral Dara M, de Colombani P, Petrova-Benedict R, on behalf of the members of the Wolfheze Transborder Migration Task Force, et al: The Minimum Package for Cross-Border TB Control and Care in the WHO European Region: a Wolfheze Consensus Statement. Eur Respir J. 2012, 40 (5): 1081-1090. 10.1183/09031936.00053012.CrossRefPubMedPubMedCentral
35.
go back to reference Heldal E, et al: Diagnosis and treatment of tuberculosis in undocumented migrants in low- or intermediate-incidence countries. Int J Tuberc Lung Dis. 2008, 12: 878-888.PubMed Heldal E, et al: Diagnosis and treatment of tuberculosis in undocumented migrants in low- or intermediate-incidence countries. Int J Tuberc Lung Dis. 2008, 12: 878-888.PubMed
Metadata
Title
Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome
Authors
Monica Sañé Schepisi
Gina Gualano
Claudia Fellus
Nazario Bevilacqua
Marco Vecchi
Pierluca Piselli
Giuliana Battagin
Giulia Silvestrini
Andrea Attanasio
Alberto Vela
Giorgia Rocca
Alessandro Rinaldi
Pietro Benedetti
Salvatore Geraci
Francesco Nicola Lauria
Enrico Girardi
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-872

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue