TB screening program for refugees from Ukraine in France
In March 2023, Guthmann et al. (1) presented and discussed the results of a French tuberculosis screening program among refugees from Ukraine in the journal Eurosurveillance.
According to the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC), Ukraine had one of the highest TB incidences in the European WHO region in 2020 (approx. 68 cases per 100,000 inhabitants) (2). Nevertheless, the WHO/ECDC has not yet recommended universal TB screening for people arriving in a European country from Ukraine (2). However, it is being discussed whether active TB screening could be useful in this group, regardless of symptoms or TB contacts.
In France, an active screening program was therefore introduced on a trial basis from February to October 2022, in which 8621 refugees from Ukraine were screened for tuberculosis using a chest X-ray (1).
This screening strategy indeed proved to be an effective measure to identify TB cases among the refugees from Ukraine. Ten cases were detected through screening, accounting for more than half of the total TB cases reported in France during this period. The prevalence of TB cases among the screened refugees was therefore 116 cases per 100,000 people, which is higher than the average prevalence in Ukraine and also significantly higher than the figure estimated by the French health authorities.
Seven of the 10 cases found were asymptomatic and might have remained undetected without the screening. This also enabled the early identification of highly infectious cases and MDR-TB strains, and thus timely treatment.
However, the challenges that such a screening intervention entails also became clear. For example, it was often difficult to offer screening in good time after arrival and in many cases the refugees refused the X-ray examinations.
DZK commentary: In a study that is expected to be published in August, Häcker et al. also come to the conclusion, using a different methodological approach, that the prevalence of TB cases in refugees in Germany is significantly above the expected value. Both studies suggest that international recommendations may need to be reconsidered and adapted in order to improve tuberculosis control under the current conditions. Good tuberculosis control requires trained staff and financial support to further increase the effectiveness of such programs.
- Guthmann, J.; Fraisse, P.; Bonnet, I.; Robert, J. Active tuberculosis screening among the displaced population fleeing Ukraine, France, February to October 2022. Euro Surveill. 2023
- European Center for Disease Prevention and Control (ECDC). Testing for tuberculosis infection and screening for tuberculosis disease among refugees arriving in European countries from Ukraine. Stockholm: ECDC; 2022.
