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Free Content Effect of screening of immigrants on tuberculosis transmission

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SETTING: In The Netherlands all immigrants from highly endemic countries undergo obligatory entry screening by X-ray, followed by voluntary half-yearly screening for 2 years.

OBJECTIVE: To estimate the contribution of screening of immigrants to reductions in tuberculosis transmission.

DESIGN: All bacteriologically confirmed tuberculosis patients diagnosed between 1994 and 1999 with mycobacterial isolates exhibiting identical DNA fingerprints were assigned to clusters. Clusters were assumed to be a consequence of recent transmission and to have had the first patient as their source case. Among patients with pulmonary tuberculosis from highly endemic countries, the characteristics of source patients were compared with those of non-clustered patients.

RESULTS: Of the 1438 selected patients, 187 (13%) were the first in a cluster, 386 (27%) were in a cluster but were not the first case, and 865 (60%) were not clustered. Independent risk factors for being the first in a cluster were young age, nationality, early year of diagnosis, longer duration of treatment and no concurrent extra-pulmonary tuberculosis. In univariate analysis, passively detected patients and patients with a long duration of stay in The Netherlands were more likely to be the first in a cluster than patients detected by screening and recent arrivals, respectively. However, these variables were strongly associated.

CONCLUSION: Screening of immigrants can reduce tuberculosis transmission. This effect is in part due to confounding by duration of stay.
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Keywords: immigrants; molecular epidemiology; screening; transmission; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Royal Netherlands Tuberculosis Association (KNCV), The Hague, The Netherlands 2: National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands

Publication date: 2002-02-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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