The role of entry-screening procedures in the identification of multidrug-resistant Mycobacterium tuberculosis cluster cases amongst patients arriving in Europe from the horn of Africa, 2016-17

Purpose: A cluster of 36 multidrug-resistant tuberculosis (MDR-TB) cases among migrants was identified in 2016-17 in eight European countries. We aimed to determine in how far country migrant entry TB screening procedures contributed to the identification of cluster cases to inform public health policy. Methods & Materials: We conducted a survey amongst countries known to be affected by the MDR-TB cluster to describe their migrant entry TB screening procedure, to identify the screening status (screened vs not-screened) of cluster cases, and to document the occasion of their diagnosis. Where cluster cases were not identified at screening, we sought to clarify why. Results: Six of eight countries responded. Entry TB screening procedures varied by country. Screening information was received for 32 out of 36 cluster cases (89%). A total of twenty-seven cases (84%; age range 15 to 25 years) had been screened, all either in Germany (19) or Switzerland (8), where screening is mandatory. Cluster cases in France (1), Italy (2) and Finland (1) did not undergo entry screening. A cluster case in Sweden was diagnosed before entry screening. Amongst screened cases, 13 (48%) were diagnosed as a result of the screening, 12 (44%) later, when they became symptomatic, and 2 (7%) as part of contact tracing investigations. Unscreened cluster cases (5) were diagnosed when TB symptoms developed and medical care was sought. Conclusion: Systematic entry screening programmes, where mandatory, contributed to MDR-TB cluster case identification for migrants with active disease. Essential, however, is ensuring barrier-free access to host-country health systems after arrival and ensuring health care workers’ awareness of TB in persons from countries with a high incidence.