[Tuberculosis screening coverage of immigrants: marked attrition in follow-up screenings]. / Dekkingsgraad van tuberculosescreening bij immigranten: sterke afname bij vervolgscreening.

OBJECTIVE: To estimate the coverage of bi-annual follow-up screening for tuberculosis amongst immigrants, excluding asylum seekers. DESIGN: Retrospective cohort study. METHODS: Participation in bi-annual chest X-ray screening during the first 18 months was recorded for immigrants who underwent entry screening in 1996 in the following Dutch municipal health services (MHS's): Zuid-Kennemerland (Haarlem), Flevoland (Lelystad), Midden-Brabant (Tilburg) en West-Friesland (Hoorn). The number of immigrants that had left the country before the subsequent screening was taken into account in the Zuid-Kennemerland MHS data on screening coverage. RESULTS: Of the 2147 immigrants who underwent entry screening in 1996 (48% men and 52% women; 68% aged 15-34 years), 1075 (50%; range: 29-76) returned for the first follow-up screening and 620 (29%; 21-61) returned for the second. In MHS Zuid-Kennemerland, 113 of the 777 immigrants who had a chest X-ray at entry had left the country before the first follow-up screening, and another 89 had left before the second. Of the remaining persons, who were probably still in the Netherlands, 454 (68%; 454/777 = 58%) returned for the first follow-up screening, and 166 (29%; 166/777 = 21%) returned for the second. CONCLUSION: The coverage of screening for tuberculosis in immigrants decreased after the obligatory entry screening, even when corrected for those who left the country.

Tuberculosis screening among immigrants in The Netherlands: what is its contribution to public health?

Understanding the epidemiology of tuberculosis in migrant communities and designing adequate and comprehensive control strategies is a major challenge facing public health authorities in many low-prevalence countries. In The Netherlands, screening immigrants from tuberculosis high prevalence countries has been conducted since 1966. In this paper, we review risk factors for tuberculosis in migrant populations, the public health importance of tuberculosis and the current screening policy in The Netherlands. TB treatment outcome in migrant populations and operational considerations that ought to be taken into account to optimize current screening practices are also reviewed. The article recommends the setting-up of an information system to evaluate the effectiveness of screening immigrants in The Netherlands, and adjustment of screening policies where needed.

How does tuberculosis relate to HIV positive and HIV negative drug users?

OBJECTIVES: (1) To compare the incidence of active tuberculosis in HIV positive and HIV negative drug users. (2) To describe the main characteristics of the tuberculosis cases. DESIGN: A prospective study was performed from 1986 to 1996 as part of an ongoing cohort study of HIV infection in Amsterdam drug users. METHODS: Data from the cohort study, including HIV serostatus and CD4-cell numbers, were completed with data from the tuberculosis registration of the tuberculosis department of the Amsterdam Municipal Health Service. Analyses were carried out with person time and survival methods. RESULTS: Of 872 participants, 24 persons developed culture confirmed tuberculosis during a total follow up period of 4000 person years (0.60 per 100 py, 95% CI: 0.40, 0.90). Nineteen cases were HIV positive (1.54 per 100 py, 95% CI: 0.86, 2.11) and five HIV negative (0.18 per 100 py, 95% CI: 0.08, 0.43). Multivariately HIV infection (relative risk: 12.9; 95% CI: 3.4, 48.8) and age above 33 years (RR: 6.8; 95% CI: 1.3, 35.0, as compared with age below 27) increased the risk for tuberculosis substantially. Additional findings were: (1) 13 of 22 pulmonary tuberculosis cases (59%) were detected by half yearly radiographic screening of the chest; (2) tuberculosis occurred relatively early in the course of HIV infection at a mean CD4 cell number of 390/microliter; (3) an estimated two thirds of the incidence of tuberculosis observed among HIV positive cases was caused by reactivation; (4) all but one patient completed the tuberculosis treatment. CONCLUSION: HIV infection increases the risk for active tuberculosis in Amsterdam drug users 13-fold. The incidence of tuberculosis in HIV negative drug users is still six times higher than in the overall Amsterdam population. In the absence of contact tracing and screening with tuberculin skin tests, periodic chest radiographic screening contributes substantially to early casefinding of active tuberculosis in Amsterdam drug users.

[Tuberculosis in HIV-positive and HIV-negative drug users in Amsterdam]. / Tuberculose bij HIV-positieve en HIV-negatieve drugsgebruikers in Amsterdam.

OBJECTIVE: To determine and to compare the incidences of active tuberculosis in HIV positive and HIV negative drug users and to describe the main characteristics of the tuberculosis cases. DESIGN: Prospective. SETTING: Municipal Health Service, Amsterdam, the Netherlands. METHOD: Data of the ongoing cohort study of HIV infection in Amsterdam drug users, including HIV serostatus and CD4 cell counts, from 1986 until 1996 were completed with data from the tuberculosis registration of the tuberculosis department of the Amsterdam Municipal Health Service and analysed statistically. RESULTS: Of 872 participants 24 persons developed culture confirmed tuberculosis during a total follow-up period of 4000 person years (py) (0.6 per 100 py). Nineteen persons were HIV positive (1.54 per 100 py) and 5 HIV negative (0.18 per 100 py). Multivariately, HIV infection and higher age increased the risk of tuberculosis substantially (relative risks 12.9; 95% confidence interval (CI): 3.4-48.8 and 6.8: 95% CI: 1.3-35.0 respectively). Thirteen of 22 pulmonary tuberculosis cases (59%) were detected by half-yearly X-ray screening of the chest. Tuberculosis occurred relatively early in the course of HIV infection at a mean CD4 cell number of 390/microliter. All but one patient completed the tuberculosis treatment. CONCLUSION: HIV infection increases the risk of active tuberculosis in Amsterdam drug users 13-fold. The incidence of tuberculosis in HIV negative drug users in 6 times higher than that in the overall Amsterdam population. Periodic chest X-ray screening contributes substantially to case-finding of active tuberculosis in Amsterdam drug users.

[Connection between 2 tuberculosis outbreaks demonstrated after 8 years by DNA-fingerprinting of the causative mycobacteria]. / Verband tussen 2 tuberculose-explosies na 8 jaar bewezen door DNA-'fingerprinting' van de oorzakelijke mycobacteriën.

OBJECTIVE: To determine the possible connection between two outbreaks of tuberculosis at an 8-year interval by DNA fingerprinting of the causative mycobacteria. DESIGN: Descriptive. SETTING: Regional Public Health Services Zeeland and Noord-Holland, the Netherlands. METHOD: The source patients of the tuberculosis explosions in an island in the province of Zeeland (28 persons infected) and an island of the Noord-Holland area (36 persons infected) were identified in 1986 and 1994 respectively. In 1994. spoligotyping was performed on dead bacteria from the suspected source from 1986. to analyse the chain of transmission. RESULTS: Identical spoligotyping patterns of the source patients proved the transmission of a Mycobacterium tuberculosis strain from a father to his son around 1986. Lack of a positive Mantoux test in the son prohibited prevention of the 1994 explosion. CONCLUSION: Thanks to the applicability of spoligotyping on non-vital mycobacteria this DNA method contributed retrospectively to demonstration of a connection between two out-breaks of tuberculosis at an 8-year interval.

[Transmission of multiresistant tuberculosis in a Dutch hospital]. / Transmissie van multiresistente tuberculose in een Nederlands ziekenhuis.

Nosocomial transmission of multiresistant tuberculosis in the Netherlands is described for the first time in this article. It was detected by systematic country-wide DNA-fingerprinting. By the time the contact case (a man aged 35) developed disease he was residing in another part of the country. Contact-investigation by the Municipal Health Services involved revealed that the (HIV negative) contact case had been in contact with the index case (a man aged 27) during hospitalisation two years earlier. An analysis of the infection control measures applied, showed that inadequate treatment, early discharge from isolation and lack of bacteriological control (no sputum conversion documented) led to this hospital transmission.

Tuberculosis control in Europe and international migration.

This is a consensus-based position paper of a Task Force, comprising representatives of nongovernmental and governmental organizations in the European Region of the International Union Against Tuberculosis and Lung Disease and the World Health Organization, on tuberculosis control in the countries of Europe and international migration. Tuberculosis among the foreign population entering European countries represents an increasing and important proportion of all tuberculosis cases reported in these countries. Adequate surveillance systems allow the identification of population segments at an excess risk of tuberculosis compared to the general population. Among groups of foreigners with a risk considerably exceeding that of the general population, screening for tuberculosis and infection with M. tuberculosis yields a large number of persons in many countries who can benefit from curative and preventive interventions. The Task Force recommends that European countries: 1) have notification systems based on both mandatory laboratory and physician reports of tuberculosis cases, to allow identification of population segments at an excess incidence of tuberculosis compared to the general population; 2) consider screening of high incidence and prevalence groups among the entering foreign population for tuberculosis and infection with M. tuberculosis amenable to curative and preventive i intervention; 3) utilize existing governmental and nongovernmental organizations to provide culturally and socially sensitive services to ensure proper follow-up and implementation of interventions; 4) provide comprehensive curative and preventive services to treat tuberculosis; and 5) evaluate efficiency and efficacy of screening procedures on an ongoing basis.