ERS-WHO/Europe survey of TB screening practices among refugees reveals need for improved coordination to end TB

WHO/Matteo Dembech

Results from a survey by the European Respiratory Society (ERS) and the WHO Regional Office for Europe show great variations among countries in tuberculosis (TB) screening practices among refugees. The survey investigated both screening and management practices among refugees in 38 national TB programmes, representing low and intermediate TB incidence countries and territories of the WHO European Region. The response rate was 95%. Findings indicate that coordination of TB screening in the Region needs to be improved to implement the End TB Strategy and eliminate the disease.

WHO recommendations

WHO recommends that TB screening be targeted to those at greatest risk. Among refugees and migrants, those at highest risk are people coming from countries with many new TB cases or who have been living or travelling in precarious situations and may have been exposed to TB infection. Systematic screening for active tuberculosis: an operational guide provides guidance on targeting and tailoring TB screening to detect active disease and provide immediate treatment, thus breaking any chain of transmission among refugees and their close contacts. TB screening must never be used as a reason to reject a refugee or a migrant.

Timely sharing of information with WHO and national health authorities is essential. This has practical implications including:

  • contact tracing;
  • rapid start of empiric treatment should TB be detected among the contacts; and/or
  • possible preventive treatment based on the resistance pattern of the index case.

WHO/ERS e-Consilium is an online platform which may be used in these cases, ensuring confidentiality of patients and communication among clinicians from different countries.

Universal health coverage should be ensured not only for the resident population but also for refugees and migrants, both documented and undocumented. The European Region is the only one in the world with a consensus document on the minimum package of cross-border TB control and care interventions. These include ensuring access to medical services, irrespective of a migrant's registration status, and a non-deportation policy until intensive TB treatment has been completed.