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Cohort analysis of asylum seekers in Oslo, Norway, 1987-1995: effectiveness of screening at entry and TB incidence in subsequent years.

SETTING
Municipalities of Baerum and Oslo, Norway.


OBJECTIVES
To examine the effectiveness of tuberculosis (TB) screening in asylum seekers 1987-1995, and to describe TB incidence rates after arrival.


DESIGN
Register-based, retrospective cohort study of 19912 asylum seekers with a mean follow-up of 6.3 years.


RESULTS
Seventy-six persons were diagnosed with TB, of whom 43 (57%) had pulmonary TB. Twenty-two cases (17 pulmonary) were found through screening at entry. Eleven persons had abnormal mass miniature X-rays (MMRs), but had inadequate follow-up and were diagnosed later through passive case finding. MMR itself had a sensitivity of 96% and a specificity of 98% for pulmonary TB, diagnosed within 1 year after arrival. TB prevalence at entry was 110/100000; for Somalis it was 577/100000. Incidence rates were stable in the total cohort after arrival, whereas rates for extra-pulmonary TB in Somalis increased.


CONCLUSIONS
Screening on entry should continue, but follow-up of abnormal MMRs must be improved. There should be more emphasis on treatment of latent infection.