title: Persistent high incidence of tuberculosis in immigrants in a low-incidence country.
abstract: Immigration from areas of high incidence is thought to have fueled the resurgence of tuberculosis (TB) in areas of low incidence. To reduce the risk of disease in low-incidence areas, the main countermeasure has been the screening of immigrants on arrival. This measure is based on the assumption of a prompt decline in the incidence of TB in immigrants during their first few years of residence in a country with low overall incidence. We have documented that this assumption is not true for 619 Somali immigrants reported in Denmark as having TB. The annual incidence of TB declined only gradually during the first 7 years of residence, from an initial 2,000 per 100,000 to 700 per 100,000. The decline was described by an exponential function with a half-time of 5.7 (95% confidence interval 4.0 to 9.7) years. This finding seriously challenges the adequacy of the customary practice of screening solely on arrival.
authors.affiliation: International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark. tll@ssi.dk
authors.forename: Troels
authors.initials: T
authors.lastname: Lillebaek
authors.forename: Ase B
authors.initials: AB
authors.lastname: Andersen
authors.forename: Asger
authors.initials: A
authors.lastname: Dirksen
authors.forename: Else
authors.initials: E
authors.lastname: Smith
authors.forename: Lene T
authors.initials: LT
authors.lastname: Skovgaard
authors.forename: Axel
authors.initials: A
authors.lastname: Kok-Jensen
mesh_terms: D003718:Denmark / Q000453:epidemiology; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D011634:Public Health; D012998:Somalia / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000208:ethnology