title: Prevalence of and risk factors for active tuberculosis in migrants screened before entry to the UK: a population-based cross-sectional study.
abstract: An increasing number of countries with low incidence of tuberculosis have pre-entry screening programmes for migrants. We present the first estimates of the prevalence of and risk factors for tuberculosis in migrants from 15 high-incidence countries screened before entry to the UK.
  
  
  
  We did a population-based cross-sectional study of applicants for long-term visas who were screened for tuberculosis before entry to the UK in a pilot programme between Oct 1, 2005, and Dec 31, 2013. The primary outcome was prevalence of bacteriologically confirmed tuberculosis. We used Poisson regression to estimate crude prevalence and created a multivariable logistic regression model to identify risk factors for the primary outcome.
  
  
  
  476 455 visa applicants were screened, and the crude prevalence of bacteriologically confirmed tuberculosis was 92 (95% CI 84-101) per 100 000 individuals. After adjustment for age and sex, factors that were strongly associated with an increased risk of bacteriologically confirmed disease at pre-entry screening were self-report of close or household contact with an individual with tuberculosis (odds ratio 11·6, 95% CI 7·0-19·3; p<0·0001) and being an applicant for settlement and dependant visas (1·3, 1·0-1·6; p=0·0203).
  
  
  
  Migrants reporting contact with an individual with tuberculosis had the highest risk of tuberculosis at pre-entry screening. To tackle this disease burden in migrants, a comprehensive and collaborative approach is needed between countries with pre-entry screening programmes, health services in the countries of origin and migration, national tuberculosis control programmes, and international public health bodies.
  
  
  
  Wellcome Trust, Medical Research Council, and UK National Institute for Health Research.
authors.affiliation: Centre for Public Health Informatics, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK. Electronic address: r.aldridge@ucl.ac.uk.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Aldridge
authors.affiliation: Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Dominik
authors.initials: D
authors.lastname: Zenner
authors.affiliation: Modelling and Economics Unit, Public Health England, London, UK; MRC Centre for Outbreak Analysis and Modelling, and National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Imperial College London, London, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
authors.affiliation: Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Morris C
authors.initials: MC
authors.lastname: Muzyamba
authors.affiliation: Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Miranda
authors.initials: M
authors.lastname: Loutet
authors.affiliation: Migration Health Division, International Organization for Migration, Geneva, Switzerland.
authors.forename: Poonam
authors.initials: P
authors.lastname: Dhavan
authors.affiliation: Migration Health Division, International Organization for Migration, Geneva, Switzerland.
authors.forename: Davide
authors.initials: D
authors.lastname: Mosca
authors.affiliation: Centre for Public Health Informatics, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hayward
authors.affiliation: Centre for Infectious Disease Epidemiology, University College London, London, UK; Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012107:Research Design; D012307:Risk Factors; D014171:Transients and Migrants; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D006113:United Kingdom