title: Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis.
abstract: All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45-1.10) to 6.41 (95% CI: 4.19-9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78-5.73; I2= 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I2= 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24-3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Bozorgmehr
authors.affiliation: Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saure
authors.affiliation: Public health authority, Pforzheim, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Joggerst
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stock
mesh_terms: D003140:Communicable Disease Control / Q000706:statistics & numerical data; D018563:Disease Notification / Q000706:statistics & numerical data; D004641:Emigration and Immigration; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D012036:Refugees / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology
keywords: asylum seekers; infection control; migrant; migration; public health policy; refugees; review; screening; tuberculosis