Tuberkulosescreening bei Asylbewerbern – Sinnvolle Maßnahmen in Deutschland

Asylbewerber aus Hochinzidenzländern der Tuberkulose haben ein erhöhtes Risiko, bereits bei der Einreise nach Deutschland latent mit M. tuberculosis infiziert oder aktiv an einer Tuberkulose erkrankt zu sein. Bei der Ankunft in Deutschland sollten Asylbewerber aus Hochinzidenzländern sowohl auf das Vorliegen einer aktiven Tuberkulose als auch auf eine latente Infektion mit M. tuberculosis untersucht werden. Asylbewerber, die nicht aus Hochinzidenzländern der Tuberkulose kommen, sollten in gleicher Weise behandelt werden, wenn sie engen Kontakt zu Tuberkulosepatienten hatten oder HIV-infiziert sind. In Abwesenheit einer effektiven Vakzine können nur durch eine stringente und frühzeitige Therapie aktiv erkrankter Personen und durch konsequente Behandlung latent infizierter Personen aus Risikogruppen die Transmission von M. tuberculosis und das Auftreten neuer Erkrankungen verhindert werden. Bei der steigenden Zahl von Asylbewerbern sind hierzu geeignete Maßnahmen zur Stärkung des öffentlichen Gesundheitswesens unumgänglich.

Asylum seekers from countries with a high incidence of tuberculosis carry a high risk of having a latent infection with M. tuberculosis or even of having active disease already upon their entry into Germany. Upon arrival in Germany, asylum seekers from countries with a high incidence of tuberculosis should be examined not only for the presence of an active tuberculosis disease but also for a latent infection with M. tuberculosis. Asylum seekers who do not originate for a country with a high incidence of tuberculosis should be treated in the same manner when they have had close contacts with tuberculosis patients or if they are infected with HIV. In the absence of effective vaccinations, only a stringent and early initiated therapy for actively infected persons and, respectively, consequent treatment of persons with a latent infection can prevent these people from becoming a risk group for the transmission of M. tuberculosis and the occurrence of new cases of the disease. In parallel with the increasing numbers of asylum seekers, suitable measures to strengthen the public health system are indispensable.

Key words

tuberculosis screening - asylum seekers

• Literatur

• 1 Odone A, Tillmann T, Sandgren A et al. Tuberculosis among migrant populations in the European Union and the European Economic Area. Eur J Public Health. Dec 13 [Epub ahead of print] 2014;
• 2 World Health Organization. Global tuberculosis report 2014. Im Internet: http://www.who.int/tb/publications/global_report/en/
• 3 Robert Koch-Institut. Bericht zur Epidemiologie. der Tuberkulose in Deutschland für 2013. Im Internet: http://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Download/TB2013.pdf
• 4 Alvarez GG, Gushulak B, Abu Rumman K et al. A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Infect Dis 2011; 11: 3-3
• 5 Campbell JR, Chen W, Johnston J et al. Latent tuberculosis infection screening in immigrants to low-incidence countries: a meta-analysis. Mol Diagn Ther 2015; 19: 107-117
• 6 Coker R, Bell A, Pitman R et al. Tuberculosis screening in migrants in selected European countries shows wide disparities. Eur Respir J 2006; 27: 801-807
• 7 Greenaway C, Sandoe A, Vissandjee B et al. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ 2011; 183
• 8 Pareek M, Watson JP, Ormerod LP et al. Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. Lancet Infect Dis 2011; 11: 435-444
• 9 Pareek M, Baussano I, Abubakar I et al. Evaluation of immigrant tuberculosis screening in industrialized countries. Emerg Infect Dis 2012; 18: 1422-1429
• 10 Walter ND, Painter J, Parker M et al. Persistent latent tuberculosis reactivation risk in United States immigrants. Am J Respir Crit Care Med 2014; 189: 88-95
• 11 Arshad S, Bavan L, Gajari K et al. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J 2010; 35: 1336-1345
• 12 Klinkenberg E, Manissero D, Semenza JC, Verver S. Migrant tuberculosis screening in the EU/EEA: yield, coverage and limitations. Eur Respir J 2009; 34: 1180-1189
• 13 Sandgren A, Schepisi MS, Sotgiu G et al. Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review. Eur Respir J 2014; 43: 1159-1171
• 14 Schneeberger Geisler S, Helbling P, Zellweger JP, Altpeter ES. Screening for tuberculosis in asylum seekers: comparison of chest radiography with an interview-based system. Int J Tuberc Lung Dis 2010; 14: 1388-1394
• 15 Corbett EL, Bandason T, Cheung YB et al. Epidemiology of tuberculosis in a high HIV prevalence population provided with enhanced diagnosis of symptomatic disease. PLoS Med 2007; 4
• 16 Wood R, Middelkoop K, Myer L et al. Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control. Am J Respir Crit Care Med 2007; 175: 87-93
• 17 Mor Z, Weinstein O, Tischler-Aurkin D et al. The yield of tuberculosis screening of undocumented migrants from the Horn of Africa based on chest radiography. Isr Med Assoc J 2015; 17: 11-13
• 18 Aldridge RW, Yates TA, Zenner D et al. Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis. Lancet Infect Dis 2014; 14: 1240-1249
• 19 Mor Z, Leventhal A, Diacon AH et al. Tuberculosis screening in immigrants from high-prevalence countries: interview first or chest radiograph first? A pro/con debate. Respirology 2013; 18: 432-438
• 20 Mathez C, Bangala Y, Bady P, Zellweger JP. Active screening for pulmonary tuberculosis among immigrants by chest x-ray at the Swiss border. Swiss Med Wkly 2007; 137: 649-654
• 21 Silivan A, Janssens J. Comment on: active screening for pulmonary tuberculosis by chest X-ray among immigrants at the Swiss border. Swiss Med Wkly 2008; 138: 355-355
• 22 Dasgupta K, Schwartzman K, Marchand R et al. Comparison of cost-effectiveness of tuberculosis screening of close contacts and foreign-born populations. Am J Respir Crit Care Med 2000; 162: 2079-2086
• 23 Painter JA, Graviss EA, Hai HH et al. Tuberculosis screening by tuberculosis skin test or QuantiFERON^®-TB Gold In-Tube Assay among an immigrant population with a high prevalence of tuberculosis and BCG Vaccination. PLoS One 2013; 8
• 24 de Visser V, Sotgiu G, Lange C et al. False-negative interferon-γ release assay results in active tuberculosis: a TBNET study. Eur Respir J 2015; 45: 279-283
• 25 Mack U, Migliori GB, Sester M et al. LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 2009; 33: 956-973
• 26 Kik SV, Franken WP, Mensen M et al. Predictive value for progression to tuberculosis by IGRA and TST in immigrant contacts. Eur Respir J 2010; 35: 1346-1353
• 27 Sloot R, Schim van der Loeff MF et al. Reply: Overestimation of coprevalent and underestimation of incident tuberculosis in close contacts. Am J Respir Crit Care Med 2015; 191: 487-487
• 28 Zellweger JP, Sotgiu G, Block M et al. Risk Assessment of Tuberculosis in Contacts by Interferon-γ Release Assays (IGRAs). A Tuberculosis Network European Trials Group Study. Am J Respir Crit Care Med 2015; 191: 1176-1184
• 29 Sester M, van Leth F, Bruchfeld J et al. Risk assessment of tuberculosis in immunocompromised patients. A TBNET study. Am J Respir Crit Care Med 2014; 190: 1168-1176
• 30 Diel R, Loddenkemper R, Nienhaus A. Predictive value of interferon-γ release assays and tuberculin skin testing for progression from latent TB infection to disease state: a meta-analysis. Chest 2012; 142: 63-75
• 31 Greenberg SD, Frager D, Suster B et al. Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance). Radiology 1994; 193: 115-119
• 32 Cain KP, McCarthy KD, Heilig CM et al. An algorithm for tuberculosis screening and diagnosis in people with HIV. N Engl J Med 2010; 362: 707-716
• 33 Kranzer K, Houben RM, Glynn JR et al. Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systemativ review and meta-analysis. Lancet Infect Dis 2010; 10: 93-102
• 34 Bassett IV, Wang B, Chetty S. Intensive tuberculosis screening for HIV-infected patients starting antiretroviral therapy in Durban, South Africa. Clin Infect Dis 2010; 51: 823-829