Contents lists available at ScienceDirect Travel Medicine and Infectious Disease journal homepage: www.elsevier.com/locate/tmaid Screening migrants from tuberculosis high-endemic countries for latent tuberculosis in Oman: A cross sectional cohort analysis ☆ Fatma Alyaquobi a , Ali A. AlMaqbali b , Amina Al-Jardani c , Nduku Ndunda d , Bader Al Rawahi a , Badr Alabri e , Ahmed Mohammed AlSadi b , Jamal A. AlBaloshi b , Fatma S. Al-Baloshi b , Naima A. Al-Essai b , Saleh A. Al-Azri c , Samiya M. Al-Zadjali c , Laila M. Al-Balushi c , Eskild Petersen f , Seif Al-Abri f,∗ a Department of Communicable Diseases Control, Directorate General for Disease Surveillance and Control, Ministry of Health, Oman b Department of Disease Surveillance and Control, Directorate General of Health Services in North Batinah, Sohar, Oman c Central Public Health Laboratory, Directorate General for Disease Surveillance and Control, Ministry of Health, Oman d QIAGEN Middle East and Africa FZ LLC, DHCC Al Baker Bldg. 26 Office 310 & 311, P.O. Box 505028, Dubai, United Arab Emirates e Department of Surveillance, Directorate General for Disease Surveillance and Control, Ministry of Health, Oman f Directorate General for Disease Surveillance and Control, Ministry of Health, Oman ARTICLE INFO Keywords: End TB Strategy Oman Immigrants Interferon-gamma release test Communicable disease ABSTRACT To fulfil the World Health Organization (WHO) End TB strategy, screening for tuberculosis (TB) in immigrants is an important component of the strategy to reduce the TB burden in low-incidence countries. Oman has an annual TB incidence rate of 5.7 per 100000 and transmission from migrants with activated latent TB infection (LTBI) to nationals is a concern. The aim of this study was to determine the proportion of migrants to the Sultanate of Oman with LTBI. The study used an interferon-gamma release assay (IGRA) to assess previous exposure to TB, defining LTBI and a positive IGRA with a normal chest X-ray. 1049 subjects were surveyed. Six participants were excluded from the analysis as they had been recently vaccinated and 1 had an indeterminate result, thus 1042 subjects were included. The overall IGRA-positive rate was 22.4% (234/1042), 30.9% and 21.2% of African and Asian migrants, respectively, were IGRA-positive. Fifty-eight of the participants had a strong IGRA reactivity defined as more than 4 IU/ml. The study shows the proportion of migrants from Asia and Africa with LTBI and 24.7% (58/234) of IGRA- positive migrants had an IGRA of > 4 IU/ml, defining a subpopulation with a high risk of developing active TB in the first two years of arrival to the country. 1. Introduction The integration of the management of latent tuberculosis infection (LTBI), which includes screening and preventive treatment for people at risk of developing TB, is now considered by the WHO as a part of the global End TB strategy, particularly in countries which have reached a low incidence of TB and which can consider the elimination in the near future [1–3]. Screening migrants for active TB in Oman begun in 1991 and was recently, in 2017, modified to include an algorithm of initial chest X-ray (CXR) followed by sputum PCR (polymerase chain reaction) microscopy and culture for those who present clinical or radiological changes suggestive of TB. Multiple studies have shown that screening in- dividuals entering a country for active TB detects only a small number of cases [4–10]. In countries with a low prevalence of tuberculosis, such as the USA, a large proportion of people who are diagnosed with active tuberculosis appear to have developed the disease from untreated LTBI [11]. However, national data from the United Kingdom showed that in 2018, 4,655 people were diagnosed with TB in England, an 8.2% https://doi.org/10.1016/j.tmaid.2020.101734 Received 16 December 2019; Received in revised form 28 April 2020; Accepted 29 April 2020 ☆ The results of this study on migrants from countries with a high prevalence of TB should inform health authorities on whether they should consider using IGRA testing as a screening test for latent TB infection in migrants upon arrival to Oman. ∗ Corresponding author. Directorate General for Disease Surveillance and Control, Ministry of Health, P.O.BOX 393, PC 100, Muscat, Oman. E-mail address: salabri@gmail.com (S. Al-Abri). Travel Medicine and Infectious Disease xxx (xxxx) xxxx 1477-8939/ © 2020 Elsevier Ltd. All rights reserved. Please cite this article as: Fatma Alyaquobi, et al., Travel Medicine and Infectious Disease, https://doi.org/10.1016/j.tmaid.2020.101734