INT J TUBERC LUNG DIS 7(10):959–966 © 2003 IUATLD Screening and management of tuberculosis in immigrants: the challenge beyond professional competence D. Chemtob,* † A. Leventhal, † D. Weiler-Ravell* † SUMMARY * Department of Tuberculosis and AIDS, † Public Health Services, Ministry of Health, Jerusalem, Israel SETTING: Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. During 1990–2000 some 1 050 000 immigrants, mostly from countries highly endemic for TB, arrived in Israel, a low prevalence country. Nevertheless, TB rates in Israel have remained low. OBJECTIVE: To emphasise the challenge beyond techni- cal competence for TB control for immigrants from the perspective of Israel’s National Tuberculosis Programme (NTP). MATERIALS AND METHODS: We defined criteria for an NTP geared to immigration, and analysed our imple- mentation of the European Task Force recommenda- tions on international migration and TB control. We interviewed immigrants and health care workers to iden- tify barriers to diagnosis, prevention and treatment of TB among immigrants. We used classical epidemiology to evaluate the impact of immigration on TB rates in the host population. RESULTS: Until now there has been no evidence of sig- nificant spread of TB from immigrants to the host pop- ulation. Successful outcome of treatment has been noted in over 75%, although a sub-population of immigrant substance abusers is proving more difficult to treat. CONCLUSIONS: The risk of TB for the host country is very low and it seems possible to enhance TB control in immigrants with measures designed to address their cul- tural needs. KEY WORDS: tuberculosis; TB control policy; tuber- culosis epidemiology; immigration; Israel MIGRATION (to move from one country, place or locality to another)* is a phenomenon that goes back to the roots of mankind. It is prompted by sociologi- cal, economic, political, psychological or religious motives. Host countries react to immigrants in differ- ent ways, ranging from encouragement and support to rejection and deportation. Denial of entrance to immigrants is sometimes ‘justified’ by invoking the threat of disease. It is estimated that one third of the world’s popu- lation is infected with TB, 1 and most new TB cases occur in developing countries. 2 This explains why TB rates among foreign-born persons coming from high prevalence countries (mainly developing countries) and migrating to low prevalence countries (mainly industrialised countries) are two to 30 times higher than those of the native-born population. 3 Tuberculosis among immigrants is a complex issue: there are numerous difficulties, ranging from the logis- *Merriam-Webster dictionary, Internet version, http://www.m-w.com tics of screening to ethical problems dealing with soci- eties and political regimes. Technical problems and the low efficacy of screening methods have been de- scribed in several countries—the screening of all asy- lum seekers entering Switzerland, 4 the screening of immigrants in England, 5 and the relatively low yields of active TB found in post arrival screening of immi- grants in USA. 6 Poor access to care and treatment outcome in foreign-born persons due to socio-cultural barriers, anti-immigrant sentiments and legislation and fear of deportation have also been partly ad- dressed. 7,8 In 1994 the European Task Force made recommendations for the control of TB in the foreign- born for use in European countries, 9 and a similar set of recommendations for use by state and local health departments was developed in the United States in 1998. 10 However, none of these has addressed the professional dilemma of efficiently achieving the main TB control objective of preventing an increase in the incidence of tuberculosis in the resident population while maintaining a humane/ethical approach to the immigrant population. In this article, we describe our Correspondence to: Daniel Chemtob, MD, MPH, DEA, Director, Department of Tuberculosis and AIDS, Manager, National Tuberculosis Programme, Ministry of Health, P O Box 1176, Jerusalem 91010, Israel. Tel: (+972 2) 672 8112. Fax: (+972 2) 672 5568. e-mail: daniel.chemtob@moh.health.gov.il Article submitted 2 August 2002. Final version accepted 15 April 2003.