Prevalence of Tuberculosis among migrants under national screening programs: a systematic review and meta-analysis.

Abstract

Background: Tuberculosis (TB) continues to pose a significant global public health threat, particularly among migrant populations. Screening policies exist in many receiving countries but differ markedly, and there is limited pooled evidence on TB and latent TB infection (LTBI) prevalence among migrants under different screening frameworks. This systematic review and meta-analysis aims to synthesize TB and LTBI prevalence among migrants and compared national screening policies to inform evidence-based public health planning.

Methods: PubMed, Embase, Web of Science and Cochrane Library were searched for studies published 2016-2023. Random-effects models generated pooled prevalence estimates with 95% CIs; subgroup analyses examined differences by screening stage, migrant category, and country-of-origin incidence. Sensitivity analyses tested robustness. Government and health-agency websites were systematically examined and scored to table national TB-screening requirements.

Results: 36 studies (26 TB, 21 LTBI) covering 40,738,331 migrants screened met inclusion criteria. The Pooled TB prevalence was 214.52/100,000 (95% CI 112.18-349.66) and LTBI prevalence 14.9% (95% CI 9.91-20.60). Countries employing both pre-entry screening and subsequent post-entry surveillance achieved the lowest TB prevalence (94.09/100,000). The highest burdens occurred among refugees/asylum seekers (439.25/100,000) and migrants from countries with TB incidence 300-499/100,000 (491.96/100,000). LTBI was most common when identified through post-entry screening (21.90%), those with multiple migrants (18.11%), and among migrants originating from countries with ≥ 500/100,000 TB incidence (30.90%). Policy comparison showed pre-entry screening is almost universal; the United States is the only country mandating systematic LTBI screening. Screening-scope scores were highest in traditional immigrant countries (16-20), intermediate in middle-income destinations such as China and Malaysia (10-14), and lowest in Nordic (4-8).

Conclusions: This study emphasizes the importance of targeted TB screening, especially for migrants from high-prevalence regions and at-risk populations. Comprehensive pre- and post-entry TB screening, along with strengthened latent TB screening and surveillance for diverse migrant populations, is essential. Meanwhile enhanced collaboration to update screening policies are key to achieving the goal of TB eradication and provide practical insights for effective TB control.