Long-term follow-up in Israel on Ethiopian migrants who underwent pre-arrival tuberculosis screening

As tuberculosis (TB) incidence in Ethiopia is 50 times higher than in Israel, Ethiopian migrants (EM) undergo pre-departure TB screening using a medical questionnaire, physical examination, tuberculin skin test (TST), and chest X-ray (CXR). This study aims to characterize EM who developed post-arrival TB in Israel, and evaluate the association between pre-departure screening measures and subsequent active TB in Israel. This cohort study included all EM who underwent pre-departure screening and were followed up in Israel between 2015 and 2024. Pre-departure data were cross-matched with the Israeli national TB registry to identify EM who developed TB during the study period. The association between pre-departure screening results and subsequent post-migration TB was evaluated using sensitivity, specificity, negative and positive predictive values (PPV). Of all 6,919 EM, 98 (1.8%) showed pre-departure CXR suggestive of pulmonary-TB. While in Israel, 40 (0.6%) developed TB during the study period, mostly within the first 2–3 years post-migration. In multivariable analysis, HIV-infection, pre-departure CXR suggestive of pulmonary-TB, and greater TST were associated with post-migration TB diagnosis. The corresponding descriptive sensitivity of TST≥10mm in association with post-migration TB was 75.0% (95% CI:58.8–87.3%) and PPV of 2.1% (95% CI:1.4–3.0%). The sensitivity of pre-departure CXR suggestive of pulmonary-TB, previous TB, HIV-infection and chronic disease among EM with TST≥10mm were 85.7 (95%CI:48.7-97.4), 80.0 (95%CI:37.6-96.4), 50.0 (95%CI:9.5-90.6) and 66.7 (95%CI:20.8-93.8), respectively; and the PPV were 15.4 (95%CI:10.4-22.1), 5.6 (95%CI:3.4-9.2), 7.1 (95%CI:1.7-24.9) and 3.3 (95%CI:1.4-7.8), respectively. Of all EM who were followed-up for up to 10 years, 40 (0.6%) EM developed post-arrival TB, mostly within 2-3 years after arrival. Migrants who were infected with HIV, had pre-departure CXR suggestive of pulmonary-TB, and greater TST indurations were at high risk of developing post-arrival TB. TST screening showed relatively high sensitivity and low PPV in association with subsequent TB in Israel. Not applicable.