Tuberculosis disease and infection screening among migrants in the Netherlands 2019–2023: a national retrospective observational study

Background Migrants from tuberculosis (TB) high-incidence countries are at increased risk of TB, therefore, screening for TB is frequently implemented in host countries, but evidence for systematic screening for TB infection (TBI) is limited. We evaluated the national migrant TB/TBI screening programme in the Netherlands to assess TB yield, TBI prevalence, and the subsequent cascade of care. Methods This retrospective observational study included all immigrants and asylum seekers screened for TB and TBI in the Netherlands in 2019–2023. We linked data from the national TB client information system to the Netherlands TB Register to assess TB yield (cases detected per 100,000 screened), TBI prevalence, and treatment initiation and completion, by migrant group, country of birth, and age group. Findings 149,214 migrants were included (87,511 immigrants; 61,703 asylum seekers). TB at entry was diagnosed in 69 immigrants and 170 asylum seekers, corresponding to yields of 79 per 100,000 (95% CI 62–100) and 276 per 100,000 (237–320), respectively. Among 202 pulmonary TB cases, 129 (63.9%) was bacteriologically confirmed and 147 (72.8%) did not report cough symptoms. TB treatment completion was 92.8% (64/69) among immigrants and 81.2% (138/170) among asylum seekers. TBI screening included 20,378 immigrants. TBI prevalence increased with age, from 0.6% in children <12 years, 4.4% in adolescents 12–17 years, to 12.9% in adults ≥ 18 years. Among them, 64.6% (31/48), 81.5% (66/81), and 64.7% (663/1024), respectively, initiated and completed treatment. Interpretation Systematic TB and TBI screening among migrants in the Netherlands effectively identifies people with TB, including those without symptoms, and enables TB prevention. These findings support targeted screening policies as a core component of TB prevention and control in low-incidence settings. Funding This work was supported by the Ministry of Health, Welfare and Sports (VWS), the Netherlands.