"Diagnosis on the Dock" project: a proactive screening program for diagnosing pulmonary tuberculosis in disembarking refugees and new SEI model

OBJECTIVE: From 2011 to 2017 the total number of refugees arrived in Europe, in particular in Italy, climbed dramatically. Our aim was to diagnose pulmonary TB in migrants coming from African coasts through a clinical-based port of arrival (PoA) screening program.METHODS: From 2016 to 2018, migrants coming from the Mediterranean Route were screened with body temperature and the presence of cough directly on the dock: if they were feverish with productive cough, their sputum were examined with NAAT; with dry cough they underwent Chest-X-ray (CXR). Those migrants with positive NAAT or CXR suggestive for TB were admitted in our ward. Moreover, we plotted a SEI simulation of our project to evaluate the epidemiological impact of our screening.RESULTS: Out of 33676 disembarking migrants, 314 (0.9%) had fever and cough: 80 (25.47%) with productive cough underwent NAAT in sputum and 16 resulted positive for TB; 234 (74.52%) with dry cough had a CXR examination and 39 were suggestive for TB, later confirmed by mycobacterial culture. SEI-new model analysis demonstrated that our screening program reduced significantly TB spreading all over the country.CONCLUSIONS: For possible future high migrant flows, PoA screening for TB has to be considered feasible and effective in decreasing TB spreading.