Screenings for refugees and migrants

Which infections are checked

The ECDC says it is likely to be effective and cost-effective to screen child, adolescent and adult migrants for active TB and latent TB, HIV, hepatitis C, hepatitis B, strongyloidiasis and schistosomiasis, and that this is often conditional on the burden of disease in the migrant's country of origin. (ECDC, 2018) UK and US bodies set their own criteria for each test, below.

Checks for active TB

UKHSA says migrants from countries with a high TB incidence (more than 40 cases per 100,000) who were not screened before arrival should be offered screening for active TB as soon as possible after arrival, starting at the first contact with health services or on registering with a GP. It says the screening should include: (UKHSA TB)

children over 11 and adults who are not pregnant: a symptom check, a chest X-ray and, for someone coughing who can produce sputum, a sputum check
children aged 11 and under: a symptom check
during pregnancy: a symptom check and a sputum check where appropriate

UKHSA says anyone with symptoms or an abnormal X-ray should be referred for specialist assessment within one working day, and that migrants from high-incidence countries remain at higher risk of TB many years after arrival. It lists a cough for more than 3 weeks, weight loss, loss of appetite, fever, night sweats and extreme tiredness as typical symptoms of TB in the lungs. (UKHSA TB)

Latent TB

UKHSA says a single IGRA blood test for latent TB should be offered to migrants who meet all of these criteria: (UKHSA TB)

aged 16 to 35
arrived in England in the last 5 years, including entry through other countries
born or lived for more than 6 months in sub-Saharan Africa or a country with a TB incidence of more than 150 per 100,000
no previous TB or latent TB, and not screened for latent TB in the UK before

NICE says those responsible for testing new entrants should test all vulnerable migrants who have not previously been checked, regardless of when they arrived in England, with people born in countries with an incidence of more than 150 per 100,000 a priority for latent TB testing, (NICE NG33) and offers a Mantoux skin test first to people who have recently arrived from a high-incidence country, with an IGRA blood test if the skin test is unavailable. (NICE NG33) The USPSTF recommends latent TB screening for adults 18 or older at increased risk, including persons who were born in, or are former residents of, countries with high TB prevalence. (USPSTF latent TB) See latent tuberculosis screening and latent TB test results.

Hepatitis B

UKHSA says to offer hepatitis B screening to people born or raised in countries where chronic hepatitis B is 2% or more, and to offer testing to close contacts of people living with hepatitis B, including household and sexual contacts. It names medium or high prevalence countries as all countries in Africa, Asia, the Caribbean, Central and South America, Eastern and Southern Europe, the Middle East and the Pacific islands, and says GPs should offer and arrange testing for people whose only risk factor is country of birth. (UKHSA hepatitis B) The USPSTF lists persons born in countries and regions with a hepatitis B prevalence of 2% or more, such as Asia, Africa, the Pacific Islands and parts of South America, among the groups that should be screened, along with US-born persons not vaccinated as infants whose parents were born in regions where it is 8% or more. (USPSTF hepatitis B) See hepatitis B screening and hepatitis B test results.

Hepatitis C

UKHSA says to offer hepatitis C screening to people born or brought up in a country where chronic hepatitis C is 2% or more, and to consider screening close contacts of someone known to be living with hepatitis C. (UKHSA hepatitis C) NICE says GPs and practice nurses should offer testing for hepatitis B and C to adults and children at increased risk, particularly migrants from medium- or high-prevalence countries, including people newly registered with the practice. (NICE PH43) In the US, the USPSTF recommends hepatitis C screening for all adults aged 18 to 79, with one-time screening for most adults. (USPSTF hepatitis C) See hepatitis C screening and hepatitis C test results.

HIV

UKHSA says to offer and recommend an HIV test to all men and women from countries with an HIV prevalence above 1%, and to everyone newly registering with a GP where diagnosed HIV prevalence locally is above 2 in 1,000. (UKHSA HIV) UKHSA also says to offer HIV testing to anyone diagnosed with TB, and that GPs can offer it alongside latent TB screening. (UKHSA TB) The USPSTF recommends HIV screening for adolescents and adults aged 15 to 65, and for younger and older people at increased risk. (USPSTF HIV) See HIV screening and HIV test results.

Usual screening on schedule

The hepatitis C and HIV recommendations above apply to all adults in the age range, wherever they were born. (USPSTF hepatitis C) (USPSTF HIV) The sources on this page do not set a different schedule for cancer, blood pressure, diabetes or other routine screening in refugees and migrants, so these follow age and sex. Someone who has not had them before can start from catching up on screenings. See cancer screenings by age, screenings by age and gender and questions to ask your doctor.

Where they differ:

Who is tested for latent TB. UKHSA offers an IGRA to people aged 16 to 35 who arrived in the last 5 years from high-incidence countries; (UKHSA TB) NICE says to test vulnerable migrants not previously checked regardless of when they arrived, and offers a skin test first; (NICE NG33) the USPSTF covers adults 18 or older born in or formerly living in high-prevalence countries, with no upper age. (USPSTF latent TB)
Hepatitis C. UKHSA and NICE offer the test based on country of birth or upbringing and other risks; (UKHSA hepatitis C) (NICE PH43) the USPSTF screens all adults aged 18 to 79. (USPSTF hepatitis C)
HIV. UKHSA ties the offer to country of origin (prevalence above 1%) or to local prevalence; (UKHSA HIV) the USPSTF screens everyone aged 15 to 65. (USPSTF HIV)

Your doctor decides what your result means for you.

Questions people ask

Which tests are offered to someone who has recently moved to a new country?

It depends on where the person was born or has lived. The ECDC names active TB, latent TB, HIV, hepatitis B, hepatitis C, strongyloidiasis and schistosomiasis as infections it is likely to be effective to screen newly arrived migrants for, often depending on how common they are in the country of origin. UK and US bodies set their own criteria for each test. (ECDC, 2018) (UKHSA TB) (USPSTF hepatitis B)

Who is offered a latent TB test in England?

UKHSA says a single IGRA blood test should be offered to migrants aged 16 to 35 who arrived in England in the last 5 years, who were born or lived for more than 6 months in sub-Saharan Africa or a country with a TB incidence of more than 150 per 100,000, with no previous TB or latent TB and no previous latent TB screening in the UK. (UKHSA TB)

Is a hepatitis B test offered because of the country I was born in?

Yes, in both the UK and the US. UKHSA says to offer hepatitis B screening to people born or raised in countries where chronic hepatitis B is 2% or more, and the USPSTF lists persons born in countries and regions with a hepatitis B prevalence of 2% or more among the groups that should be screened. (UKHSA hepatitis B) (USPSTF hepatitis B)

Do the usual age-based screenings still apply?

Yes. The USPSTF recommends hepatitis C screening for adults aged 18 to 79 and HIV screening for people aged 15 to 65 regardless of where they were born, and the usual cancer, blood pressure and other screenings follow age and sex. The sources on this page do not set a different cancer screening schedule for migrants. (USPSTF hepatitis C) (USPSTF HIV)