Low yield of screening asylum seekers from countries with a tuberculosis incidence of <50 per 100 000 population

In low tuberculosis (TB) incidence countries foreign-born patients constitute a high percentage of the TB burden, up to 90% in Scandinavian countries [1] and 73% in the Netherlands in 2014 [2]. Several European Union (EU) countries have developed screening strategies to identify TB in migrants at an early stage and prevent transmission, but there is no uniform EU policy [3–5]. In the Netherlands, TB screening of migrants has been stipulated in the Alien&#39;s Act since 1966. At that time, screening was mainly carried out for migrant workers from Southern European countries, Morocco and Turkey. Since the 1990s, TB screening has increasingly included immigrants and asylum seekers from other countries in the world. For the screening of asylum seekers a mobile radiography screening programme has been in place since 1992 with national coverage [6]. The annual overall yield of TB screening has been well above 200 cases per 100 000 persons screened until a few years ago [6, 7]. It declined to 85 cases per 100 000 persons screened in 2014, due to the high number of asylum seekers from countries with traditionally low TB incidence rates such as Iran, Iraq and, predominantly, Syria [2]. Screening asylum seekers from areas with a TB incidence of