Routine screening for tuberculosis (TB)
Specific groups in the population are at higher risk of TB infection and must undergo screening.
These groups include:
- Newly arrived migrants from countries with a high incidence of TB.
- Close contacts of people with infectious pulmonary TB.
- People who have been exposed to infection and who will work with patients or children.
Examination of newly arrived migrants
All asylum seekers and refugees to Norway, regardless of their country of origin, are required to undergo a TB test within two weeks of their arrival in the country. Other migrants who intend to stay for over three months in Norway are tested if they come from a country with a high TB incidence. The TB regulations require that this group should be tested "as soon as possible".
The screening method used differs by age group. Children up to 10 years are examined with a personal consultation, whereas older children and adults are given lung X-rays. In addition, children and adults who come from a country with very high incidence will also be given an IGRA (blood test). People with active TB should be referred for immediate treatment. If the tests indicate latent TB (TB infection without disease, based on a positive IGRA test), preventive treatment should be considered. Active TB disease must be excluded before preventive treatment is given.
In practice, only pulmonary TB infects others. Most infections occur when people with untreated pulmonary TB infect their closest contacts. Around each case of pulmonary TB, contacts should be traced to detect infected individuals, and limited testing should be performed around children who have become ill to find the source of infection.
It can be difficult to determine who is infected because it depends on the surroundings and the individual susceptibility of the contact. As a rule of thumb, anyone who has been in speaking distance with a person with untreated, direct microscopy-positive pulmonary TB for over eight hours is considered to be exposed to infection.
Screening before working with patients or children
People who work with patients and children up to primary school age are required to have a TB test if they have been in a country with a high TB incidence for more than three months the last three years or have otherwise been exposed to infection. The employer is obliged to ensure that the employee’s lung X-rays do not show active lung TB prior to starting work with patients and children. It is also recommended that this group should be offered an IGRA test, with optional preventive treatment, if the results are positive. However, these results do not have to be available before the employee starts work.
Voluntary health check after three months
In addition to the mandatory TB testing on arrival, the Norwegian Directorate of Health recommends that newly arrived asylum seekers, refugees and family reunifications are offered a health examination after three months in Norway. This examination should identify if each person has increased risk for infectious diseases, and tests and follow-up should be offered accordingly.