SETTING: Tuberculosis Control Program, Western Australia. OBJECTIVE: To assess the effectiveness and efficiency of tuberculosis (TB) surveillance in immigrants. DESIGN: Retrospective descriptive analysis of records of immigrants who first registered with the Tuberculosis Program from January 1994 to December 1995, having entered Western Australia on health undertakings (non-legal contracts signed by those determined during pre- migration screening to require post-arrival evaluation). RESULTS: Of 1344 immigrants on health undertakings for TB in the period, 587 (44%) had findings directly related to TB through pre-migration screening, 69 of whom required treatment for active disease. Another 443 (33%) had chest X-ray changes for which TB could not be excluded. Of the remaining 314 (23%), 172 had poor quality X-rays. Post-arrival assessment and follow-up of the whole group detected four of seven additional cases of active TB, 373 persons (28%) requiring ongoing surveillance, 667 (50%) with non-TB conditions and 280 (21%) with normal chest X-rays. CONCLUSIONS: Migrant surveillance for TB in Australia is effective in detecting active disease and identifying a high- risk subgroup requiring further evaluation. Efficiency can be improved and high compliance achieved with simple administrative changes. Routine pre- migration Mantoux testing is inappropriate, and its inclusion in post-arrival assessments should be a national policy decision.

Western Australia Health undertaking immigrants Tuberculosis surveillance

immigrant Australia health care policy Population Surveillance follow up human middle aged priority journal Aged Humans Adolescent male female Aged, 80 and over tuberculosis Infant Child, Preschool high risk population Western Australia Article Retrospective Studies major clinical study tuberculin test adult thorax radiography Emigration and Immigration Child health survey