Tuberculosis screening in refugee children from Ukraine - results from Germany
This summary provides an overview of the publication by Häcker B et al, published in May 2025 in the International Journal of TB and Lung Disease (IJTLD), which presents an analysis of a survey on tuberculosis screening in 2022 in refugee children from Ukraine.
Since the start of the war in Ukraine in February 2022, over one million people have fled to Germany - around a third of them are children, mostly of primary school age.
Although the ECDC and the WHO do not recommend general TB screening for refugees from Ukraine, screening is mandatory in Germany for people accommodated in a communal facility. While adults are usually screened using X-rays, different requirements apply to children, as exposure to radiation should be avoided as far as possible. For this reason, the German Central Committee against Tuberculosis (DZK), together with the Society for Pediatric Pneumology (GPP), recommends in a joint statement that children with symptoms, risk factors or known contact with TB cases should be screened for TB. However, comprehensive screening of all Ukrainian children is not recommended.
In order to gain an overview of the practical implementation of screening, the BVÖGD's Tuberculosis Working Group surveyed health authorities across Germany about their experiences. 36 health authorities from nine federal states submitted data on a total of 3,462 children who were screened for tuberculosis between March and November 2022.
In the under-fives, 719 children were examined either by symptom-oriented questioning (n=256), IGRA (n=156) or THT (n=866). 17 children in this age group tested positive (symptoms: 4, IGRA: 7, THT (>10mm): 6), one child was diagnosed with active tuberculosis. In the age group from six to 15 years, 2,743 children were examined, 99 test results were conspicuous (4/464 symptom screening, 88/1,720 IGRA, 7/559 THT), of which three children had confirmed tuberculosis. This means that the case detection rate in both age groups together was around 116/100,000 children, a figure that is not reflected in either the Ukrainian or the German reporting data. We assume that a selection has already taken place through screening before placement in a community facility and that particularly high-risk groups such as children from orphanages or other disadvantaged groups were screened.
The study also showed that IGRA and THT had >10mm-like detection rates - even in children with a high probability of BCG vaccination.
Targeted screening can be an important tool for the early detection and treatment of tuberculosis - especially in children from risk groups.
However, the results particularly underline the need for better data collection and evaluation of TB screening measures. This is the only way to decide in the long term how screening strategies in Germany should be further developed and adapted to current situations.
Authors:inside: B. Häcker, F. Brinkmann, L. Staroske, R.Otto-Knapp, C. Breuer, M. Priwitzer, T. Bauer
Contact: bhaecker@dzk-tuberkulose.de
[BH1]Häcker B, BrinkmannF, Staroske L, Otto-Knapp R, Breuer C, Priwitzer M, Bauer T. TB screening ofchildren from Ukraine in Germany. Int J Tuberc Lung Dis. 2025 May25;29(5):234-236. doi: 10.5588/ijtld.24.0400. PMID: 40281672.
