Berklar hjá innflytjendum á Íslandi

Abstract

Objective: The purpose of the study was to find the incidence and prevalence of tuberculosis among the foreign-born in Iceland. Material and methods: The study material was obtained from (a) the National TB register and (b) the files of the Immigration Office on recidency applicants in 1995. Results: In 1975-1996 there were 32 cases of TB in the foreign-born out of a total of 468. The proportion of cases among the foreign-born rose significantly during the period (p<0.001). In 22 years the incidence of TB among the foreign-born was 18.0 but 8.4 among those born in Iceland (p<0.001). The incidence of TB in Asian-born was 173.7, or 21 times that among those born in Iceland (p<0.001). The second highest incidence (18.8) was in those born in North and South America. Tuberculosis usually appeared within five years of immigration. During 1995 the 559 applicants for recidence permit provided health certificates. Of these 363 had a tuberculin skin test (TST) and 42% were positive. The corresponding figure for those born in Africa was 68%, in Asia 58% and in East Europa 50%. Most of those with positive TST had a chest x-ray but also 23% of the others. 26.2% had neither a TST nor a chest x-ray but still received a health certificate. Only 33% of those positive received isoniazide to eliminate infection and 88% of these completed at least six months of isoniazide treatment. Conclusion: A TST is an indispensable part of health screening for immigrants and also a chest x-ray when appropriate. Treatment of TB infection should be used more often.

Tilgangur: Tilgangur rannsóknar var að finna nýgengi berkla meöal innflytjenda á Íslandi. Efniviður og aðferðir: Efniviður var annars vegar sóttur í berklaskrá og hins vegar í skrá Útlendingaeftirlitsins um þá sem sóttu um dvalarleyfi árið 1995. Niðurstöður: Á árunum 1975-1996 greindust 468 berklatilfelli á Íslandi, þar af 32 berklatilfelli meðal innflytjenda. Hlutfall innflytjenda meðal berklaveikra jókst marktækt á tímabilinu (p<0,001). Nýgengi berklaveiki meðal innflytjenda var 18,0 á 22 árum en meðal innfæddra Íslendinga 8,4 (p<0,001). Nýgengi meðal innflytjenda frá Asíu var 173,7 eða 21 sinnum hærra en meðal innfæddra Íslendinga (p<0,001) en þar á eftir komu innflytjendur frá ríkjum Ameríku með nýgengi 18,8. Berklaveiki kom venjulega fram innan fimm ára frá komu til landsins. Árið 1995 framvísuðu 559 manns sem sóttu um dvalarleyfi læknisvottorði. Af þeim fór rúmur fjórðungur (26,2%) hvorki í berklapróf né lungnamynd. Af 363 berklaprófuðum umsækjendum um dvalarleyfi voru 42% jákvæðir. Samsvarandi tölur fyrir fólk frá Afríku voru 68%, Asíu 58% og Austur-Evrópu 50%. Flestir jákvæðra fóru í lungnamynd en einnig 23% neikvæðra. Aðeins 33% jákvæðra fengu meðferð til að uppræta sýkingu og tóku 88% þeirra lyf í að minnsta kosti sex mánuöi. Ályktun: Berklapróf ætti að vera ófrávíkjanlegur hluti af heilbrigðisskoðun innflytjenda ásamt lungnamynd þegar hún á við. Það ætti aö veita meðferð gegn berklasmitun oftar en gert er í dag.