Poor tuberculosis screening in Sweden
In Sweden, the incidence of tuberculosis, or TB, is now very low, but globally it is still a major problem. For this reason, refugees coming to Sweden are infected to a greater extent than Swedes, but this varies greatly between different countries of origin.
Syria, for example, is a low-risk country, with TB levels similar to many European countries. Since 2003, the number of cases of active TB in Sweden has more than doubled.
“It is worrying, but at the same time we have not seen any signs of an increased spread of infection in the country, with the increase in occurrences entirely correlating with the number of people coming here from high-risk countries,” says Knut Lönnroth, Professor of Social Medicine at the Department of Global Public Health at Karolinska Institutet and researcher at the Global TB Programme of the World Health Organization in Geneva.
TB screening in practice
He is studying how the Swedish TB screening works in practice, something which has previously been poorly documented. All active TB cases are, by law, to be reported to the Public Health Agency of Sweden. This means that there are good statistics on those who fall ill with the disease. But by far the most common situation is for the disease to be latent, dormant, and the track kept of these people is not at all as good.
“All asylum seekers in Sweden are to be offered a voluntary health examination including a TB test. But partly because of practical difficulties in reaching them, fewer than half are examined. However, there is nothing to suggest that unwillingness among asylum seekers is a decisive factor,” says Knut Lönnroth.
Lacks national statistics
The Public Health Agency of Sweden lacks national statistics both on how many people have been tested and how many have tested positive. In many countries, TB testing is mandatory, but before there is a clear picture of how the Swedish system actually works, it is very difficult to discuss which strategy is the most optimal,” believes Knut Lönnroth. And even if there is a lack of substantial knowledge regarding Swedish TB work, most signs nevertheless indicate that it is functioning relatively well, so there is no reason for concern.
“It is important not to think that the spread of infection will necessarily increase now that we are receiving more immigrants. The figures we see only reflect the global situation,” says Knut Lönnroth.
Text: Fredrik Hedlund, first published in the magazine Medicinsk Vetenskap number 1, 2017.