Laws and regulations
In 2003, new regulations and a handbook on tuberculosis came into force in Norway (6, 7). The handbook provides guidelines for the tests to be undertaken and at what level, but not where, when and by whom.
The mandatory screening of asylum seekers and immigrants from high-incidence countries was retained. At the same time, the authorities recommended wider use of preventive treatment.
The screening of all asylum seekers was previously undertaken at Tanum transit reception centre in Asker outside Oslo. Currently, the internationally applied Mantoux test is undertaken at three different reception centres in the Oslo region, and the x-ray examination at one centre. According to the handbook, everybody should take the Mantoux test, and additionally a chest x-ray should be taken of everyone over 15 years old.
If pathologies are detected by the chest x-ray examination or a suspicion of active tuberculosis is aroused in other ways, a further examination should be undertaken by a specialist. These examinations commonly take place in the TB Clinic of Oslo University Hospital Ullevål before the asylum seekers are allowed to settle in a local community. If active tuberculosis is detected, the infected patient has until recently been required to stay at Løren transit reception centre until the treatment was concluded.
All persons who have pathological x-ray findings or a strongly positive Mantoux test (≥ 15 mm) must be examined by a specialist. On the other hand, the handbook does not specify to whom preventive treatment should be provided. All those who have a Mantoux test from 6 to 14 mm should be examined by the municipal health services and referred for treatment according to specified guidelines. From Tanum, the asylum seekers have been sent to a transit reception centre, to ordinary asylum reception centres or they have settled privately at their own initiative (Figure 1).
A previous Norwegian study showed that 32 per cent of the asylum seekers who had positive x-ray findings were not given any follow-up (8). Another Norwegian cohort study showed that 11 asylum seekers (14 per cent) who were later diagnosed with tuberculosis had positive x-ray findings upon arrival but had not been followed up (3).