Open flanks in the management of tuberculosis in Germany under the pressure of migration.

To prevent transmission is the ultimate goal of any TB control strategy. So far, asylum seekers/immigrants are only actively screened for TB after arrival in Germany, if admitted to mass accommodation facilities. The current TB control strategy in Germany is assessed by a SWOT-analysis (strengths, weaknesses, opportunities and threats) including the impact of active case finding, environmental case finding (ECF) also known as contact tracing, passive case finding (PCF) and effective TB treatment. According to the number-needed-to-screen (NNS), asylum seekers from most countries and unaccompanied minors would have to be screened for active TB by a chest radiograph at entry independently of the type of accommodation. This would include children between 10 and 15 years of age and a follow-up for at least 3 to 5 years, with a denser follow-up in the first year. ECF and PCF only contribute little to a proactive reduction of the pre-patency period. The available data on the epidemiology and the NNS of TB in migrants are sufficient to come up with a more powerful control strategy for TB in migrants in Germany to close the existing open flanks. It is time for action.