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World Health Organization WHO chose the theme, 2024 the theme continues "Yes! We can end tuberculosis!"

Tuberculosis is quite rare here in Iceland, with about one case diagnosed each month (6-20 cases per year). In the period 2015-2022, 85 cases of tuberculosis were reported in this country. Of these, about 21 were diagnosed during residence permit screening (25%), 18 persons (21%) with Icelandic citizenship, and 46 persons (54%) of foreign origin were diagnosed due to their symptoms or tuberculosis in household members. Most people with Icelandic citizenship are thought to have been infected here, either in their younger years (people born before 1960) or recently, but it is quite rare for Icelandic citizens to be able to reliably trace the infection to stay abroad.

Residence permit screening is an important tool to catch those who are already sick with tuberculosis and can be contagious, but on the same occasion, efforts are also made to find as many people as possible who are infected with tuberculosis, but not sick, to offer preventive treatment. The screening and possibly treatment for active tuberculosis or tuberculosis infection is often people's first impression of the health care system in a new country. People excluded from residence permit screening (18% of TB cases in 2015-2022) often do not have much lower background risk than people from countries who receive screening upon arrival, the incidence of tuberculosis is almost the same in Romania (not screened) and Ukraine (screened).

How can we further reduce tuberculosis disease in this country?

Some people diagnosed with tuberculosis here in Iceland have been symptomatic and even contagious for several months before being diagnosed. Diagnostic delay is one of the main problems in efforts to prevent the spread of tuberculosis globally and is an important measure of the effectiveness of TB prevention. If symptoms have persisted for four weeks before a TB diagnosis is made in a person with infectious tuberculosis, it is rather unlikely that anyone other than the household member of the sick person will take the infection, in Iceland those who have been infected recently are usually offered preventive treatment. The longer a person with tuberculosis is symptomatic, the higher the risk that individuals who cannot be traced have become infected, will not receive preventive treatment, and later become ill themselves.

Why is the diagnosis delayed? – reasons are varied, including:

In the first few weeks after people become ill with tuberculosis, there is usually little to strongly indicate that it is tuberculosis rather than another disease. Since tuberculosis is not very common here, many healthcare professionals have rarely seen tuberculosis patients and tuberculosis comes late to mind, often suspecting tuberculosis first in interpreters of studies, such as chest images if respiratory symptoms are present or upon histological analysis if tuberculosis causes bulks in the lymph nodes, skin or spine, and malignancy is suspected.

People who are concerned about tuberculosis do not necessarily know where to look nor that treatment for tuberculosis is free of charge to a patient in Iceland.

Fear of the disease or stigma due to the tuberculosis infection and/or one's stigma can delay people seeking help.

What system thresholds may be lowered to reduce diagnostic delays in this country?

Recently, the Chief Epidemiologist issued guidance on the use of tuberculosis testing, screening according to current procedures, and tracing, so that healthcare professionals across the country have access to the same basic documentation and can put a process of diagnosis and treatment in place anywhere.

There are no guidelines or policies in Iceland on access to screening for tuberculosis infection or tuberculosis disease among people who regularly stay in high-risk areas, nor for people who are exempt from screening because of a residence permit but think they have been exposed to tuberculosis. There may be opportunities for improvement in this regard.

In many places, tuberculosis-related healthcare is distinguished from other service components, specially trained staff in specially designed housing, etc. In Iceland, there are no special tuberculosis receptions, but screening is generally done by the primary care provider, if tuberculosis illness is present, infectious disease doctors do the treatment. An important aspect of promoting access to appropriate services for people concerned about tuberculosis is that information about where they are is available in a language that is useful to the seeker. Proposals for improvements in this regard based on a WHO Europe project will be submitted to the National Institutes of Health in the near future.

See also:

• World TB Day 2024 at the World Health Organization

• Cost-effectiveness of active tuberculosis screening among high-risk populations in low tuberculosis incidence countries: a systematic review, 2008 to 2023

• Diagnoses of tuberculosis in Europe are available from the European Centre for Disease Prevention and Prevention ECDC

• Use of tuberculin tests (Icelandic)

• Guidelines for tuberculosis screening and tracing (Icelandic)

• Tuberculosis. Guidance for health, social work and cleaning workers.

The Chief Epidemiologist