Undetected Transmission: The Impact of Tuberculosis on Migrant Youth in Scotland

Overview

This retrospective observational study evaluated tuberculosis burden, screening uptake, treatment initiation, and time to treatment among migrant and asylum-seeking children and adolescents attending a targeted screening service in Scotland. Screening uptake and treatment initiation were high, although some participants experienced prolonged intervals before treatment.

Background

TB remains a major global public health challenge. Migrant, refugee, and asylum-seeking populations may experience risks related to exposures before migration, conditions during migration journeys, and barriers to healthcare after arrival. Scotland is a low-incidence setting where targeted screening is recommended for higher-risk populations, but implementation varies. Evidence on screening outcomes and subsequent care pathways among migrant children and adolescents remains limited.

Data Highlights

• Individuals assessed: 131

• Individuals screened: 117 (89.3%)

• Median age: 16 years

• Participants from high-TB-burden countries: 59 (45.0%)

• LTBI cases: 13 (11.1% of those screened)

• Active TB cases: 2 (1.7%)

• Overall TB positivity: 15 of 117 (12.8%)

• Treatment initiated by data collection: 14 of 15 cases (93.3%)

• Median time to treatment initiation: 35 days

• LTBI treatment initiated after more than 90 days: 3 of 13 cases

Key Findings

• Targeted screening achieved 89.3% uptake and identified both latent and active TB.

• Thirteen participants had LTBI, and 2 had active pulmonary or disseminated TB.

• Twelve of the 15 TB-positive participants originated from high-incidence countries, whereas 3 originated from medium- or low-incidence countries.

• Treatment had been initiated in 14 of 15 cases at the time of data collection and was subsequently initiated in the remaining case.

• Five of 13 participants with LTBI began treatment within 28 days, while 3 began treatment after more than 90 days.

• No evaluated variable was significantly associated with LTBI positivity after correction for multiple testing, and the small number of cases limited statistical power.

• Fourteen individuals declined screening or were not screened for operational reasons, leaving their TB status unknown.

Clinical Implications

Targeted screening was feasible and identified a substantial burden of latent and active TB in this single-service cohort. Cases among participants from medium- or low-incidence countries suggest that country of origin alone may not capture individual risk. Migration-related exposures and experiences may warrant consideration alongside country-of-origin incidence, while culturally appropriate communication, interpreters, reminder systems, and integration with broader migrant health assessments may help strengthen continuity of care.

Conclusion

Migrant and asylum-seeking children and adolescents attending this targeted service had high screening uptake and treatment engagement, but clinically important latent and active TB was identified and treatment-initiation intervals varied. Larger multisite studies are needed to confirm the findings, evaluate wider applicability, and determine how migration-related exposures and patient- and system-level factors affect TB risk and care pathways.

Related Resources & Content

1. Silent Spread: Tuberculosis Burden and Care Pathway Delays Among Migrant and Asylum-Seeking Children and Adolescents in Scotland — Lucas S, Montgomery L, Sculthorpe N, Mackay W, McKay L. International Journal of Infectious Diseases. 2026;171:108930. doi:10.1016/j.ijid.2026.108930.

2. Global Tuberculosis Report 2024 — World Health Organization. Geneva: WHO; 2024.

3. Roadmap Towards Ending TB in Children and Adolescents — World Health Organization. 3rd ed. Geneva: WHO; 2023.

4. Tuberculosis Annual Report 2023 — Public Health Scotland. Edinburgh: Public Health Scotland; 2024.

5. Tuberculosis (NG33) — National Institute for Health and Care Excellence. London: NICE; 2023.

6. Refugee and Asylum-Seeking Children and Young People: Guidance for Paediatricians — Royal College of Paediatrics and Child Health. London: RCPCH; 2022.