Abstract: We read with great interest the Lancet Editorial (Sept 12, p 1013)1The LancetAdapting to migration as a planetary force.Lancet. 2015; 386: 1013Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar emphasising the slow and inadequate response of health institutions and professional bodies to the ongoing refugee crisis in Europe. We welcome that the Editorial focuses on the health and wellbeing of refugee children and wish to highlight specific issues relating to tuberculosis. With waves of refugees crossing country borders, public health systems in Europe are establishing screening procedures for infectious diseases likely to accompany the new arrivals.2Nicolai T Fuchs O von Mutius E Caring for the wave of refugees in Munich.N Engl J Med. 2015; 373: 1593-1595Crossref PubMed Scopus (43) Google Scholar One such travel companion is tuberculosis, which is highly endemic in many eastern European, African, and Middle Eastern countries. Dedicated policies for tuberculosis screening in refugees are available in many countries. A survey was done with professionals involved in tuberculosis control programmes in 29 member states of the Organisation for Economic Co-operation and Development in 2010. The results showed that 86% of these countries had tuberculosis screening programmes for active tuberculosis and 55% of these countries had latent tuberculosis infection in refugees.3Pareek M Baussano I Abubakar I Dye C Lalvani A Evaluation of immigrant tuberculosis screening in industrialized countries.Emerg Infect Dis. 2012; 18: 1422-1429Crossref PubMed Scopus (85) Google Scholar The ptbnet—a clinical research network of more than 100 physicians in 24 European countries providing care for children with tuberculosis4Tebruegge M Ritz N Koetz K et al.Availability and use of molecular microbiological and immunological tests for the diagnosis of tuberculosis in Europe.PLoS One. 2014; 9: e99129Crossref PubMed Scopus (30) Google Scholar, 5Basu Roy R Sotgiu G Altet-Gómez N Identifying predictors of interferon-gamma release assay results in pediatric latent tuberculosis: a protective role of bacillus Calmette-Guerin? A pTB-NET collaborative study.Am J Respir Crit Care Med. 2012; 186: 378-384Crossref PubMed Scopus (85) Google Scholar—would like to express concerns that refugee children and adolescents are at risk of being neglected as a group if only symptom-based tuberculosis screening is used. Children often have few and only non-specific tuberculosis symptoms, which can be missed by such screening approaches. A survey among members of the ptbnet shows the heterogeneity of national tuberculosis screening policies for refugee children and adolescents (unpublished). Although in the UK no tuberculosis screening is implemented in this age group, stratified screening or general routine screening based on interviews, symptoms, chest radiography, or immune-based screening (tuberculin skin test or interferon-γ release assay) are done in arrivals—eg, in Austria, Belgium, Germany, Spain, Sweden, and Switzerland. In an ideal world, tuberculosis exposure would be assessed and baseline tuberculosis screening completed for every refugee child and adolescent on arrival, with a subsequent follow-up over the next 2 years. Given the substantial pressure this approach would exert on health- care resources, many countries have opted to simply modify their original guidelines they developed before the migration crisis. Some countries are exclusively aiming to identify adults with active tuberculosis, arguing that this screening will restrict transmission within refugee centres and to the resident population. However, this strategy neglects addressing the reservoir of tuberculosis that is latent tuberculosis infection. Epidemiological evidence shows that progression of latent tuberculosis infection to active tuberculosis usually occurs within the first 2 years of arrival and that children have the highest risk for progression.6Borrell S Español M Orcau A et al.Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona.Clin Microbiol Infect. 2010; 16: 568-574Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 7Abubakar I Laundy MT French CE Shingadia D Epidemiology and treatment outcome of childhood tuberculosis in England and Wales: 1999–2006.Arch Dis Child. 2008; 93: 1017-1021Crossref PubMed Scopus (55) Google Scholar Recognition of tuberculosis symptoms needs to be integrated into immediate health assessments of refugees, including children and adolescents. Long-term assimilation of arrivals into health-care systems should include screening for both latent and active tuberculosis, as well as training primary and emergency treatment service in vigilance for and recognition of tuberculosis symptoms in this vulnerable population. We declare no competing interests. Adapting to migration as a planetary forceThe spectre of hundreds of thousands of refugees crossing Europe and being turned away by nations, despite urgent and heart-rending appeals for safe haven, has disturbing historical echoes. In 1938, Hertha Nathorff, a Jewish physician living in Germany, wrote: "I'm counting the days until we come out of this living hell…Everyone has only one wish: to get out of this country. And they don't hesitate to say so openly." During 1938 and 1939, the world, including the USA, Europe, and Latin America, was reluctant to admit escaping Jewish refugees—with, as we know, horrific consequences. Full-Text PDF