2022 special Ukraine policy visa and the potential TB risk

In response to the conflict between Russia and Ukraine, the New Zealand Government announced the 2022 Ukrainian Special Policy which allows Ukrainian-born citizens and residents in New Zealand to sponsor a family who ordinarily reside in the Ukraine. Based on an estimated 1,600 eligible sponsors, officials estimate that up to 2,400 parents or 4,000 wider family members may seek to enter New Zealand, although the actual number is likely to be lower. All arrivals will be granted either a two-year working visa or two-year student visa and will have full access to publicly funded health and disability services. As of 16 June 2022, 780 visas have been approved and 213 people have arrived under this policy setting.

According to 2019 WHO estimates, Ukraine has the fourth highest Tuberculosis (TB) incidence rate among the 53 countries of the WHO European Region. Ukraine has one of the highest burdens of multidrug resistant tuberculosis (MDR-TB) in the world.

As part of the policy setting, all health requirements for entering New Zealand have been waived for this visa. This information is intended to provide a high-level overview to primary care professionals around tuberculosis symptoms, screening and treatment.

TB is a notifiable disease in New Zealand.

Symptoms of TB presenting in lungs include:

• persistent cough (3 weeks+)
• hemoptysis
• chest pain with cough
• weight loss
• loss of appetite
• fever
• night sweats
• fatigue
• swollen glands.

Tuberculosis is spread through coughing, sneezing, or spitting. It can stay inactive in the body for many years (called latent TB) before developing into an active disease.

The highest risk period for development of disease is in the first five years after infection.

• All Ukrainian arrivals should be referred for chest X-ray screening due to the high incidence of tuberculosis in the Ukrainian population.
• Ukrainian arrivals with symptoms may have active TB and should be referred with high priority.
• Chest X-rays can be arranged through DHB chest X-ray referral and the following should be annotated on the form: “Chest X-ray to exclude TB infection: high risk patient – recently arrived Ukrainian Refugee (eligible for publicly funded healthcare in NZ)”
• If a chest X-ray comes back abnormal, Public Health Units (now the National Public Health Service) will become involved in the case, including in obtaining a sputum sample and in the follow up management required for all contacts.
• It is advised to offer vaccination against TB for those who are <5, are tuberculin negative and don’t have a history of BCG vaccination. Contact your local public health service to find out who can give the BCG vaccine in your area.

Treatment for tuberculosis involves a combination of antibiotics and monitoring of treatment by a specialist team. Completion of treatment is extremely important to ensure patients are cured and do not develop multidrug resistant tuberculosis.