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Haldar P, Ahyow L, Dedicoat M. Responding to the tuberculosis risk of forced mass migration from Ukraine: a complex challenge with no single solution. Thorax 2023; 79:5-6. [PMID: 37758459 DOI: 10.1136/thorax-2023-220502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Pranabashis Haldar
- Respiratory Sciences and NIHR Respiratory BRC, University of Leicester, Leicester, UK
| | - Lauren Ahyow
- Tuberculosis Unit, UK Health Security Agency, London, UK
| | - Martin Dedicoat
- Tuberculosis Unit, UK Health Security Agency, London, UK
- Infectious Diseases, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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2
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Litvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. THE LANCET. INFECTIOUS DISEASES 2023; 23:1395-1407. [PMID: 37696278 PMCID: PMC10665202 DOI: 10.1016/s1473-3099(23)00372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tuberculosis is a communicable disease of public health concern that inequitably impacts the most vulnerable populations worldwide. Vulnerable populations are those with a high risk for tuberculosis disease and whose disadvantaged or marginalised socioeconomic position limits their access to the health system. We conducted an overview of reviews that aimed to assess the burden (ie, prevalence and incidence) of tuberculosis disease among 12 vulnerable populations globally. METHODS We did an overview of reviews using a systematic search in MEDLINE, Embase, and the Cochrane Database for Systematic Reviews for articles published in English, French, and Chinese, from Jan 1, 2010 to March 8, 2023. We did an initial search on Oct 28, 2021, and updated our search on March 8, 2023. We included systematic and scoping reviews reporting on the prevalence or incidence of active tuberculosis among 12 vulnerable populations. Evidence gaps were supplemented with primary or secondary database studies. Study characteristics and outcome data related to tuberculosis burden were tabulated, including prevalence ratios and incidence rate ratios, and evidence was synthesised narratively. This trial is registered with PROSPERO (CRD42022324421). FINDINGS We screened 13 169 citations and included 44 publications (23 reviews and 21 primary or database studies) in the final synthesis. The comprehensiveness and methodological quality of the evidence differed across population groups. Prevalence of more than 1000 cases per 100 000 were reported in all vulnerable populations. On the basis of pooled estimates, prevalence ratios were often more than 25 among people experiencing homelessness, incarcerated populations, refugees, asylum seekers, and people living with HIV compared with the general population. Incidence was infrequently reported, with the best-available incidence rate ratios documented for people who were incarcerated. There was scarce evidence specific to miners, nomadic populations, sex workers, men who have sex with men, and transgender individuals. INTERPRETATION The burden of tuberculosis is substantially higher among vulnerable populations than general populations, suggesting a need for improved integration of these groups, including dedicated efforts for their identification, targeted screening and prevention measures, as well as treatment support. FUNDING WHO.
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Affiliation(s)
- Stefan Litvinjenko
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, ON, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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3
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Pescarini JM, Goes EF, Pinto PFPS, Dos Santos BPS, Machado DB, Abubakar I, Rodrigues LC, Brickley EB, Smeeth L, Barreto ML. Mortality among over 6 million internal and international migrants in Brazil: a study using the 100 Million Brazilian Cohort. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100455. [PMID: 36890851 PMCID: PMC9986634 DOI: 10.1016/j.lana.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
Background To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course. Methods We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals. Findings The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05). Interpretation Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants. Funding The Wellcome Trust.
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Affiliation(s)
- Julia M. Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Emanuelle F. Goes
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Daiane B. Machado
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Laura C. Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B. Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Health Data Research (HDR), London, UK
| | - Mauricio L. Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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4
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Macfarlane L, Brij S, Child F, Turnbull L, Lee A, Barrera M, Hogan C. Active and latent TB screening in recently arrived persons from Afghanistan: feasibility and lessons learned. Clin Med (Lond) 2023; 23:164-169. [PMID: 36958840 PMCID: PMC11046555 DOI: 10.7861/clinmed.2022-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
We describe an active and latent tuberculosis (TB) screening programme undertaken in Manchester, UK in response to the arrival of a cohort of refugees from Afghanistan. In total, 217 adults and 347 children were offered screening, which involved a symptom questionnaire, Mantoux test or interferon gamma release assay, blood-borne virus screening and a chest X-ray in participants over the age of 11. We found a latent TB infection (LTBI) rate of 15% in adults and 1.5% in children, which is lower than global LTBI estimates. One case of active TB was detected. Screening was undertaken in the hotels where participants were temporarily housed, leading to high participant engagement levels. Attendance rates were almost doubled compared with a previous hospital-based screening programme. Hotel-based screening for TB presented several challenges, including transfer of information and results to secondary care. Understanding these challenges and learning from the programme has helped us refine our screening protocol to optimise migrant TB screening in Manchester in the future.
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Affiliation(s)
| | - Seema Brij
- Manchester Royal Infirmary, Manchester, UK
| | - Fran Child
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Alice Lee
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Celia Hogan
- North Manchester General Hospital, Manchester, UK
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5
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Dao TP, Hoang XHT, Nguyen DN, Huynh NQ, Pham TT, Nguyen DT, Nguyen HB, Do NH, Nguyen HV, Dao CH, Nguyen NV, Bui HM. A geospatial platform to support visualization, analysis, and prediction of tuberculosis notification in space and time. Front Public Health 2022; 10:973362. [PMID: 36159240 PMCID: PMC9500499 DOI: 10.3389/fpubh.2022.973362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Background Tuberculosis has caused significant public health and economic burdens in Vietnam over the years. The Vietnam National Tuberculosis Program is facing considerable challenges in its goal to eliminate tuberculosis by 2030, with the COVID-19 pandemic having negatively impacted routine tuberculosis services at all administrative levels. While the turnaround time of tuberculosis infection may delay disease detection, high transportation frequency could potentially mislead epidemiological studies. This study was conducted to develop an online geospatial platform to support healthcare workers in performing data visualization and promoting the active case surveillance in community as well as predicting the TB incidence in space and time. Method This geospatial platform was developed using tuberculosis notification data managed by The Vietnam National Tuberculosis Program. The platform allows case distribution to be visualized by administrative level and time. Users can retrieve epidemiological measurements from the platform, which are calculated and visualized both temporally and spatially. The prediction model was developed to predict the TB incidence in space and time. Results An online geospatial platform was developed, which presented the prediction model providing estimates of case detection. There were 400,370 TB cases with bacterial evidence to be included in the study. We estimated that the prevalence of TB in Vietnam was at 414.67 cases per 100.000 population. Ha Noi, Da Nang, and Ho Chi Minh City were predicted as three likely epidemiological hotspots in the near future. Conclusion Our findings indicate that increased efforts should be undertaken to control tuberculosis transmission in these hotspots.
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Affiliation(s)
| | - Xuyen Hong Thi Hoang
- Hanoi Medical University Hospital, Hanoi, Vietnam,Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | | | | | | | | | | | | | - Hanh My Bui
- Hanoi Medical University Hospital, Hanoi, Vietnam,Hanoi Medical University, Hanoi, Vietnam,*Correspondence: Hanh My Bui
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Langholz Kristensen K, Norredam M, Graff Jensen S, Seersholm N, Jørgensen ML, Exsteen BB, Huber FG, Munk-Andersen E, Lillebaek T, Ravn P. Tuberculosis screening among newly arrived asylum seekers in Denmark. Infect Dis (Lond) 2022; 54:819-827. [PMID: 36000199 DOI: 10.1080/23744235.2022.2106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) screening programmes among asylum seekers tend to focus on chest radiography (CXR) for early diagnosis, whereas knowledge on sputum examination is limited. We evaluated active TB screening using CXR and sputum culture among asylum seekers arriving in Denmark. In addition, we assessed the coverage of a voluntary health assessment. METHODS Between 1 February 2017 and 31 March 2019, all newly arrived asylum seekers in Denmark ≥ 18 years from TB high-incidence countries or risk groups, who attended a voluntary general health assessment, were offered active TB screening with CXR and spot sputum examination. Sputum samples were examined by culture and smear microscopy. RESULTS Coverage of the general health assessment was 65.1%. Among 1,154 referred for active TB screening, 923 (80.0%) attended. Of these, 854 were screened by CXR and one case of active TB was identified equivalent to a yield of 0.12%. Sputum samples were collected from 758 and one M. tuberculosis culture-positive TB case (also identified by CXR) was identified, equivalent to a yield of 0.13%. No cases were found by sputum culture screening only. In addition, screening found three cases of malignant disease. CONCLUSION We suggest that TB screening should focus on asylum seekers from TB high-incidence countries. Furthermore, early health assessments should be of high priority to ensure migrant health.
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Affiliation(s)
- Kristina Langholz Kristensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
| | - Sidse Graff Jensen
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Marie Louise Jørgensen
- Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Banoo Bakir Exsteen
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark.,Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Franziska Grundtvig Huber
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Di Napoli A, Ventura M, Grande E, Frova L, Mirisola C, Petrelli A. Nationwide longitudinal population-based study on mortality in Italy by immigrant status. Sci Rep 2022; 12:10986. [PMID: 35768625 PMCID: PMC9243023 DOI: 10.1038/s41598-022-15290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/22/2022] [Indexed: 11/09/2022] Open
Abstract
A systematic analysis of the mortality of immigrant residents throughout Italy has never been carried out. The present study aimed to evaluate differences in mortality by immigrant status. A longitudinal study of the Italian resident population (native and immigrants) recorded in the 2011 National Institute of Statistics Census was conducted. This cohort was followed up from 2012 to 2018 until death, emigration, or end of the study period. The exposure variable was the immigrant status, measured through citizenship, dichotomized into Italian and immigrant. The main outcome was overall and cause-specific mortality. Age-standardized mortality ratios (SMRs) were calculated. The SMRs among immigrants were half that of Italians, both for men (SMR 0.52) and women (SMR 0.51), with the lowest SMRs observed for subjects from North Africa and Oceania. For some causes of death, mortality was higher among immigrants: tuberculosis in both men (SMR 4.58) and women (SMR 4.72), and cervical cancer (SMR 1.58), complications of pregnancy, childbirth, and puerperium (SMR 1.36), and homicide (SMR 2.13) for women. A multivariable quasi-Poisson regression analysis, adjusted for age and macro area of residence in Italy, confirmed a lower all-cause mortality for immigrants compared to Italians, both for men (RR 0.46) and women (RR 0.44). Although immigration to Italy is no longer a recent phenomenon, and the presence of immigrants is acquiring structural characteristics, our study confirms their health advantage, with a lower mortality than that of Italians for almost all causes of death and for all areas of origin.
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Affiliation(s)
- Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy.
| | - Martina Ventura
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
| | - Enrico Grande
- National Institute of Statistics (Istat), Rome, Italy
| | - Luisa Frova
- National Institute of Statistics (Istat), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via di San Gallicano, 25a - 00153, Rome, Italy
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8
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Marx FM, Hauer B, Menzies NA, Haas W, Perumal N. Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis. BMC Public Health 2021; 21:2172. [PMID: 34836526 PMCID: PMC8622109 DOI: 10.1186/s12889-021-12142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
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Affiliation(s)
- Florian M Marx
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany. .,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany.,Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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9
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Pampaloni A, Locatelli ME, Venanzi Rullo E, Alaimo S, Cosentino F, Marino A, Moscatt V, Scuderi D, Puglisi S, Lupo G, Celesia BM, Pintaudi S, Pulvirenti C, Ceccarelli M, Nunnari G, Pulvirenti A, Cacopardo B. "Diagnosis on the Dock" project: A proactive screening program for diagnosing pulmonary tuberculosis in disembarking refugees and new SEI model. Int J Infect Dis 2021; 106:98-104. [PMID: 33737130 DOI: 10.1016/j.ijid.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE From 2011 to 2017, the total number of refugees arriving in Europe, particularly in Italy, climbed dramatically. Our aim was to diagnose pulmonary TB in migrants coming from the African coast using a clinical-based port of arrival (PoA) screening program. METHODS From 2016 to 2018, migrants coming via the Mediterranean Route were screened for body temperature and the presence of cough directly on the dock: if they were feverish with productive cough, their sputum was examined with NAAT; with a dry cough, they underwent Chest-X-ray (CXR). Those migrants with positive NAAT or CXR suggestive for TB were admitted to our ward. In addition, we plotted an SEI simulation of our project to evaluate the epidemiological impact of our screening. RESULTS Out of 33.676 disembarking migrants, 314 (0.9%) had fever and cough: 80 (25.47%) with productive cough underwent NAAT in sputum, and 16 were positive for TB; 234 (74.52%) with dry cough had a CXR examination, and 39 were suggestive of TB, later confirmed by mycobacterial culture. The SEI-new model analysis demonstrated that our screening program significantly reduced TB spreading all over the country. CONCLUSIONS For possible future high migrant flows, PoA screening for TB has to be considered feasible and effective in decreasing TB spreading.
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Affiliation(s)
- Alessio Pampaloni
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
| | - Maria Elena Locatelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Salvatore Alaimo
- Bioinformatics Section, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Daniele Scuderi
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Sara Puglisi
- Department of Anaesthesia and Critical Care, University of Milan, Milan, Italy
| | - Gaetano Lupo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Sergio Pintaudi
- Emergency Department, ARNAS Garibaldi Hospital, Catania, Italy
| | | | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfredo Pulvirenti
- Bioinformatics Section, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
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10
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Health assessment for migrants and asylum seekers upon arrival and while hosted in reception centres: Italian guidelines. Health Policy 2020; 125:393-405. [PMID: 33461797 DOI: 10.1016/j.healthpol.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND During 2016-17, national guidelines were developed in order to provide evidence-based recommendations on health assessments for migrants and asylum seekers upon their arrival in Italy. METHODS Scientific literature published between 2005 and 2016 was searched in different databases. A free search was also performed on international organizations' websites in order to identify additional relevant documents. A multidisciplinary panel discussed the resulting evidence and formulated recommendations. RESULTS Evidence-based recommendations were formulated: signs and symptoms of specific diseases should to be actively searched for active TB, malaria, STI, intestinal parasites, diabetes, anaemia. In case of other health conditions (latent TB, HIV, HBV, HCV, STI, strongyloides, schistosoma, diabetes), testing should be offered to asymptomatic subjects coming from endemic areas or exposed to risk factors. Mass screening is recommended for anaemia and hypertension; a pregnancy test should be considered, while inclusion in cervical cancer screening and vaccination programs is recommended. A modulated, progressive approach was developed, covering an initial evaluation during rescue operations, a full medical examination at first line reception stage and the referral to national health services during second line reception. CONCLUSIONS It is important to produce and periodically update guidelines on these issues and local peculiarities should be taken into account in their design and implementation. Guidelines can not only support economic sustainability, but also counteract stigmatization dynamics.
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11
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Langholz Kristensen K, Lillebaek T, Holm Petersen J, Hargreaves S, Nellums LB, Friedland JS, Andersen PH, Ravn P, Norredam M. Tuberculosis incidence among migrants according to migrant status: a cohort study, Denmark, 1993 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 31690363 PMCID: PMC6836680 DOI: 10.2807/1560-7917.es.2019.24.44.1900238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Migrants account for the majority of tuberculosis (TB) cases in low-incidence countries in western Europe. TB incidence among migrants might be influenced by patterns of migration, but this is not well understood. Aim To investigate differences in TB risk across migrant groups according to migrant status and region of origin. Methods This prospective cohort study included migrants ≥ 18 years of age who obtained residency in Denmark between 1 January 1993 and 31 December 2015, matched 1:6 to Danish-born individuals. Migrants were grouped according to legal status of residency and region of origin. Incidence rates (IR) and incidence rate ratios (IRR) were estimated by Poisson regression. Results The cohort included 142,314 migrants. Migrants had significantly higher TB incidence (IR: 120/100,000 person-years (PY); 95% confidence interval (CI): 115–126) than Danish-born individuals (IR: 4/100,000 PY; 95% CI: 3–4). The IRR was significantly higher in all migrant groups compared with Danish-born (p < 0.01). A particularly higher risk was seen among family-reunified to refugees (IRR: 61.8; 95% CI: 52.7–72.4), quota refugees (IRR: 46.0; 95% CI: 36.6–57.6) and former asylum seekers (IRR: 45.3; 95% CI: 40.2–51.1), whereas lower risk was seen among family-reunified to Danish/Nordic citizens (IRR 15.8; 95% CI: 13.6–18.4) and family-reunified to immigrants (IRR: 16.9; 95% CI: 13.5–21.3). Discussion All migrants had higher TB risk compared with the Danish-born population. While screening programmes focus mostly on asylum seekers, other migrant groups with high risk of TB are missed. Awareness of TB risk in all high-risk groups should be strengthened and screening programmes should be optimised.
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Affiliation(s)
- Kristina Langholz Kristensen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Sally Hargreaves
- Institute for Infection & Immunity, St. George's, University of London, London, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jon S Friedland
- Institute for Infection & Immunity, St. George's, University of London, London, United Kingdom
| | - Peter Henrik Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Medicine, Infectious Disease Section, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Marie Norredam
- Department of Infectious Diseases, Section of Immigrants Medicine, University Hospital Hvidovre, Hvidovre, Denmark.,Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
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12
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Chattu VK, Sakhamuri S, Motilal S, Pounder LJ, Persad VK, Pierre N, Persad S, Pooran N, Pottinger AM. Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago. Healthcare (Basel) 2020; 8:healthcare8030236. [PMID: 32727008 PMCID: PMC7551204 DOI: 10.3390/healthcare8030236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender.
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Affiliation(s)
- Vijay Kumar Chattu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Occupational Medicine Clinic, St. Michael’s Hospital, Toronto, ON M5C 2C5, Canada
- Institute of International Relations, The University of the West Indies, St. Augustine, Trinidad and Tobago
- Correspondence: (V.K.C.); (S.S.); Tel.: +1-416-864-6060 (V.K.C.)
| | - Sateesh Sakhamuri
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
- Correspondence: (V.K.C.); (S.S.); Tel.: +1-416-864-6060 (V.K.C.)
| | - Shastri Motilal
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago;
| | - Liam J. Pounder
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Vasishma Kanita Persad
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Neelmani Pierre
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Shivannie Persad
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Nikesha Pooran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Akua Mosi Pottinger
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
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13
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Proença R, Mattos Souza F, Lisboa Bastos M, Caetano R, Braga JU, Faerstein E, Trajman A. Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis. BMC Public Health 2020; 20:838. [PMID: 32493327 PMCID: PMC7268459 DOI: 10.1186/s12889-020-08907-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. METHODS Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. RESULTS Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542-2384] and 37% (95% CI = 23-52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I2] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. CONCLUSION Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.
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Affiliation(s)
- Raquel Proença
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - José Ueleres Braga
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Anete Trajman
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- McGill University, Montreal, QC, Canada.
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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14
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Pasta L, Suero LAM, Filippazzo MG, Farinella EM, Gargano C, Serravalle D, D’Amico N. The Health Problems at the Landing of the Migrants in Lampedusa from 2011 to June 2019: Analysis of the Data and Revision of the Literature. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2019. [DOI: 10.1007/s12134-019-00719-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Greenaway C, Pareek M, Abou Chakra CN, Walji M, Makarenko I, Alabdulkarim B, Hogan C, McConnell T, Scarfo B, Christensen R, Tran A, Rowbotham N, Noori T, van der Werf MJ, Pottie K, Matteelli A, Zenner D, Morton RL. The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: a systematic review. ACTA ACUST UNITED AC 2019; 23. [PMID: 29637888 PMCID: PMC5894252 DOI: 10.2807/1560-7917.es.2018.23.14.17-00542] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
: The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. Methods: We conducted a systematic review to determine effectiveness (yield and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. Results: We identified six systematic reviews, one report and three individual studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110–2,340), migrant type (170–1,192), TB incidence in source country (19–336) and screening setting (220–1,720). The CXR yield was lower (19.6 vs 336/100,000) and the numbers needed to screen were higher (5,076 vs 298) among migrants from source countries with lower TB incidence (≤ 50 compared with ≥ 350/100,000). Cost-effectiveness was highest among migrants originating from high (> 120/100,000) TB incidence countries. The foreign-born had similar or better TB treatment outcomes than those born in the EU/EEA. Acceptance of CXR screening was high (85%) among migrants. Discussion: Screening programmes for active TB are most efficient when targeting migrants from higher TB incidence countries. The limited number of studies identified and the heterogeneous evidence highlight the need for further data to inform screening programmes for migrants in the EU/EEA.
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Affiliation(s)
- Christina Greenaway
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Claire-Nour Abou Chakra
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Québec, Canada
| | - Moneeza Walji
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Iuliia Makarenko
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Balqis Alabdulkarim
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Catherine Hogan
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
| | - Ted McConnell
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Brittany Scarfo
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anh Tran
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Nick Rowbotham
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Kevin Pottie
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, World Health Organization Collaborating Centre for TB/HIV and TB Elimination, Brescia, Italy
| | - Dominik Zenner
- Department of Infection and Population Health, University College London, London, United Kingdom.,Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
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16
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Collin SM, Wurie F, Muzyamba MC, de Vries G, Lönnroth K, Migliori GB, Abubakar I, Anderson SR, Zenner D. Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews. Eur Respir Rev 2019; 28:28/152/180107. [PMID: 31142548 DOI: 10.1183/16000617.0107-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/22/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence? METHODS We conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to "direct" or "indirect" effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as "sufficient", "tentative", "insufficient" or "no" using a framework based on the consistency of evidence within and between reviews. RESULTS We found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection. DISCUSSION Our review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.
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Affiliation(s)
- Simon M Collin
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Fatima Wurie
- TB Unit, National Infection Service, Public Health England, London, UK
| | - Morris C Muzyamba
- TB Unit, National Infection Service, Public Health England, London, UK
| | | | | | | | | | - Sarah R Anderson
- TB Unit, National Infection Service, Public Health England, London, UK
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17
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Bozorgmehr K, Preussler S, Wagner U, Joggerst B, Szecsenyi J, Razum O, Stock C. Using country of origin to inform targeted tuberculosis screening in asylum seekers: a modelling study of screening data in a German federal state, 2002-2015. BMC Infect Dis 2019; 19:304. [PMID: 30943917 PMCID: PMC6448304 DOI: 10.1186/s12879-019-3902-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening programmes for tuberculosis (TB) among immigrants rarely consider the heterogeneity of risk related to migrants' country of origin. We assess the performance of a large screening programme in asylum seekers by analysing (i) the difference in yield and numbers needed to screen (NNS) by country and WHO-reported TB burden, (ii) the possible impact of screening thresholds on sensitivity, and (iii) the value of WHO-estimated TB burden to improve the prediction accuracy of screening yield. METHODS We combined individual data of 119,037 asylum seekers screened for TB in Germany (2002-2015) with TB estimates of the World Health Organization (WHO) (1990-2014) for their 81 countries of origin. Adjusted rate ratios (aRR) and 95% credible intervals (CrI) of the observed yield of screening were calculated in Bayesian Poisson regression models by categories of WHO-estimated TB incidence. We assessed changes in sensitivity depending on screening thresholds, used WHO TB estimates as prior information to predict TB in asylum seekers, and modelled country-specific probabilities of numbers needed to screen (NNS) conditional on different screening thresholds. RESULTS The overall yield was 82 per 100,000 and the annual yield ranged from 44.1 to 279.7 per 100,000. Country-specific yields ranged from 10 (95%- CrI: 1-47) to 683 (95%-CrI: 306-1336) per 100,000 in Iraqi and Somali asylum seekers, respectively. The observed yield was higher in asylum seekers from countries with a WHO-estimated TB incidence > 50 relative to those from countries ≤50 per 100,000 (aRR: 4.17, 95%-CrI: 2.86-6.59). Introducing a threshold in the range of a WHO-estimated TB incidence of 50 and 100 per 100,000 resulted in the lowest "loss" in sensitivity. WHO's TB prevalence estimates improved prediction accuracy for eight of the 11 countries, and allowed modelling country-specific probabilities of NNS. CONCLUSIONS WHO's TB data can inform the estimation of screening yield and thus be used to improve screening efficiency in asylum seekers. This may help to develop more targeted screening strategies by reducing uncertainty in estimates of expected country-specific yield, and identify thresholds with lowest loss in sensitivity. Further modelling studies are needed which combine clinical, diagnostic and country-specific parameters.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, INF 130.3, 69120 Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stella Preussler
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrich Wagner
- Public health authority, Section for Disease Control, Landkreis Karlsruhe, Karlsruhe, Germany
| | | | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, INF 130.3, 69120 Heidelberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, DKFZ, Heidelberg, Germany
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18
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Li T, Du X, Shewade HD, Soe KT, Zhang H. What happens to migrant tuberculosis patients who are transferred out using a web-based system in China? PLoS One 2018; 13:e0206580. [PMID: 30408131 PMCID: PMC6224056 DOI: 10.1371/journal.pone.0206580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 10/16/2018] [Indexed: 11/22/2022] Open
Abstract
Background In China, internal migrants constitute one-fifth of tuberculosis (TB) patients registered for treatment in web-based TB information management system (TBIMS). Though China added a specific module in the web-based TBIMS in 2009, web-based transfer-out is not specifically recommended in the national guidelines. Objective In this country wide study among all registered migrant TB patients (2014–2015) that were transferred out using web-based TBIMS in China, to determine the i) timing of transfer-out in relation to period of treatment; ii) delay and attrition during transfer interval (between transfer-out and transfer-in); and iii) extent and risk factors for ‘not evaluated’ as the treatment outcome. Methods This was a cohort study involving review of web-based TBIMS data. Modified Poisson regression was used to build a predictive model for risk factors of ‘not evaluated’ as the treatment outcome. Results Among 7 284 patients, 5 900 (81.0%) were transferred out during the first two months after initiation of treatment or before treatment initiation and 7 088 (97.3%) patients had arrived at transfer-in unit. The median transfer interval was three (interquartile range: 0–14) days. Sixteen percent (1 176/7 284) patients had ‘not evaluated’ as their treatment outcome. ‘Not evaluated’ contributed to 66% of the unfavourable outcomes. Patients transferred from referral hospitals, migrated from out of prefecture, transferred out of prefecture, with sputum smear negative pulmonary TB, with TB pleurisy and with long delay between symptom onset and treatment initiation had significantly higher risk of ‘not evaluated’ as the outcome. Conclusion Web-based transfer helped as the delay and attrition during the transfer interval was quite short and treatment outcomes of more than four-fifths of transferred out migrant TB patients were available with transfer-out BMU. Once strategies to address the independent predictors of ‘not evaluated’ treatment outcome are devised, China may consider mandatory use of web-based TBIMS for transferring out migrant TB patients.
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Affiliation(s)
- Tao Li
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Xin Du
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Kyaw Thu Soe
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, The Republic of The Union of Myanmar
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
- * E-mail:
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Dobler CC, Fox GJ, Douglas P, Viney KA, Ahmad Khan F, Temesgen Z, Marais BJ. Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives. Eur Respir J 2018; 52:13993003.00591-2018. [PMID: 29794133 DOI: 10.1183/13993003.00591-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
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Affiliation(s)
- Claudia C Dobler
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Mayo Clinic Center for Tuberculosis, Rochester, MN, USA
| | - Greg J Fox
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Kerri A Viney
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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20
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Kumwenda GP, Chipungu G, Sloan DJ, Kaimila Y, Chiumya K, Pangani H. The occurrence and frequency of genomic mutations that mediate Isoniazid and Rifampicin resistance in Mycobacterium tuberculosis isolates from untreated pulmonary Tuberculosis cases in urban Blantyre, Malawi. Malawi Med J 2018; 30:1-5. [PMID: 29868151 PMCID: PMC5974378 DOI: 10.4314/mmj.v30i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The emergence and spread of drug-resistant Tuberculosis (TB) is a major public health threat. TB resistance originates in the course of treatment due to genomic mutations in Mycobacterium tuberculosis (MTB). An increase in new cases with drug-resistant TB could be an indicator of high levels of circulating resistant strains. This study was conducted to determine the occurrence and frequency of genomic mutations that mediate Isoniazid (INH) and Rifampicin (RIF) resistance among isolates from untreated TB cases in urban Blantyre, Malawi. Methods A cross-sectional retrospective study was conducted on a panel of 141(n=141) MTB clinical isolates recovered between June 2010 and January 2012 from >2+ Ziehl-Neelsen smear positive new pulmonary-TB patients with no history of treatment. Frozen isolates were revived using the BACTEC MGIT detection system. DNA was extracted using GenoLyse DNA extraction kit and detection of genomic mutations was carried out using the GenoType MTBDRplus Ver 2.0 assay. Results Out of the 141 isolates studied, 3 (2.1%) were found carrying mutations in the katG gene that confer resistance to Isoniazid (INH). No mutations were detected in the inhA promoter region gene that confer weak INH resistance or in the rpoB gene that confer Rifampicin resistance. All katG mutant genes had a S315T1 single point mutation, a genomic alteration that mediates high INH resistance. Conclusion The katG mutant gene conferring resistance to INH was the only genomic mutation observed among the isolates studied and the frequency of occurrence was low. Our findings suggest low levels of circulating drug-resistant MTB strains in urban Blantyre, Malawi.
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Affiliation(s)
| | | | | | - Yankho Kaimila
- The University of Malawi, College of Medicine, Blantyre, Malawi
| | - Kondwani Chiumya
- The University of Malawi, College of Medicine - Wellcome Trust TB Research Laboratory, Blantyre, Malawi
| | - Harry Pangani
- The University of Malawi, College of Medicine - Wellcome Trust TB Research Laboratory, Blantyre, Malawi
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with
Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John's College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 09/04/2023] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John’s College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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Bozorgmehr K, Wahedi K, Noest S, Szecsenyi J, Razum O. Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015. ACTA ACUST UNITED AC 2018; 22. [PMID: 29019315 PMCID: PMC5710125 DOI: 10.2807/1560-7917.es.2017.22.40.16-00677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with Shigella spp. (80,200 EUR), Salmonella spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96–4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Wahedi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Noest
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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van de Berg S, Erkens C, van Rest J, van den Hof S, Kamphorst M, Keizer S, de Vries G. Evaluation of tuberculosis screening of immigrants in the Netherlands. Eur Respir J 2017; 50:50/4/1700977. [DOI: 10.1183/13993003.00977-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/11/2017] [Indexed: 11/05/2022]
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Giorgi Rossi P, Riccardo F, Pezzarossi A, Ballotari P, Dente MG, Napoli C, Chiarenza A, Velasco Munoz C, Noori T, Declich S. Factors Influencing the Accuracy of Infectious Disease Reporting in Migrants: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070720. [PMID: 28678172 PMCID: PMC5551158 DOI: 10.3390/ijerph14070720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/30/2017] [Indexed: 02/07/2023]
Abstract
We conducted a scoping review of literature to improve our understanding of the accuracy of infectious disease monitoring in migrants in the Europe. We searched PubMed for papers relevant to the topic including: case reports, observational and experimental studies, reviews, guidelines or policy documents; published after 1994. We identified 532 papers, 27 of which were included in the review. Legislation and right to access health care influence both the accuracy of rates and risk measures under estimating the at risk population, i.e., the denominator. Furthermore, the number of reported cases, i.e., the numerator, may also include cases not accounted for in the denominator. Both biases lead to an overestimated disease occurrence. Restriction to healthcare access and low responsiveness may cause under-detection of cases, however a quantification of this phenomenon has not been produced. On the contrary, screening for asymptomatic diseases increases ascertainment leading to increased detection of cases. Incompleteness of denominator data underestimates the at-risk population. In conclusion, most studies show a lower probability of under-reporting infectious diseases in migrants compared with native populations.
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Affiliation(s)
- Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, 42122 Reggio Emilia, Italy.
- Arcispedale Santa Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy.
| | - Flavia Riccardo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Annamaria Pezzarossi
- Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, 42122 Reggio Emilia, Italy.
- Arcispedale Santa Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy.
| | - Paola Ballotari
- Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, 42122 Reggio Emilia, Italy.
- Arcispedale Santa Maria Nuova-IRCCS, 42123 Reggio Emilia, Italy.
| | - Maria Grazia Dente
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Christian Napoli
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Antonio Chiarenza
- Research and Innovation Unit, AUSL Reggio Emilia, 42122 Reggio Emilia, Italy.
| | - Cesar Velasco Munoz
- European Centre for Disease Prevention and Control (ECDC), 17183 Stockholm, Sweden.
- IS Global, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, 08036 Barcelona, Spain.
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), 17183 Stockholm, Sweden.
| | - Silvia Declich
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy.
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Chan IHY, Kaushik N, Dobler CC. Post-migration follow-up of migrants identified to be at increased risk of developing tuberculosis at pre-migration screening: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:770-779. [PMID: 28410979 DOI: 10.1016/s1473-3099(17)30194-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Post-migration follow-up of migrants considered at increased risk of developing tuberculosis based on pre-migration screening abnormalities (high-risk migrants) is implemented in several low-incidence countries. We aimed to determine the rate of tuberculosis in this population to inform cross-border tuberculosis control policies. METHODS We searched MEDLINE and Embase (since inception to Jan 12, 2017) for studies evaluating post-migration follow-up of high-risk migrants. Outcomes evaluated were the number of tuberculosis cases occurring post-migration, expressed as the tuberculosis incidence per 100 000 person-years of follow-up, as cumulative incidence of tuberculosis per 100 000 persons, and the cumulative incidence of tuberculosis at the first post-migration follow-up visit. Random-effects models were used to summarise outcomes across studies. FINDINGS We identified 20 publications (describing 23 study cohorts) reporting the pre-migration screening outcomes of 8 355 030 migrants processed between Jan 1, 1981, and May 1, 2014, with 222 375 high-risk migrants identified. The pooled cumulative incidence of tuberculosis post-migration in our study population from 22 cohorts was 2794 per 100 000 persons (95% CI 2179-3409; I2=99%). The pooled cumulative incidence of tuberculosis at the first follow-up visit from ten cohorts was 3284 per 100 000 persons (95% CI 2173-4395; I2=99%). The pooled tuberculosis incidence from 15 cohorts was 1249 per 100 000 person-years of follow-up (95% CI 924-1574; I2=98%). INTERPRETATION The high rate of tuberculosis in high-risk migrants suggests that tuberculosis control measures in this population, including more sensitive pre-migration screening, preventive treatment of latent tuberculosis infection, or post-migration follow-up, are potentially effective cross-border tuberculosis control strategies in low-incidence countries. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Isaac H Y Chan
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Nishta Kaushik
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Claudia C Dobler
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
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Bozorgmehr K. Post-migration follow-up of migrants at risk of tuberculosis. THE LANCET. INFECTIOUS DISEASES 2017; 17:692. [PMID: 28653632 DOI: 10.1016/s1473-3099(17)30329-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, D-69120 Heidelberg, Germany.
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Abedi S, Moosazadeh M, Afshari M, Charati JY, Nezammahalleh A. Determinant factors for mortality during treatment among tuberculosis patients: Cox proportional hazards model. Indian J Tuberc 2017; 66:39-43. [PMID: 30797281 DOI: 10.1016/j.ijtb.2017.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/20/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Investigating the survival of tuberculosis (TB) patients is one of the main parts of the TB control program. It can be related to many factors. This study aimed to estimate the survival experience and its associated factors among these patients. METHODOLOGY All TB patients detected during March 2005 to 31 September 2014 were entered into this prospective cohort. Each patient was investigated from the diagnosis date and followed until the last available information during treatment. Data analysis was performed using Kaplan Meier and multivariate Cox regression models. RESULTS The survival experience of 2493 TB patients was investigated 73.7% of which were pulmonary type. Mean and median survival time were 6.5 and 6.2 months respectively. The incidence rate of death among patients during the treatment courses was 0.99 (95% confidence interval: 0.84-1.1) per 100 person-months. Controlling the confounders, the incidence (95% confidence interval) of death was significantly higher among men (HR=1.8; 1.2-2.6), diabetic patients (HR=1.7; 1.2-2.6), cancerous patients (HR=4.8; 2.6-8.8) and HIV positive patients (HR=22.1; 7.3-66.4). CONCLUSION This study showed that male gender, TB/HIV co-infection and concurrent development of TB and cancer were determinant factors of death during the treatment period of TB.
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Affiliation(s)
- Siavosh Abedi
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Asghar Nezammahalleh
- Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Bozorgmehr K, Joggerst B, Wagner U, Stock C. Yield of tuberculosis screening in asylum-seekers by country of origin: analysis of screening data in a German federal state (2002–2015). Eur Respir J 2017; 49:49/4/1602327. [DOI: 10.1183/13993003.02327-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/26/2016] [Indexed: 11/05/2022]
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Bozorgmehr K, Razum O, Saure D, Joggerst B, Szecsenyi J, Stock C. Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis. Euro Surveill 2017; 22:30491. [PMID: 28367795 PMCID: PMC5388130 DOI: 10.2807/1560-7917.es.2017.22.12.30491] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/03/2016] [Indexed: 12/03/2022] Open
Abstract
All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45-1.10) to 6.41 (95% CI: 4.19-9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78-5.73; I2 = 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I2 = 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24-3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Daniel Saure
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | | | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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31
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Pescarini JM, Rodrigues LC, Gomes MGM, Waldman EA. Migration to middle-income countries and tuberculosis-global policies for global economies. Global Health 2017; 13:15. [PMID: 28298223 PMCID: PMC5353961 DOI: 10.1186/s12992-017-0236-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background International migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a matter of concern in high-income countries and targeted screening of migrants for active and latent TB infection is a main strategy to manage risk and minimize transmission. In this paper, we discuss some aspects of TB control and migration in the context of middle-income countries, together with the prospect of responding with equitable and comprehensive policies. Main body TB rates in middle-income countries remain disproportionally high among the poorest and most vulnerable groups in large cities where most migrant populations are concentrated. Policies that tackle migrant TB in high-income countries may be inadequate for middle-income countries because of their different socio-economic and cultural scenarios. Strategies to control TB in these settings must take into account the characteristics of middle-income countries and the complexity of TB as a disease of poverty. Intersectoral policies of social protection such as cash-transfer programs help reducing poverty and improving health in vulnerable populations. We address the development of new approaches to improve well-established strategies including contact tracing and active and latent TB screening as an ‘add on’ to the existing health care guidelines of conditional cash transfer programs. In addition, we discuss how it might improve health and welfare among both poor migrants and locally-born populations. Authorities from middle-income countries should recognise that migrants are a vulnerable social group and promote cooperation efforts between sending and receiving countries for mitigation of poverty and prevention of disease in this group. Conclusions Middle-income countries have long sent migrants overseas. However, the influx of large migrant populations into their societies is relatively new and a growing phenomenon and it is time to set comprehensive goals to improve health among these communities. Conditional cash transfer policies with TB screening and strengthening of DOTS are some strategies that deserve attention. Reduction of social and health inequality among migrants should be incorporated into concerted actions to meet TB control targets.
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Affiliation(s)
- Julia Moreira Pescarini
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil. .,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - M Gabriela M Gomes
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,CIBIO-InBIO, Centro de Investigacao em Biodiversidade e Recursos Geneticos, Universidade do Porto, Rua Padre Armando Quintas, n° 7, Vairão, 4485-661, Portugal.,Instituto de Matematica e Estatistica, Universidade de São Paulo, R. do Matão, 1010 - Vila Universitaria, São Paulo, SP, 05508-090, Brazil
| | - Eliseu Alves Waldman
- Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil
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[Incidental findings in chest X‑rays]. Radiologe 2017; 57:263-269. [PMID: 28283729 DOI: 10.1007/s00117-017-0230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Conventional projection radiography (chest x‑ray) is one of the most frequently requested procedures in radiology. Even though chest x‑ray imaging is frequently performed in asymptomatic patients for preoperative assessment, clinically relevant incidental findings are relatively scarce. This is due to the relatively low sensitivity of chest x‑rays where few clinically relevant incidental findings are to be expected, as any detectable pathologies will as a rule already be clinically symptomatic. Recommendations from relevant societies for the management of incidental findings, apart from the clarification of incidental nodules, do not exist. This review article therefore describes the most frequent and typical incidental findings of lung parenchyma (apart from pulmonary nodules), mediastinal structures including the hilum of the lungs, pleura, chest wall and major vessels. Also described are those findings which can be diagnosed with sufficient certainty from chest x‑rays so that further clarification is not necessary and those which must be further clarified by multislice imaging procedures or other techniques.
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Weinrich JM, Diel R, Sauer M, Henes FO, Meywald-Walter K, Adam G, Schön G, Bannas P. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience. Eur Radiol 2017; 27:3244-3248. [DOI: 10.1007/s00330-016-4684-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/28/2016] [Accepted: 11/29/2016] [Indexed: 01/15/2023]
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Durando P, Garbarino S, Orsi A, Alicino C, Dini G, Toletone A, Ciprani F, Conte G, Santorsa R, Icardi G. Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study. BMJ Open 2016; 6:e012011. [PMID: 27697871 PMCID: PMC5073613 DOI: 10.1136/bmjopen-2016-012011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | - Sergio Garbarino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | | | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Fabrizio Ciprani
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giuseppe Conte
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Roberto Santorsa
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
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Meier V, Artelt T, Cierpiol S, Gossner J, Scheithauer S. Tuberculosis in newly arrived asylum seekers: A prospective 12 month surveillance study at Friedland, Germany. Int J Hyg Environ Health 2016; 219:811-815. [PMID: 27498629 DOI: 10.1016/j.ijheh.2016.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In the European Union tuberculosis prevalence-rates are among the lowest in the world. The prevalence of active tuberculosis in migrant populations has to be analyzed to get valid data on the risk of tuberculosis and for the decision of screening activities. METHODS Therefore, we prospectively quantified the risk of active tuberculosis among asylum seekers at time of arrival. Investigation was performed as regular part of the admission screenings for people arriving at Friedland, Germany, a primary major receiving center during one year. RESULTS In 11.773 newly arrived asylum seekers 16 X-ray investigations gave the suspicion of active tuberculosis, thereof 11 cases could be verified by culture, thereof 9 cases were classified as microscopically positive. These data translate into rates of 136 per 100.000 suspected cases, 93 per 100.000 verified cases, and finally 76 per 100.000 infectious cases, respectively. Prevalence was higher in asylum seekers coming from Eritrea and Russia compared to the main origins of current migration Syria, Afghanistan, Iraq, Iran, and Lebanon. One case of MDR-tuberculosis could be detected in a migrant from Russia. CONCLUSIONS Prevalence rates of tuberculosis in newly arrived asylum seekers are higher than in native European populations. Rates seem to reflect the prevalence in the home countries. X-ray investigation during first examination may help identifying people needing further tests for detecting infectious tuberculosis and therefore may prevent transmission. However due to the low prevalence rates screening procedures have to be reviewed.
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Affiliation(s)
- Volker Meier
- Department of Hospital Hygiene, Evangelisches Krankenhaus Goettingen-Weende, Goettingen, Germany
| | - Tanja Artelt
- Infection Control and Infectious Diseases, University Medicine Goettingen, University Hospital Goettingen, Germany
| | - Stefanie Cierpiol
- Department of Radiology, Evangelisches Krankenhaus Goettingen-Weende, Goettingen, Germany
| | - Johannes Gossner
- Department of Radiology, Evangelisches Krankenhaus Goettingen-Weende, Goettingen, Germany
| | - Simone Scheithauer
- Infection Control and Infectious Diseases, University Medicine Goettingen, University Hospital Goettingen, Germany.
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Pacelli B, Zengarini N, Broccoli S, Caranci N, Spadea T, Di Girolamo C, Cacciani L, Petrelli A, Ballotari P, Cestari L, Grisotto L, Giorgi Rossi P. Differences in mortality by immigrant status in Italy. Results of the Italian Network of Longitudinal Metropolitan Studies. Eur J Epidemiol 2016; 31:691-701. [PMID: 27461270 DOI: 10.1007/s10654-016-0177-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 01/05/2023]
Abstract
Despite a rapid increase in immigration from low-income countries, studies on immigrants' mortality in Italy are scarce. We aimed to describe differences in all and cause-specific mortality among immigrants and Italians residing in Turin and Reggio Emilia (Northern Italy), two cities participating in the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS). We used individual data from the municipal population registers linked to the cause of death registers. All people aged 1-64 years residing between 2001 and 2010 were enrolled (open cohort) and followed up until 2013. The mortality of citizens from high migratory pressure countries (as a whole, and for each macro-area group) was compared with that of Italians; differences were estimated by Poisson regression adjusted by age and calendar year mortality rate ratios (MRRs), and by age-standardized mortality ratios for the analysis of cause-specific mortality. Compared with Italians, immigrants had lower overall mortality (MRR for men: 0.82, 95 % CI: 0.75-0.90; for women: 0.71, 95 % CI: 0.63-0.81). Sub-Saharan Africans experienced a significant higher mortality than Italians (MRR for men 1.29, 95 % CI: 1.03-1.61; for women: 1.70, 95 % CI: 1.22-2.36). Higher mortality for immigrants compared to Italians was observed for infectious diseases, congenital anomalies, some site-specific tumours and homicide mortality. Our study showed heterogeneity in mortality across the macro-areas of origin, and in particular Sub-Saharan Africans seemed to be a vulnerable population. The extension to other cohorts of IN-LiMeS will allow the health status of immigrants and vulnerable groups to be studied and monitored in more depth.
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Affiliation(s)
- Barbara Pacelli
- Regional Health and Social Care Agency of Emilia-Romagna, via A. Moro 21, Bologna, 40127, Italy.
| | | | - Serena Broccoli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency of Emilia-Romagna, via A. Moro 21, Bologna, 40127, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, TO, Italy
| | - Chiara Di Girolamo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Cacciani
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Paola Ballotari
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Laura Cestari
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Schepisi MS, Gualano G, Piselli P, Mazza M, D’Angelo D, Fasciani F, Barbieri A, Rocca G, Gnolfo F, Olivani P, Ferrarese M, Codecasa LR, Palmieri F, Girardi E. Active Tuberculosis Case Finding Interventions Among Immigrants, Refugees and Asylum Seekers in Italy. Infect Dis Rep 2016; 8:6594. [PMID: 27403270 PMCID: PMC4927939 DOI: 10.4081/idr.2016.6594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
In Italy tuberculosis (TB) is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014) at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0%) reported TB history or symptoms suggestive of active TB and 546 (61.3%) were referred to the TB clinic. Of them, 254 (46.5%) did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population.
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Affiliation(s)
- Monica Sañé Schepisi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, Department of Clinical Research, National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
| | - Pierluca Piselli
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | | | | | | | | | - Giorgia Rocca
- Salute per i migranti forzati (SaMiFo) Centro Astalli, Local Health Unit AUSL RM A, Rome, Italy
| | - Filippo Gnolfo
- Salute per i migranti forzati (SaMiFo) Centro Astalli, Local Health Unit AUSL RM A, Rome, Italy
| | | | - Maurizio Ferrarese
- Regional Reference Center for TB -Villa Marelli Institute, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Luigi Ruffo Codecasa
- Regional Reference Center for TB -Villa Marelli Institute, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, Department of Clinical Research, National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
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Pareek M, Greenaway C, Noori T, Munoz J, Zenner D. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review. BMC Med 2016; 14:48. [PMID: 27004556 PMCID: PMC4804514 DOI: 10.1186/s12916-016-0595-5] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/08/2016] [Indexed: 02/08/2023] Open
Abstract
Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.
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Affiliation(s)
- Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. .,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Christina Greenaway
- Division of Infectious Diseases and Department of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jose Munoz
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Dominik Zenner
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Centre for Infectious Disease Epidemiology, University College London, London, UK
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Diel R, Loddenkemper R, Nienhaus A. Consequences of tuberculosis among asylum seekers for health care workers in Germany. J Occup Med Toxicol 2016; 11:4. [PMID: 26884805 PMCID: PMC4754836 DOI: 10.1186/s12995-016-0093-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Immigrants have been contributing to the incidence of tuberculosis (TB) in Germany for many years. The current wave of migration of asylum seekers to Germany may increase that figure. Healthcare workers (HCW) who look after refugees not only in hospitals and medical practices but also in aid projects may be exposed to cases of TB. Methods The incremental TB cases arising from imported TB as well as from TB cases that developed later in refugees were calculated in a Markov model over a period of 5 years. Infectious and non-infectious susceptible TB and multidrug-resistant TB (MDR-TB) cases were determined separately. In addition, the total amount of latent TB in contact persons and the risk of infection by HCW were estimated. Due to uncertainty of future refugee flows to Europe, different scenarios were considered in univariate and multivariate sensitivity analysis. Results Assuming a decrease in immigration by half each year to the bottom line of 2014, and in light of the current number of 800,000 asylum seekers, we calculated an additional 10,090 TB cases by the end of the fifth year (5976 cases of infectious pulmonary TB and 143 cases of pulmonary MDR-TB). In case of an unchanging influx of asylum seekers over the 5-year period, 19,031 TB cases would arise, 377 of which infectious MDR-TB. Eighty -seven ensuing TB cases would develop in HCW in the same period, 3 of which MDR-TB cases. Conclusions Although the total number of TB cases in HCW expected to ensue from the current influx of asylum seekers is rather small, the 3 MDR-TB cases we calculated have to be taken seriously. We consider it essential to increase awareness of protective measures such as respiratory masks and, in the event of documented exposure, of supply-oriented occupational health screening.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Airway Research Center North (ARCN), Niemannsweg 11, 24015 Kiel, Germany
| | | | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center, Hamburg-Eppendorf, Germany ; Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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Abstract
Increasing immigration from high tuberculosis (TB) incidence countries is a challenge for surveillance and control in Finland. Here, we describe the epidemiology of TB in immigrants by using national surveillance data. During 1995-2013, 7030 (84·7%) native and 1199 (14·4%) immigrant cases were identified. The proportion of immigrant cases increased from 5·8% in 1995 to 32·1% in 2013, consistent with increasing immigrant population (2·1-5·6%) and decreasing incidence of TB in the native population (from 12·1 to 3·5/100 000). TB cases in immigrants were significantly younger, more often female, and had extrapulmonary TB more often than native cases (P < 0·01 for all comparisons); multidrug resistance was also more common in immigrants than natives (P < 0·01). Immigrant cases were born in 82 different countries; most commonly in Somalia and the former Soviet Union/Russia. During 2008-2013, 433 Mycobacterium tuberculosis isolates from immigrants were submitted for spoligotyping; 10 different clades were identified. Clades were similar to those found in the case's country of birth. Screening immigrants from high-incidence countries and raising awareness of common characteristics and symptoms of TB is important to ensure early diagnosis and to prevent transmission.
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Campbell JR, Chen W, Johnston J, Cook V, Elwood K, Krot J, Marra F. Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis. Mol Diagn Ther 2015; 19:107-17. [DOI: 10.1007/s40291-015-0135-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lönnroth K, Migliori GB, Abubakar I, D'Ambrosio L, de Vries G, Diel R, Douglas P, Falzon D, Gaudreau MA, Goletti D, González Ochoa ER, LoBue P, Matteelli A, Njoo H, Solovic I, Story A, Tayeb T, van der Werf MJ, Weil D, Zellweger JP, Abdel Aziz M, Al Lawati MR, Aliberti S, Arrazola de Oñate W, Barreira D, Bhatia V, Blasi F, Bloom A, Bruchfeld J, Castelli F, Centis R, Chemtob D, Cirillo DM, Colorado A, Dadu A, Dahle UR, De Paoli L, Dias HM, Duarte R, Fattorini L, Gaga M, Getahun H, Glaziou P, Goguadze L, del Granado M, Haas W, Järvinen A, Kwon GY, Mosca D, Nahid P, Nishikiori N, Noguer I, O'Donnell J, Pace-Asciak A, Pompa MG, Popescu GG, Robalo Cordeiro C, Rønning K, Ruhwald M, Sculier JP, Simunović A, Smith-Palmer A, Sotgiu G, Sulis G, Torres-Duque CA, Umeki K, Uplekar M, van Weezenbeek C, Vasankari T, Vitillo RJ, Voniatis C, Wanlin M, Raviglione MC. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45:928-52. [PMID: 25792630 PMCID: PMC4391660 DOI: 10.1183/09031936.00214014] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/02/2015] [Indexed: 12/31/2022]
Abstract
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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Affiliation(s)
- Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Both authors contributed equally
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
- Both authors contributed equally
| | - Ibrahim Abubakar
- TB Section, University College London and Public Health England, London, UK
| | - Lia D'Ambrosio
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | - Roland Diel
- University Hospital Schleswig Holstein, Institute for Epidemiology, Kiel, Germany
| | - Paul Douglas
- Global Health Borders Refugee and Onshore Services, Dept of Immigration and Border Protection, Sydney, Australia
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Marc-Andre Gaudreau
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Delia Goletti
- National Institute for Infectious Diseases, Rome, Italy
| | - Edilberto R. González Ochoa
- Research and Surveillance Group on TB, Leprosy and ARI, Epidemiology Board, Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
| | - Philip LoBue
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Howard Njoo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Montreal, QC, Canada
| | - Ivan Solovic
- TB Dept, National Institute for TB, Respiratory Diseases and Thoracic Surgery, Vysne Hagy, Catholic University, Ružomberok, Slovakia
| | | | - Tamara Tayeb
- National TB Control Programme, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Diana Weil
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Stefano Aliberti
- Università degli Studi di Milano – Bicocca, UO Clinica Pneumologica, AO San Gerardo, Monza, Italy
| | | | | | - Vineet Bhatia
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-Chirurgica e dei Trapianti, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Amy Bloom
- US Agency for International Development, Washington, DC, USA
| | - Judith Bruchfeld
- Unit of Infectious Diseases, Institution of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | | | - Rosella Centis
- WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Andrei Dadu
- TB and M/XDR-TB Control Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Ulf R. Dahle
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hannah M. Dias
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Mina Gaga
- National Referral Centre for Mycobacteria, Athens Chest Hospital, Ministry of Health, Athens, Greece
| | | | - Philippe Glaziou
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Lasha Goguadze
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | - Walter Haas
- Dept of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Asko Järvinen
- Finnish Lung Health Association, Helsinki, Finland
- Helsinki University Central Hospital, Division of Infectious Diseases, Helsinki, Finland
| | - Geun-Yong Kwon
- Korea Centers for Disease Control and Prevention (KCDC), Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Payam Nahid
- University of California, San Francisco, CA, USA
- American Thoracic Society (ATS), New York, NY, USA
| | - Nobuyuki Nishikiori
- Stop TB and Leprosy Elimination, WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | - Joan O'Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Giorgia Sulis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Carlos A. Torres-Duque
- Asociacion Latinoamericana de Torax (ALAT) - Fundacion Neumologica Colombiana, Bogota, Colombia
| | | | - Mukund Uplekar
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Maryse Wanlin
- Fonds des Affections Respiratoires (FARES), Brussels, Belgium
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Baussano I, Mercadante S, Pareek M, Lalvani A, Bugiani M. High rates of Mycobacterium tuberculosis among socially marginalized immigrants in low-incidence area, 1991-2010, Italy. Emerg Infect Dis 2014; 19:1437-45. [PMID: 23965807 PMCID: PMC3810899 DOI: 10.3201/eid1909.120200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Migration from low- and middle-income countries to high-income countries increasingly determines the severity of tuberculosis (TB) cases in the adopted country. Socially marginalized groups, about whom little is known, may account for a reservoir of TB among the immigrant populations. We investigated the rates of and risk factors for Mycobacterium tuberculosis transmission, infection, and disease in a cohort of 27,358 socially marginalized immigrants who were systematically screened (1991-2010) in an area of Italy with low TB incidence. Overall TB and latent TB infection prevalence and annual tuberculin skin testing conversion rates (i.e., incidence of new infection) were 2.7%, 34.6%, and 1.7%, respectively. Prevalence of both TB and latent TB infection and incidence of infection increased as a function of the estimated TB incidence in the immigrants' countries of origin. Annual infection incidence decreased with time elapsed since immigration. These findings have implications for control policy and immigrant screening in countries with a low prevalence of TB.
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Thillai M, Pollock K, Pareek M, Lalvani A. Interferon-gamma release assays for tuberculosis: current and future applications. Expert Rev Respir Med 2013; 8:67-78. [DOI: 10.1586/17476348.2014.852471] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mor Z, Leventhal A, Diacon AH, Finger R, Schoch OD. Tuberculosis screening in immigrants from high-prevalence countries: interview first or chest radiograph first? A pro/con debate. Respirology 2013; 18:432-8. [PMID: 23336500 DOI: 10.1111/resp.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 01/14/2013] [Indexed: 11/28/2022]
Abstract
Immigration from high tuberculosis (TB) prevalence countries has a substantial impact on the epidemiology of TB in receiving countries with low TB incidence. Cross-border migration offers an ideal opportunity for active case finding that will result in a lower caseload in the host country and a reduced spread of disease to both the indigenous and migrant populations. Screening strategies can start 'offshore', thereby indirectly assisting and empowering public health systems in the source countries, or be performed at ports of entry with or without long-term engagement of 'onshore' facilities and systems to provide either preventive therapy or surveillance for reactivation of latent TB. The chest radiograph seems to be playing a key role in this process, but questions remain regarding when, where and in whom radiographs are best done for optimal yield and cost-effectiveness, and with what other tests they might best be combined to further increase the usefulness of transborder TB control.
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Affiliation(s)
- Zohar Mor
- Ramla Department of Public Health, Ministry of Health, Ramla, Israel
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48
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Sañé Schepisi M, Gualano G, Fellus C, Bevilacqua N, Vecchi M, Piselli P, Battagin G, Silvestrini G, Attanasio A, Vela A, Rocca G, Rinaldi A, Benedetti P, Geraci S, Lauria FN, Girardi E. Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome. BMC Public Health 2013; 13:872. [PMID: 24053349 PMCID: PMC3852535 DOI: 10.1186/1471-2458-13-872] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers. Methods Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup. Results Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis. Conclusion The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.
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Affiliation(s)
- Monica Sañé Schepisi
- Clinical Epidemiology Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases, IRCCS L, Spallanzani, Rome, Italy.
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Dara M, Gushulak BD, Posey DL, Zellweger JP, Migliori GB. The history and evolution of immigration medical screening for tuberculosis. Expert Rev Anti Infect Ther 2013; 11:137-46. [PMID: 23409820 DOI: 10.1586/eri.12.168] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying and managing TB in immigrating populations has been an important aspect of immigration health for over a century, with the primary aim being protecting the host population by preventing the import of communicable diseases carried by the arriving migrants. This review describes the history and development of screening for TB and latent TB infection in the immigration context (describing both screening strategies and diagnostic tests used over the last century), outlining current practices and considering the future impact of new advances in screening. The recent focus of the WHO, regarding their elimination strategy, is further increasing the importance of diagnosing and treating latent TB infection. The last section of this review discusses the latest public health developments in the context of TB screening in immigrant populations.
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Affiliation(s)
- Masoud Dara
- WHO Regional Office for Europe, Copenhagen, Denmark
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Godoy P, Caylà JA, Carmona G, Camps N, Álvarez J, Rodés A, Altet N, Pina JM, Barrabeig I, Orcau À, Parron I, Alsedà M, March J, Follia N, Minguell S, Domínguez À. Immigrants do not transmit tuberculosis more than indigenous patients in Catalonia (Spain). Tuberculosis (Edinb) 2013; 93:456-60. [DOI: 10.1016/j.tube.2013.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/11/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
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