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Dynamics of Mycobacterium tuberculosis Lineages in Oman, 2009 to 2018. Pathogens 2022; 11:pathogens11050541. [PMID: 35631062 PMCID: PMC9148118 DOI: 10.3390/pathogens11050541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Study aim. Effective Tuberculosis (TB) control measures in Oman have reduced the annual incidence of tuberculosis cases by 92% between 1981 and 2016. However, the current incidence remains above the program control target of <1 TB case per 100,000 population. This has been partly attributed to a high influx of migrants from countries with high TB burdens. The present study aimed to elucidate Mycobacterium tuberculosis infection dynamics among nationals and foreigners over a period of 10 years. Methods. The study examined TB cases reported between 2009 and 2018 and examined the spatial heterogeneity of TB cases and the distribution of M. tuberculosis genotypes defined by spoligotypes and MIRU-VNTR among Omanis and foreigners. Results. A total of 484 spoligoprofiles were detected among the examined isolates (n = 1295). These include 943 (72.8%) clustered and 352 (27.2%) unique isolates. Diverse M. tuberculosis lineages exist in all provinces in Oman, with most lineages shared between Omanis and foreigners. The most frequent spoligotypes were found to belong to EAI (318, 30.9%), CAS (310, 30.1%), T (154, 14.9%), and Beijing (88, 8.5%) lineages. However, the frequencies of these lineages differed between Omanis and foreigners. Of the clustered strains, 192 MTB isolates were further analysed via MIRU-VNTR. Each isolate exhibited a unique MIRU-VNTR profile, indicative of absence of ongoing transmission. Conclusions. TB incidence exhibits spatial heterogeneity across Oman, with high levels of diversity of M. tuberculosis lineages among Omanis and foreigners and sub-lineages shared between the two groups. However, MIRU-VNTR analysis ruled out ongoing transmission.
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Wahedi K, Biddle L, Bozorgmehr K. Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers: A modelling study with screening data from a German federal state (2002-2015). PLoS One 2020; 15:e0241852. [PMID: 33151980 PMCID: PMC7644037 DOI: 10.1371/journal.pone.0241852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Rather than screening all new arrivals (indiscriminate screening), a few countries apply targeted screening based on incidence of tuberculosis in asylum-seekers' country of origin. However, evaluations of its cost-effectiveness have been scarce. The aim of this modelling study was to assess whether the introduction of a screening threshold based on the tuberculosis incidence in the country of origin is sensible from an economic perspective. To this end, we compare the current, indiscriminate screening policy for pulmonary tuberculosis in Germany with a hypothetical targeted screening programme using several potential screening thresholds based on WHO-reported incidence of tuberculosis in countries of origin. Screening data is taken from a large German federal state over 14 years (2002-2015). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented. Our analysis shows that incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for screening asylum-seekers from countries with an incidence <50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs. The high cost per case found and per case prevented at the <50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures.
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Affiliation(s)
- Katharina Wahedi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Louise Biddle
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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3
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Sanchini A, Andrés M, Fiebig L, Albrecht S, Hauer B, Haas W. Assessment of the use and need for an integrated molecular surveillance of tuberculosis: an online survey in Germany. BMC Public Health 2019; 19:321. [PMID: 30885160 PMCID: PMC6423790 DOI: 10.1186/s12889-019-6631-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of an integrated molecular surveillance (IMS) of tuberculosis (TB) is of high priority for TB control. IMS is defined as the systematic inclusion of molecular typing results in the national TB surveillance system. Although not standardized, an IMS of TB is already implemented in several low TB incidence countries. Germany is in the process of implementing a nationwide IMS of TB. This requires close collaboration between national and local health authorities. We conducted an online survey to understand the current use of molecular typing results for TB surveillance among the local public health offices (PHO)s in Germany, and to collect their perception and expectations towards the implementation of a nationwide IMS of TB. Methods The online survey was developed using the software Voxco and included 31 questions. The survey was sent to all the 377 local PHOs in Germany in April 2017. Responses were collected until June 2017. Results A total of 174/377 (46.2%) local PHOs participated in our survey, and 88/377 (23.3%) used molecular typing results in their routine TB surveillance work. The PHOs used molecular typing results especially as support for epidemiological contact tracing (62/88, 70.4%). We found statistically significant differences between answers of PHOs that did not use molecular typing results (n = 86) vs. PHOs that did use molecular typing results (n = 88): the latter perceived the use of molecular typing results as more beneficial for their work compared to the former (65.9% vs. 34.9%, p < 0.05). Moreover, the PHOs using molecular typing results expect for the future more support and coordination from regional and national public health institutes, especially regarding the identification and analysis of molecular clusters. Conclusions Our study is a step forward in the broader goal of implementing an IMS of TB in Germany. The local PHOs currently using the molecular typing results highlighted their positive attitude towards the implementation of an IMS, but also their needs of more support. Similar assessments might serve as an example for other countries which are on the way to implement a nationwide IMS of TB. Electronic supplementary material The online version of this article (10.1186/s12889-019-6631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Sanchini
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.
| | - Marta Andrés
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Ear Institute, University College London, London, UK
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany.,Current address: Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling - APOPO, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stefan Albrecht
- Department for Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 15, 13353, Berlin, Germany
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4
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Sharp A, Donahoe JT, Milliken A, Barocio J, Charalambous S, McLaren ZM. Do Incarcerated Populations Serve as a Reservoir for Tuberculosis in South Africa? Am J Trop Med Hyg 2018; 99:1390-1396. [PMID: 30277198 DOI: 10.4269/ajtmh.17-0652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Tuberculosis (TB) prevalence among incarcerated populations is as much as 1,000 times higher than in the general population. This study evaluates whether correctional facilities serve as a reservoir through which TB is transmitted to surrounding communities. Tuberculosis test data were extracted from the South African National Health Laboratory Service database for patients tested for TB between 2005 and 2011. We conducted graphical analysis to assess the relationship of TB rates between incarcerated and non-incarcerated populations over time. We performed generalized linear modeling with a log link function to assess TB risk in communities surrounding correctional facilities, net of confounders. We assessed linkages between incarcerated and non-incarcerated populations over time using Granger causality analysis. Tuberculosis prevalence among incarcerated populations was four times higher than in the general population. Tuberculosis incidence rates in incarcerated and non-incarcerated populations followed similar trends over time. The presence of a correctional facility in a municipality was associated with 34.9% more detected TB cases (confidence interval: 11.6-63.2; P < 0.01), controlling for potential confounders. Detected TB in incarcerated populations did not have predictive power in explaining detected TB rates in the non-incarcerated population after controlling for serial correlation in the time series data. Despite high TB prevalence, trends in correctional facilities do not appear to be driving temporal trends in the general population. However, correctional facilities still act as a TB reservoir that raises the overall TB risk in the vicinity. Intensified TB control policies for correctional facilities, formerly incarcerated individuals, and surrounding communities will reduce TB prevalence overall.
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Affiliation(s)
- Alana Sharp
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - J Travis Donahoe
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Amanda Milliken
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jacqueline Barocio
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Zoë M McLaren
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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5
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Quattrocchi A, Barchitta M, Nobile CGA, Prato R, Sotgiu G, Casuccio A, Vitale F, Agodi A. Determinants of patient and health system delay among Italian and foreign-born patients with pulmonary tuberculosis: a multicentre cross-sectional study. BMJ Open 2018; 8:e019673. [PMID: 30082341 PMCID: PMC6078265 DOI: 10.1136/bmjopen-2017-019673] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this cross-sectional study was to identify key factors associated with patient delay (PD), health system delay (HSD) and total delay (TOTD) in patients with tuberculosis (TB) to inform control programmes. SETTING The study was conducted in four Italian regions in 2014-2016. Data were obtained using a questionnaire including: sociodemographic and lifestyle data, TB comorbidities, patient knowledge and attitudes towards TB, stigma, access to TB care and health-seeking behaviours. PARTICIPANTS Patients' inclusion criteria were being diagnosed as a new smear positive pulmonary TB case and living in one of the participating Italian regions. Overall, 344 patients from 30 healthcare centres were invited to participate and 253 patients were included in the analysis (26.5% non-response rate); 63.6% were males and 55.7% were non-Italian born. OUTCOME MEASURES Risk factors for PD, HSD and TOTD in patients with TB were assessed by multivariable analysis. Adjusted ORs (aOR) and 95% CIs were calculated. RESULTS Median PD, HSD and TOTD were 30, 11 and 45 days, respectively. Factors associated with longer PD were: stigma (aOR 2.30; 95% CI 1.06 to 4.98), chest pain (aOR 2.67; 95% CI 1.24 to 6.49), weight loss (aOR 4.66; 95% CI 2.16 to 10.05), paying for transportation (aOR 2.66; 95% CI 1.24 to 5.74) and distance to the health centre (aOR 2.46; 95% CI 1.05 to 5.74) (the latter three were also associated with TOTD). Shorter HSD was associated with foreign-born and female status (aOR 0.50; 95% CI 0.27 to 0.91; aOR 0.28; 95% CI 0.15 to 0.53, respectively), dizziness (aOR 0.18, 95% CI 0.04 to 0.78) and seeking care at hospital (aOR 0.35; 95% CI 0.18 to 0.66). Prior unspecific treatment was associated with longer HSD (aOR 2.25; 95% CI 1.19 to 4.25) and TOTD (aOR 2.55; 95% CI 1.18 to 5.82). Haemoptysis (aOR 0.12; 95% CI 0.03 to 0.43) and repeated visits with the same provider (aOR 0.29; 95% CI 0.11 to 0.76) showed shorter TOTD. CONCLUSIONS This study identifies several determinants of delays associated with patient's behaviours and healthcare qualities. Tackling TB effectively requires addressing key risk factors that make individuals more vulnerable by the means of public health policy, cooperation and advocacy to ensure that all patients have easy access to care and receive high-quality healthcare.
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Affiliation(s)
- Annalisa Quattrocchi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
- LaPoSS, Laboratory of Policies and Social Services, University of Catania, Catania, Italy
| | - Carmelo G A Nobile
- Department of Health Sciences, University of Catanzaro 'Magna Græcia', Catanzaro, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Sciences for Health Promotion and Mother-Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
- LaPoSS, Laboratory of Policies and Social Services, University of Catania, Catania, Italy
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6
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Mburu JW, Kingwara L, Esther M, Andrew N. Molecular clustering of patients with Mycobacterium tuberculosis strains cultured from the diabetic and non-diabetic newly diagnosed TB positive cases. J Clin Tuberc Other Mycobact Dis 2018; 12:21-26. [PMID: 31720394 PMCID: PMC6830120 DOI: 10.1016/j.jctube.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Social determinants of health, biological, and individual variants have been associated with Pulmonary TB (PTB) case clustering. None of the studies have focused on diabetes mellitus (DM) despite it being one of the co-morbidity affecting TB patients. Minimal data is available and it is not clear whether patients with DM and TB are more likely than TB patients without DM to be grouped into similar molecular clusters thus indicating a bias in transmission among TB/DM co-morbidity patients. OBJECTIVE To determine proportion of TB strains within TB and TB/DM cases that were clustered with their corresponding clinical outcomes and hence could be attributable to active TB transmission in the two urban counties of Nairobi, Kenya. METHODS We carried out a prospective cohort study of non-pregnant patients aged 15 years and above that tested positive for TB in two peri‑urban counties in Kenya between February 2014 and August 2015. Clinical and socio-demographic data were obtained from a questionnaire and medical records of the National TB program patient data base at two, three, five and six months. Spoligotyping data was then obtained and compared from previously identified strains in a data bank from the spolDB4. RESULTS We identified 7 different TB strains out of which East Asia Beijing, Euro America and Indo oceanic being the most dominant strain within the two counties accounting for 92.4% of the infections. DM was not a significant factor in increasing the likelihood of PTB patients to cluster according to the genotype of the infecting Mycobacterium tuberculosis bacillus. TB lineages, DM and County of the patient were found to be independent of the clinical outcomes that were observed in the study. CONCLUSION Diabetes mellitus is not a significant factor in increasing the molecular clustering among PTB patients.
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Affiliation(s)
- Josephine W. Mburu
- National Tuberculosis Reference Laboratory, MOH, Kenya
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | | | - Magiri Esther
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | - Nyerere Andrew
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
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7
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Pescarini JM, Simonsen V, Ferrazoli L, Rodrigues LC, Oliveira RS, Waldman EA, Houben R. Migration and tuberculosis transmission in a middle-income country: a cross-sectional study in a central area of São Paulo, Brazil. BMC Med 2018; 16:62. [PMID: 29706130 PMCID: PMC5925834 DOI: 10.1186/s12916-018-1055-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 04/10/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Little is known about the impact of growing migration on the pattern of tuberculosis (TB) transmission in middle-income countries. We estimated TB recent transmission and its associated factors and investigated the presence of cross-transmission between South American migrants and Brazilians. METHODS We studied a convenient sample of cases of people with pulmonary TB in a central area of São Paulo, Brazil, diagnosed between 2013 and 2014. Cases with similar restriction fragment length polymorphism (IS6110-RFLP) patterns of their Mycobacterium tuberculosis complex isolates were grouped in clusters (recent transmission). Clusters with both Brazilian and South American migrants were considered mixed (cross-transmission). Risk factors for recent transmission were studied using logistic regression. RESULTS Isolates from 347 cases were included, 76.7% from Brazilians and 23.3% from South American migrants. Fifty clusters were identified, which included 43% South American migrants and 60.2% Brazilians (odds ratio = 0.50, 95% confidence interval = 0.30-0.83). Twelve cross-transmission clusters were identified, involving 24.6% of all clustered cases and 13.8% of all genotyped cases, with migrants accounting for either an equal part or fewer cases in 11/12 mixed clusters. CONCLUSIONS Our results suggest that TB disease following recent transmission is more common among Brazilians, especially among those belonging to high-risk groups, such as drug users. Cross-transmission between migrants and Brazilians was present, but we found limited contributions from migrants to Brazilians in central areas of São Paulo and vice versa.
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Affiliation(s)
- Julia Moreira Pescarini
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil.
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Rein Houben
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
- TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, UK
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8
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Thomas HL, Harris RJ, Muzyamba MC, Davidson JA, Lalor MK, Campbell CNJ, Anderson SR, Zenner D. Reduction in tuberculosis incidence in the UK from 2011 to 2015: a population-based study. Thorax 2018; 73:769-775. [PMID: 29674389 DOI: 10.1136/thoraxjnl-2017-211074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Following nearly two decades of increasing tuberculosis in the UK, TB incidence decreased by 32% from 2011 to 2015. Explaining this reduction is crucial to informing ongoing TB control efforts. METHODS We stratified TB cases notified in the UK and TB cases averted in the UK through pre-entry screening (PES) between 2011 and 2015 by country of birth and time since arrival. We used population estimates and migration data to establish denominators, and calculated incidence rate ratios (IRRs) between 2011 and 2015. We calculated the contribution of changing migrant population sizes, PES and changes in TB rates to the reduction in TB notifications. RESULTS TB IRRs fell in all non-EU migrant and UK-born populations between 2011 and 2015 (0.61; 95% CI 0.59 to 0.64 and 0.78; 0.73 to 0.83 respectively), with the greatest decrease in recent non-EU migrants (0.54; 0.48 to 0.61). 61.9% of the reduction in TB notifications was attributable to decreases in TB rates, 33.4% to a fall in the number of recent/mid-term non-EU migrants and 11.4% to PES. A small increase in notifications in EU-born migrants offset the reduction by 6.6%. CONCLUSIONS Large decreases in TB rates in almost all populations accounted for the majority of the reduction in TB notifications, providing evidence of the impact of recent interventions to improve UK TB control. The particularly large decrease in TB rates in recent non-EU migrants provides evidence of the effectiveness of screening interventions that target this population. These findings will inform ongoing improvements to TB control.
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Affiliation(s)
- H Lucy Thomas
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Ross J Harris
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Morris C Muzyamba
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Jennifer A Davidson
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Maeve K Lalor
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Colin N J Campbell
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
| | - Sarah R Anderson
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Dominik Zenner
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
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9
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Molecular epidemiology of tuberculosis in Tasmania and genomic characterisation of its first known multi-drug resistant case. PLoS One 2018; 13:e0192351. [PMID: 29466411 PMCID: PMC5821347 DOI: 10.1371/journal.pone.0192351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background The origin and spread of tuberculosis (TB) in Tasmania and the types of strains of Mycobacterium tuberculosis complex (MTBC) present in the population are largely unknown. Objective The aim of this study was to perform the first genomic analysis of MTBC isolates from Tasmania to better understand the epidemiology of TB in the state. Methods Whole-genome sequencing was performed on cultured isolates of MTBC collected from 2014–2016. Single-locus variant analysis was applied to determine the phylogeny of the isolates and the presence of drug-resistance mutations. The genomic data were then cross-referenced against public health surveillance records on each of the cases. Results We determined that 83.3% of TB cases in Tasmania from 2014–2016 occurred in non-Australian born individuals. Two possible TB clusters were identified based on single locus variant analysis, one from November-December 2014 (n = 2), with the second from May-August 2015 (n = 4). We report here the first known isolate of multi-drug resistant (MDR) M. tuberculosis in Tasmania from 2016 for which we established its drug resistance mutations and potential overseas origin. In addition, we characterised a case of M. bovis TB in a Tasmanian-born person who presented in 2014, approximately 40 years after the last confirmed case in the state’s bovids. Conclusions TB in Tasmania is predominantly of overseas origin with genotypically-unique drug-susceptible isolates of M. tuberculosis. However, the state also exhibits features of TB that are observed in other jurisdictions, namely, the clustering of cases, and drug resistance. Early detection of TB and contact tracing, particularly of overseas-born cases, coordinated with rapid laboratory drug-susceptibility testing and molecular typing, will be essential for Tasmania to reach the World Health Organisation’s TB eradication goals for low-incidence settings.
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10
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Häcker B, Otto-Knapp R, Bauer T, Schaberg T. [Tuberculosis in Germany - prevention, diagnosis, therapy]. MMW Fortschr Med 2018; 160:44-51. [PMID: 29464608 DOI: 10.1007/s15006-018-0003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Walterhöferstrasse 11, Haus Q, D-14165, Berlin, Deutschland.
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Walterhöferstrasse 11, Haus Q, D-14165, Berlin, Deutschland
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Walterhöferstrasse 11, Haus Q, D-14165, Berlin, Deutschland
| | - Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Walterhöferstrasse 11, Haus Q, D-14165, Berlin, Deutschland
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11
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Andrés M, Göhring-Zwacka E, Fiebig L, Priwitzer M, Richter E, Rüsch-Gerdes S, Haas W, Niemann S, Brodhun B. Integration of molecular typing results into tuberculosis surveillance in Germany-A pilot study. PLoS One 2017; 12:e0188356. [PMID: 29166403 PMCID: PMC5699808 DOI: 10.1371/journal.pone.0188356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
An integrated molecular surveillance for tuberculosis (TB) improves the understanding of ongoing TB transmission by combining molecular typing and epidemiological data. However, the implementation of an integrated molecular surveillance for TB is complex and requires thoughtful consideration of feasibility, demand, public health benefits and legal issues. We aimed to pilot the integration of molecular typing results between 2008 and 2010 in the German Federal State of Baden-Württemberg (population 10.88 Million) as preparation for a nationwide implementation. Culture positive TB cases were typed by IS6110 DNA fingerprinting and results were integrated into routine notification data. Demographic and clinical characteristics of cases and clusters were described and new epidemiological links detected after integrating typing data were calculated. Furthermore, a cross-sectional survey was performed among local public health offices to evaluate their perception and experiences. Overall, typing results were available for 83% of notified culture positive TB cases, out of which 25% were clustered. Age <15 years (OR = 4.96, 95% CI: 1.69–14.55) and being born in Germany (OR = 2.01, 95% CI: 1.44–2.80) were associated with clustering. At cluster level, molecular typing information allowed the identification of previously unknown epidemiological links in 11% of the clusters. In 59% of the clusters it was not possible to identify any epidemiological link. Clusters extending over different counties were less likely to have epidemiological links identified among their cases (OR = 11.53, 95% CI: 3.48–98.23). The majority of local public health offices found molecular typing useful for their work. Our study illustrates the feasibility of integrating typing data into the German TB notification system and depicts its added public health value as complementary strategy in TB surveillance, especially to uncover transmission events among geographically separated TB patients. It also emphasizes that special efforts are required to strengthen the communication between local public health offices in different counties to enhance TB control.
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Affiliation(s)
- Marta Andrés
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Elke Göhring-Zwacka
- State Health Department (Landesgesundheitsamt) Baden-Württemberg, Stuttgart, Germany
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Martin Priwitzer
- Local Public Health Office (Gesundheitsamt) Stuttgart, Stuttgart, Germany
| | | | - Sabine Rüsch-Gerdes
- National Reference Center (NRC) for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Niemann
- National Reference Center (NRC) for Mycobacteria, Research Center Borstel, Borstel, Germany
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Borstel-Lübeck, Borstel, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Mizukoshi F, Miyoshi-Akiyama T, Iwai H, Suzuki T, Kiritani R, Kirikae T, Funatogawa K. Genetic diversity of Mycobacterium tuberculosis isolates from Tochigi prefecture, a local region of Japan. BMC Infect Dis 2017; 17:365. [PMID: 28545488 PMCID: PMC5445273 DOI: 10.1186/s12879-017-2457-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/09/2017] [Indexed: 12/27/2022] Open
Abstract
Background Foreign-born patients with tuberculosis (TB) may introduce globally disseminated isolates of Mycobacterium tuberculosis into large cities in Japan. The risk of dissemination of these isolates into local regions, however, has not been determined. This study analyzed the molecular epidemiology of M. tuberculosis isolates obtained from TB patients living in a local region of Japan. Methods Whole genome sequences of 169 M. tuberculosis isolates, obtained from 148 Japanese-born and 21 foreign-born patients living in Tochigi, Japan, were analyzed using the Comprehensive analysis server for the Mycobacteriumtuberculosis complex (CASTB). Results The 169 isolates were clustered into four clades; Lineage 2 (111 isolates 65.7%), Lineage 4 (43 isolates, 25.4%), Lineage 1 (13 isolates, 7.7%), and Lineage 3 (2 isolates, 1.2%). Of the 111 isolates belonging to Lineage 2, 79 (71.2%) were of the atypical Beijing sub-genotype. Of the 13 Lineage 1 isolates, nine (69.2%) were from foreign-born patients. The isolates belonging to Lineage 4 were further clustered into three clades, two containing isolates shared by both Japanese- and foreign-born patients. The two isolates belonging to Lineage 3 were obtained from foreign-born patients. Conclusions The genotypic diversity of M. tuberculosis in a local region of Japan is increased primarily by the presence of isolates obtained from foreign-born patients. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2457-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fuminori Mizukoshi
- Tochigi Prefectural Institute of Public Health and Environmental Science, Utsunomiya, Tochigi, Japan
| | - Tohru Miyoshi-Akiyama
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Iwai
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takako Suzuki
- Tochigi Prefectural Institute of Public Health and Environmental Science, Utsunomiya, Tochigi, Japan
| | - Reiko Kiritani
- Tochigi Prefectural Institute of Public Health and Environmental Science, Utsunomiya, Tochigi, Japan
| | - Teruo Kirikae
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan. .,Present Address: Department of Microbiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Keiji Funatogawa
- Tochigi Prefectural Institute of Public Health and Environmental Science, Utsunomiya, Tochigi, Japan
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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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Hanway A, Comiskey CM, Tobin K, O'Toole RF. Relating annual migration from high tuberculosis burden country of origin to changes in foreign-born tuberculosis notification rates in low-medium incidence European countries. Tuberculosis (Edinb) 2016; 101:67-74. [PMID: 27865401 DOI: 10.1016/j.tube.2016.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/22/2016] [Accepted: 07/31/2016] [Indexed: 11/19/2022]
Abstract
The level of immigration from high tuberculosis (TB) burden countries (HBCs) which impacts on the foreign-born TB notification rate is largely unknown. In this work, we performed a cross-sectional analysis of epidemiological data from 2000 to 2013 from nine European countries: Austria, Denmark, Finland, Hungary, Netherlands, Norway, Spain, Sweden, and the United Kingdom. Crude notification rates were calculated for foreign- and native-born populations and a multiple-linear regression model predicting notification rates with HBC population data was generated. From 2000 to 2013, the population percentage with a foreign birthplace increased on average each year in all nine countries, ranging from +0.11%/year in the Netherlands to +0.66%/year in Spain. An annual increase in HBC migrants above +0.43% per year (95% Confidence Interval: 0.24%-0.63%) corresponded with higher TB notification rates in the foreign-born population of the countries analyzed. This indicates that migration from HBCs can exert a measurable effect on the foreign-born TB notification rate. However, an increase in the foreign-born TB notification rate coincided with an average annual rise in national TB notification rates only in countries, Norway (+3.85%/year) and Sweden (+2.64%/year), which have a high proportion (>80%) of TB cases that are foreign-born.
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Affiliation(s)
- Aidan Hanway
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | - Katy Tobin
- School of Nursing and Midwifery, Trinity College Dublin, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Ronan F O'Toole
- Breathe Well Centre, School of Medicine, University of Tasmania, Hobart, Australia.
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Razum O, Wenner J. Social and health epidemiology of immigrants in Germany: past, present and future. Public Health Rev 2016; 37:4. [PMID: 29450046 PMCID: PMC5809856 DOI: 10.1186/s40985-016-0019-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/21/2016] [Indexed: 01/22/2023] Open
Abstract
Germany has experienced different forms of immigration for many decades. At the end of and after the Second World War, refugees, displaced persons and German resettlers constituted the largest immigrant group. In the 1950s, labor migration started, followed by family reunification. There has been a constant migration of refugees and asylum seekers reaching peaks in the early 1990s as well as today. Epidemiological research has increasingly considered the health, and the access to health care, of immigrants and people with migration background. In this narrative review we discuss the current knowledge on health of immigrants in Germany. The paper is based on a selective literature research with a focus on studies using representative data from the health reporting system. Our review shows that immigrants in Germany do not suffer from different diseases than non-immigrants, but they differ in their risk for certain diseases, in the resources to cope with theses risk and regarding access to treatment. We also identified the need for differentiation within the immigrant population, considering among others social and legal status, country of origin and duration of stay. Though most of the studies acknowledge the need for differentiation, the lack of data currently rules out analyses accounting for the existing diversity and thus a full understanding of health inequalities related to migration to Germany.
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Affiliation(s)
- Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Judith Wenner
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Standard Genotyping Overestimates Transmission of Mycobacterium tuberculosis among Immigrants in a Low-Incidence Country. J Clin Microbiol 2016; 54:1862-1870. [PMID: 27194683 DOI: 10.1128/jcm.00126-16] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/29/2016] [Indexed: 11/20/2022] Open
Abstract
Immigrants from regions with a high incidence of tuberculosis (TB) are a risk group for TB in low-incidence countries such as Switzerland. In a previous analysis of a nationwide collection of 520 Mycobacterium tuberculosis isolates from 2000 to 2008, we identified 35 clusters comprising 90 patients based on standard genotyping (24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat [MIRU-VNTR] typing and spoligotyping). Here, we used whole-genome sequencing (WGS) to revisit these transmission clusters. Genome-based transmission clusters were defined as isolate pairs separated by ≤12 single nucleotide polymorphisms (SNPs). WGS confirmed 17/35 (49%) MIRU-VNTR typing clusters; the other 18 clusters contained pairs separated by >12 SNPs. Most transmission clusters (3/4) of Swiss-born patients were confirmed by WGS, as opposed to 25% (4/16) of the clusters involving only foreign-born patients. The overall clustering proportion was 17% (90 patients; 95% confidence interval [CI], 14 to 21%) by standard genotyping but only 8% (43 patients; 95% CI, 6 to 11%) by WGS. The clustering proportion was 17% (67/401; 95% CI, 13 to 21%) by standard genotyping and 7% (26/401; 95% CI, 4 to 9%) by WGS among foreign-born patients and 19% (23/119; 95% CI, 13 to 28%) and 14% (17/119; 95% CI, 9 to 22%), respectively, among Swiss-born patients. Using weighted logistic regression, we found weak evidence of an association between birth origin and transmission (adjusted odds ratio of 2.2 and 95% CI of 0.9 to 5.5 comparing Swiss-born patients to others). In conclusion, standard genotyping overestimated recent TB transmission in Switzerland compared to WGS, particularly among immigrants from regions with a high TB incidence, where genetically closely related strains often predominate. We recommend the use of WGS to identify transmission clusters in settings with a low incidence of TB.
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Screening for Infectious Diseases among Newly Arrived Migrants: Experiences and Practices in Non-EU Countries of the Mediterranean Basin and Black Sea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15550-8. [PMID: 26670237 PMCID: PMC4690938 DOI: 10.3390/ijerph121215002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/27/2015] [Accepted: 11/30/2015] [Indexed: 01/05/2023]
Abstract
Changing migration dynamics in the Mediterranean Sea and differences in infectious diseases (ID) burden between the countries of origin have raised questions whether public health actions are needed to avoid the transmission of ID. Screening newly arrived migrants for ID is one health monitoring option, offering opportunities for prevention, early detection and treatment. The authors conducted a survey among country experts in non-European Union countries of the Mediterranean and Black Sea, in order to explore current ID screening practices and policies for newly arrived migrants. The association between the existence of guidelines and the proportion of refugees in the population was also estimated. Eighteen country experts responded (90%) out of the 20 invited. Eleven countries (61%) implemented screening programmes and six (38%) had national guidelines. Screening was performed most often for tuberculosis at the holding level. A higher proportion of refugees in the population was associated with the existence of guidelines for screening (p = 0.05). Fourteen experts (88%) considered screening among migrants useful. The results show that screening for ID in newly arrived migrants is relevant for non-EU countries of the Mediterranean and Black Sea. Common guidelines could be promoted focusing on both individual and public health benefits of screening programmes.
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Marx FM, Fiebig L, Hauer B, Brodhun B, Glaser-Paschke G, Magdorf K, Haas W. Higher Rate of Tuberculosis in Second Generation Migrants Compared to Native Residents in a Metropolitan Setting in Western Europe. PLoS One 2015; 10:e0119693. [PMID: 26061733 PMCID: PMC4465484 DOI: 10.1371/journal.pone.0119693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. METHODS A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. RESULTS Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. CONCLUSIONS There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
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Affiliation(s)
- Florian M. Marx
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
- Division of Global Health Equity, Brigham and Women’s Hospital and Harvard Medical School, Boston, United States of America
- * E-mail:
| | - Lena Fiebig
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Barbara Hauer
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Bonita Brodhun
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Klaus Magdorf
- Department of Pediatric Pneumology and Immunology, Charité –Universitätsmedizin, Berlin, Germany
| | - Walter Haas
- Respiratory Infections Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Mengistu A, Enquselassie F, Hailu E, Aseffa A, Beyene D. Identification and Characterization of Mycobacterium Tuberculosis Isolates from Cattle Owners in North Western and North Eastern Parts of Rural Ethiopia. INTERNATIONAL JOURNAL OF INNOVATION AND APPLIED STUDIES 2015; 10:85-94. [PMID: 30310557 PMCID: PMC6176739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tuberculosis (TB) is a major global public health problem resulting in a considerable morbidity and mortality worldwide. Ethiopia ranks 8th among the 22 high TB burden countries. Establishing an appropriate and improved intervention strategy to prevent and control tuberculosis requires the presence of evidence based data on the genetic diversity of its causative agent. The current research work, therefore, was to differentiate strains of Mycobacterium tuberculosis isolated from pulmonary tuberculosis patients who own cattle in North Eastern and North Western parts of Ethiopia using molecular techniques. Sputum samples were collected from Acid Fast Bacilli (AFB) positive pulmonary tuberculosis patients and cultured on Lowenstein-Jensen (LJ) medium containing glycerol and sodium pyruvate. Deoxyribonucleic acid (DNA) was extracted from each positive culture, spoligotyping and single nucleotide polymorphisms were performed to further differentiate strains of M. tuberculosis, after deletion typing PCR confirmed that all the isolates were Mycobacterium tuberculosis. The mean age of study participants was 35.7 years (18-63 years) + 13.24. The majority (55.7%) were from North Gondar zone. Spoligotyping revealed that (47/50) 94% had interpretable patterns and 3 lineages namely; East-Africa-Indian (57.4%), Euro-American-African (EAA lineage-Lineage 4) 38.3% and Ethiopian (lineage-7) 2/50 (4.3%). Lineage 7 was registered in North Wollo zone only. In this study 8 clusters (with cluster size ranging from 2-8), 8 unique and 10 new patters were recorded. Spoligotype International Types (SIT) (21, 25, 26, 35, 53, 109, 149 and 289), were found as clusters and of these SIT 25 (7) and SIT 289 (8) were the predominant ones. Our study proved that 3 Mycobacterium tuberculosis lineages, namely; the ancient, intermediate between the modern lineages as well as modern were identified. Besides, considerable clustering was seen, which indicates the presence of current TB transmission in the study areas.
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Affiliation(s)
- Araya Mengistu
- Faculty of Veterinary Medicine, University of Gondar, Ethiopia
| | | | - Elena Hailu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Odone A, Tillmann T, Sandgren A, Williams G, Rechel B, Ingleby D, Noori T, Mladovsky P, McKee M. Tuberculosis among migrant populations in the European Union and the European Economic Area. Eur J Public Health 2014; 25:506-12. [PMID: 25500265 PMCID: PMC4440450 DOI: 10.1093/eurpub/cku208] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report ‘Key Infectious Diseases in Migrant Populations in the EU/EEA’ commissioned by The European Centre for Disease Prevention and Control. Methods: We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012. Results: In 2010, of the 73 996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers. Conclusion: This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA.
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Affiliation(s)
- Anna Odone
- 1 Department of Global Health and Social Medicine, Harvard School of Public Health, Boston, MA, USA 2 Unit of Public Health, University of Parma, Parma, Italy
| | - Taavi Tillmann
- 3 European Observatory on Health Systems and Policies, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Andreas Sandgren
- 4 European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Gemma Williams
- 5 LSE Health, London School of Economics and Political Science, London, UK
| | - Bernd Rechel
- 3 European Observatory on Health Systems and Policies, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - David Ingleby
- 6 Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Teymur Noori
- 4 European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Philipa Mladovsky
- 5 LSE Health, London School of Economics and Political Science, London, UK
| | - Martin McKee
- 3 European Observatory on Health Systems and Policies, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
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Bonura C, Gomgnimbou MK, Refrégier G, Aleo A, Fasciana T, Giammanco A, Sola C, Mammina C. Molecular epidemiology of tuberculosis in Sicily, Italy: what has changed after a decade? BMC Infect Dis 2014; 14:602. [PMID: 25407589 PMCID: PMC4241219 DOI: 10.1186/s12879-014-0602-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to investigate the molecular epidemiology of Mycobacterium tuberculosis complex (MTBC) isolates in the province of Palermo, Sicily, Italy, by characterizing 183 isolates identified in the years 2004-2012. A comparison with 104 MTBC strains identified in the same geographic area in the years 1994-2000 was also carried out. Methods One hundred eighty-three MTBC isolates identified in Palermo, Italy, in the years 2004-2012 were analyzed by spoligotyping and the 24 mycobacterial interspersed repetitive unit (MIRU)-variable-number tandem-repeat (VNTR) method typing. Susceptibility testing to streptomycin, isoniazid, rifampin and ethambutol was also performed. Furthermore, the spoligotyping dataset obtained from 104 MTBC isolates identified from 1994 to 2000 was reanalyzed. Distribution into lineages and clustering of isolates in the two periods was compared. Results One hundred seventy-seven out of the 183 isolates of MTBC submitted to molecular typing were fully characterized. Of these, 108 were from Italian-born and 69 from foreign-born individuals. Eleven different lineages and 35 families-subfamilies were identified with the most represented lineages being Haarlem (26.5%), T (19.2%), LAM (13.6%) and S (8.5%). Except for the Haarlem lineage, where isolates from foreign-born patients were overrepresented, the distribution of isolates in the families belonging to the Euro-American clone reflected the proportions of the two subpopulations. A total of 27 (15.2%) strains were clustered and three clusters were mixed. Approximately 25% of the 183 MTBC isolates under study proved to be resistant to at least one antiTB drug, with only three isolates categorized as multidrug resistant (MDR). When MTBC isolates identified in the years 1994-2000 were reanalyzed, lineages T (30.8%), LAM (29.8%), Haarlem (16.3%) and S (13.5%) proved to be predominant. No MTBC isolates belonging to CAM, U, CAS, Turkish and Ural lineages were identified. Conclusions A wide heterogeneity was detected among the MTBC strains isolated in the years 2004-2012. Six lineages were not present among the isolates of the period 1994-2000. Comparison between distribution of lineages in the two consecutive periods depicts rapid and deep changes in the TB epidemiology in Palermo, Italy. An universal and continued laboratory-based surveillance of TB in Sicily is required. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0602-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Celestino Bonura
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Michel K Gomgnimbou
- CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France.
| | - Guislaine Refrégier
- CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France.
| | - Aurora Aleo
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Teresa Fasciana
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Anna Giammanco
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Christophe Sola
- CNRS-Université Paris-Sud, Institut de Génétique et Microbiologie, UMR8621, Infection Genetics Emerging Pathogen Evolution Team, Orsay, France.
| | - Caterina Mammina
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.
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Screening for infectious diseases among newly arrived migrants in EU/EEA countries--varying practices but consensus on the utility of screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11004-14. [PMID: 25337945 PMCID: PMC4211019 DOI: 10.3390/ijerph111011004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 01/05/2023]
Abstract
Screening is one possible tool for monitoring infectious diseases among migrants. However, there is limited information on screening programmes targeted for newly arrived migrants in EU/EEA countries. Our aim was to investigate the implementation, practices and usefulness of these programmes. We conducted a survey among country experts from EU/EEA countries and Switzerland, asking whether their countries had implemented screening programmes. We also estimated the association between the implementation of these programmes and the rate of asylum-seekers in the population. Of the countries, 16 (59%) had implemented screening programmes and 15 (56%) had national guidelines. The rate of asylum-seekers was associated with implementation of screening programmes (p = 0.014). Screening was performed most often for tuberculosis; most commonly on holding level, and was targeted to specific migrant groups in over half of the countries performing screening. Twenty-five of all the country experts (96%) considered screening among migrants useful, and 24 (92%) would welcome EU level guidelines for screening. The implementation of screening programmes varied, and the practices were different among countries. Our survey suggests, that establishing EU level guidelines for screening would be useful, although they would have to take into account differences between individual countries.
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Kato-Miyazawa M, Miyoshi-Akiyama T, Kanno Y, Takasaki J, Kirikae T, Kobayashi N. Genetic diversity of Mycobacterium tuberculosis isolates from foreign-born and Japan-born residents in Tokyo. Clin Microbiol Infect 2014; 21:248.e1-8. [PMID: 25595707 DOI: 10.1016/j.cmi.2014.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
Sequences of the full genomes of 259 clinical isolates of Mycobacterium tuberculosis, obtained from foreign-born and Japan-born patients in Tokyo, Japan, were determined, and a phylogenetic tree constructed by concatenated single-nucleotide polymorphism (SNP) sequences. The 259 isolates were clustered into four clades: Lineage 2 (East Asian or "Beijing" genotype; n = 182, 70.3%), Lineage 4 (Euro-American, n = 46, 17.8%), Lineage 1 (Indo-Oceanic, n = 23, 8.9%), and Lineage 3 (East African-Indian, n = 8, 3.1%). Of the 259, 36 (13.9%) were resistant to at least one drug. There was no multi-drug-resistant isolate. Drug resistance was greater for the strains in Lineage 2 than the non-Lineage 2. The proportion of Lineage 2 isolates was significantly smaller in foreign-born (n = 43/91, 47.3%) than in Japan-born (n = 139/168, 82.7%) patients, whereas the proportion of Lineage 1 isolates was significantly larger in foreign-born (n = 19/91, 20.9%) than in Japan-born (n = 4/168, 2.4%) patients. We also found eight SNPs specific to the typical Beijing sub-genotype in Lineage 2, including 4 non-synonymous SNPs. Of the 259 isolates, 244 had strain-specific SNP(s) and small (1-30-bp) insertions and deletions (indels). The numbers of strain-specific SNPs and indels per isolate were significantly larger from foreign-born (median 89, range 0-520) than from Japan-born (median 23, range 0-415) (p 3.66E-15) patients. These results suggested that M. tuberculosis isolates from foreign-born patients had more genetic diversity than those from Japan-born patients.
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Affiliation(s)
| | - T Miyoshi-Akiyama
- Department of Infectious Diseases, Japan; Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Y Kanno
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - J Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - T Kirikae
- Department of Infectious Diseases, Japan.
| | - N Kobayashi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan; National Hospital Organization Tokyo National Hospital, Tokyo, Japan
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Zammarchi L, Bartalesi F, Bartoloni A. Tuberculosis in tropical areas and immigrants. Mediterr J Hematol Infect Dis 2014; 6:e2014043. [PMID: 24959340 PMCID: PMC4063601 DOI: 10.4084/mjhid.2014.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 11/08/2022] Open
Abstract
About 95% of cases and 98% of deaths due to tuberculosis (TB) occur in tropical countries while, in temperate low incidence countries, a disproportionate portion of TB cases is diagnosed in immigrants. Urbanization, poverty, poor housing conditions and ventilation, poor nutritional status, low education level, the HIV co-epidemic, the growing impact of chronic conditions such as diabetes are the main determinants of the current TB epidemiology in tropical areas. TB care in these contests is complicated by several barriers such as geographical accessibility, educational, cultural, sociopsychological and gender issues. High quality microbiological and radiological facilities are not widely available, and erratic supply of anti-TB drugs may affect tropical areas from time to time. Nevertheless in recent years, TB control programs reached major achievements in tropical countries as demonstrated by several indicators. Migrants have a high risk of acquire TB before migration. Moreover, after migration, they are exposed to additional risk factors for acquiring or reactivating TB infection, such as poverty, stressful living conditions, social inequalities, overcrowded housing, malnutrition, substance abuse, and limited access to health care. TB mass screening programs for migrants have been implemented in low endemic countries but present several limitations. Screening programs should not represent a stand-alone intervention, but a component of a wider approach integrated with other healthcare activities to ensure the health of migrants.
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Affiliation(s)
- Lorenzo Zammarchi
- Infectious Diseases Unit, Department of Experimental & Clinical Medicine, University of Florence School of Medicine, Florence, Italy
| | | | - Alessandro Bartoloni
- Infectious Diseases Unit, Department of Experimental & Clinical Medicine, University of Florence School of Medicine, Florence, Italy
- SOD Malattie Infettive e Tropicali, AOU Careggi, Firenze, Italy
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Abstract
BACKGROUND The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing age-targeted guidelines. METHODS A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified. RESULTS Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR. CONCLUSIONS The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.
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Abarca Tomás B, Pell C, Bueno Cavanillas A, Guillén Solvas J, Pool R, Roura M. Tuberculosis in migrant populations. A systematic review of the qualitative literature. PLoS One 2013; 8:e82440. [PMID: 24349284 PMCID: PMC3857814 DOI: 10.1371/journal.pone.0082440] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature. METHODS Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized. FINDINGS TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and "the personal touch" of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school. CONCLUSIONS Understanding immigrants' views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.
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Affiliation(s)
- Bruno Abarca Tomás
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Christopher Pell
- Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Aurora Bueno Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Service of Preventive Medicine, San Cecilio University Hospital, Granada, Spain
- Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Públic, (CIBERESP), Madrid, Spain
| | - José Guillén Solvas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Service of Preventive Medicine, San Cecilio University Hospital, Granada, Spain
- Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Públic, (CIBERESP), Madrid, Spain
| | - Robert Pool
- Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - María Roura
- Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Tuberculosis transmission among immigrants and autochthonous populations of the eastern province of Saudi Arabia. PLoS One 2013; 8:e77635. [PMID: 24147042 PMCID: PMC3798324 DOI: 10.1371/journal.pone.0077635] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background Eastern province of Saudi Arabia is an industrial zone with large immigrant population and high level of tuberculosis case notification among immigrants. The impact of immigration and current trends of tuberculosis transmission among immigrants and autochthonous population in the region had not been investigated so far using molecular tools. Methodology During 2009- 2011, a total of 524 Mycobacterium tuberculosis isolates were collected from the central tuberculosis reference laboratory, representing an estimated 79.2% of the culture-positive tuberculosis cases over the study period in the province. These isolates were genotyped by using 24 locus-based MIRU-VNTR typing and spoligotyping followed by first line drug susceptibility testing. The molecular clustering profiles and phylogenetic diversity of isolates were determined and compared to the geographical origins of the patients. Principle Findings Genotyping showed an overall predominance of Delhi/CAS (29.4%), EAI (23.8%) and Ghana (13.3%) lineages, with slightly higher proportions of Delhi/CAS among autochthonous population (33.3 %) and EAI (30.9%) among immigrants. Rate of any drug resistance was 20.2% with 2.5% of multi-drug resistance. Strain cluster analysis indicated 42 clusters comprising 210 isolates, resulting in a calculated recent transmission index of 32.1%. Overall shared cluster ratio was 78.6% while 75.8% were shared between autochthonous population and immigrant population with a predominance of immigrants from South east Asia (40.7%). In contrast, cross national transmission within the immigrant population was limited (24.2%). Younger age (15-30- p value-0.043, 16-45, p value 0.030), Saudi nationality (p value-0.004) and South East Asian origin (p value-0.011) were identified as significant predisposing factors for molecular strain clustering. Conclusions The high proportion of molecular clusters shared among the autochthonous and immigrant populations suggests a high permeability of tuberculosis transmission between both populations in the province. These results prompt for the need to strengthen the current tuberculosis control strategies and surveillance programs.
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Sandgren A, Schepisi MS, Sotgiu G, Huitric E, Migliori GB, Manissero D, van der Werf MJ, Girardi E. Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review. Eur Respir J 2013; 43:1159-71. [PMID: 24114966 PMCID: PMC3971120 DOI: 10.1183/09031936.00117213] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) control programmes of many low TB incidence countries of the European Union/European Economic Area (EU/EEA) perceive challenges in controlling TB due to high numbers of TB in migrants from high-incidence countries. To assess the extent of TB transmission from the foreign-born to the native-born population, we quantitatively investigated the dynamics of TB transmission between these populations in the EU/EEA, using published molecular epidemiological studies. We searched PubMed and EMBASE databases from 1990 to August 2012. We identified 15 studies performed during 1992–2007 covering 12,366 cases, of which median (range) 49.2% (17.7%–86.4%) were foreign-born. The proportion of clustered isolates ranged between 8.5% and 49.1% of the total number of TB cases genotyped and among these, foreign-born cases were equally or more likely to have unique isolates compared to native-born cases. One third of the clusters were “mixed”, i.e. composed of foreign- and native-born cases, involving 0–34.2% of all genotyped cases. Cross-transmission among foreign and native populations was bidirectional, with wide differences across studies. This systematic review provides evidence that TB in a foreign-born population does not have a significant influence on TB in the native population in EU/EEA. TB in foreign-born cases does not have a significant influence on TB in the native population in EU/EEAhttp://ow.ly/pTTXv
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Affiliation(s)
- Andreas Sandgren
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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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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Martinez VN, Komatsu NK, De Figueredo SM, Waldman EA. Equity in health: tuberculosis in the Bolivian immigrant community of São Paulo, Brazil. Trop Med Int Health 2012; 17:1417-24. [PMID: 22909059 DOI: 10.1111/j.1365-3156.2012.03074.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil. METHODS Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders. RESULTS We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality. CONCLUSIONS Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.
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Affiliation(s)
- Vanessa N Martinez
- Public Health School of University of São Paulo, São Paulo, Brazil São Paulo Municipal Department of Health, São Paulo, Brazil
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Garzelli C, Rindi L. Molecular epidemiological approaches to study the epidemiology of tuberculosis in low-incidence settings receiving immigrants. INFECTION GENETICS AND EVOLUTION 2012; 12:610-8. [DOI: 10.1016/j.meegid.2011.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 10/17/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Kamper-Jørgensen Z, Andersen AB, Kok-Jensen A, Kamper-Jørgensen M, Bygbjerg IC, Andersen PH, Thomsen VO, Lillebaek T. Migrant tuberculosis: the extent of transmission in a low burden country. BMC Infect Dis 2012; 12:60. [PMID: 22423983 PMCID: PMC3342118 DOI: 10.1186/1471-2334-12-60] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 03/18/2012] [Indexed: 11/17/2022] Open
Abstract
Background Human migration caused by political unrest, wars and poverty is a major topic in international health. Infectious diseases like tuberculosis follow their host, with potential impact on both the migrants and the population in the recipient countries. In this study, we evaluate Mycobacterium tuberculosis transmission between the national population and migrants in Denmark. Methods Register study based on IS6110-RFLP results from nationwide genotyping of tuberculosis cases during 1992 through 2004. Cases with 100% identical genotypes were defined as clustered and part of a transmission chain. Origin of clusters involving both Danes and migrants was defined as Danish/migrant/uncertain. Subsequently, the proportion of cases likely infected by the "opposite" ethnic group was estimated. Results 4,631 cases were included, representing 99% of culture confirmed cases during 1992 through 2004. Migrants contributed 61.6% of cases. Up to 7.9% (95% CI 7.0-8.9) of migrants were infected by Danes. The corresponding figure was 5.8% (95% CI 4.8-7.0) for Danes. Thus, transmission from Danes to migrants occurred up to 2.5 (95% CI 1.8-3.5) times more frequent than vice versa (OR = 1). A dominant strain, Cluster-2, was almost exclusively found in Danes, particular younger-middle-aged males. Conclusions Transmission between Danes and migrants is limited, and risk of being infected by the "opposite" ethnic group is highest for migrants. TB-control efforts should focus on continues micro-epidemics, e.g. with Cluster-2 in Danes, prevention of reactivation TB in high-risk migrants, and outbreaks in socially marginalized migrants, such as Somalis and Greenlanders. Fears that TB in migrants poses a threat for resident Danes seem exaggerated and unjustified. We believe this to be true for other low incidence countries as well.
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Affiliation(s)
- Zaza Kamper-Jørgensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
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Iñigo J, García de Viedma D, Arce A, Palenque E, Herranz M, Rodríguez E, Ruiz-Serrano MJ, Bouza E, Chaves F. Differential findings regarding molecular epidemiology of tuberculosis between two consecutive periods in the context of steady increase of immigration. Clin Microbiol Infect 2012; 19:292-7. [PMID: 22404140 DOI: 10.1111/j.1469-0691.2012.03794.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The demographic characteristics of the population of Madrid, with a steady increase in immigrants, from 4.7% in 1998 to 17.4% in 2007, provide an opportunity to study in depth the transmission of TB. Our aim was to compare two 3-year longitudinal molecular studies of TB to define transmission patterns and predictors of clustering. Two prospective population-based molecular and epidemiological studies (2002-2004 and 2005-2007) of TB patients were conducted in nine urban districts in Madrid using the same methodology. During the period 2002-2007, 2248 cases of TB were reported, and the incidence decreased from 23.5 per 100,000 in 2002 to 20.8 in 2007 (p <0.001). A total of 1269 isolates were molecularly characterized and included in the study. The comparison between the two periods showed that the percentage of foreign-born patients among TB cases increased from 36.2% to 45.7% (p <0.001). Furthermore, the percentage of clustered cases decreased (36.6% vs. 30.6%; p 0.028), and this decline was associated with a decrease of clustered cases among men and people under 35 years. We also observed a decrease in cases belonging to clusters containing ≥ 6 people (14.2% vs. 8.2%; p <0.001), and in cases belonging to mixed clusters containing Spanish-born and foreign-born patients (18.5% vs. 11.1%, p <0.001). Our molecular epidemiology study provides clues to interpret the decrease in the incidence of TB in a context of steady increase of immigration. In our region, the decrease in the incidence of TB can be explained predominantly as a result of a decline in recent transmission.
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Affiliation(s)
- J Iñigo
- Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
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Ricks PM, Cain KP, Oeltmann JE, Kammerer JS, Moonan PK. Estimating the burden of tuberculosis among foreign-born persons acquired prior to entering the U.S., 2005-2009. PLoS One 2011; 6:e27405. [PMID: 22140439 PMCID: PMC3226620 DOI: 10.1371/journal.pone.0027405] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/16/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The true burden of reactivation of remote latent tuberculosis infection (reactivation TB) among foreign-born persons with tuberculosis (TB) within the United States is not known. Our study objectives were to estimate the proportion of foreign-born persons with TB due reactivation TB and to describe characteristics of foreign-born persons with reactivation TB. METHODS We conducted a cross-sectional study of patients with an M. tuberculosis isolate genotyped by the U.S. National TB Genotyping Service, 2005-2009. TB cases were attributed to reactivation TB if they were not a member of a localized cluster of cases. Localized clusters were determined by a spatial scan statistic of cases with isolates with matching TB genotype results. Crude odds ratios and 95% confidence intervals were used to assess relations between reactivation TB and select factors among foreign-born persons. MAIN RESULTS Among the 36,860 cases with genotyping and surveillance data reported, 22,151 (60%) were foreign-born. Among foreign-born persons with TB, 18,540 (83.7%) were attributed to reactivation TB. Reactivation TB among foreign-born persons was associated with increasing age at arrival, incidence of TB in the country of origin, and decreased time in the U.S. at the time of TB diagnosis. CONCLUSIONS Four out of five TB cases among foreign-born persons can be attributed to reactivation TB and present the largest challenge to TB elimination in the U.S. TB control strategies among foreign-born persons should focus on finding and treating latent tuberculosis infection prior to or shortly after arrival to the United States and on reducing the burden of LTBI through improvements in global TB control.
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Affiliation(s)
- Philip M. Ricks
- Division of Tuberculosis Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin P. Cain
- Division of Tuberculosis Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John E. Oeltmann
- Division of Tuberculosis Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J. Steve Kammerer
- Division of Tuberculosis Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick K. Moonan
- Division of Tuberculosis Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Molecular characterization of Mycobacterium tuberculosis isolates from Kandy, Sri Lanka. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60024-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Borgdorff MW, van den Hof S, Kalisvaart N, Kremer K, van Soolingen D. Influence of sampling on clustering and associations with risk factors in the molecular epidemiology of tuberculosis. Am J Epidemiol 2011; 174:243-51. [PMID: 21606233 DOI: 10.1093/aje/kwr061] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Molecular epidemiologic studies may use genotypic clustering of isolates as an indicator of recent transmission. It has been shown that missing cases lead to underestimating clustering, and modelling studies suggested that they may also lead to underestimating odds ratios for clustering. Using a national, comprehensive database from the Netherlands covering 15 years between 1993 and 2007 and including over 12,000 patients and their isolates, the authors determined the effects of sampling at random, in time, and by geographic area. As expected, sampling reduced the observed clustering percentages. However, sampling did not reduce the observed odds ratios for clustering. The main explanations for this discrepancy with model outcomes were that a substantial proportion of clustered cases were found in large clusters and that risk factors for clustering tended to be-among clustered cases-also risk factors for large clusters. The authors conclude that, in settings where risk factors for clustering may be interpreted as risk factors for recent transmission, these risk factors are also associated with larger cluster sizes. As a result, odds ratios would show limited sampling bias.
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Affiliation(s)
- Martien W Borgdorff
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, the Netherlands.
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García de Viedma D, Mokrousov I, Rastogi N. Innovations in the molecular epidemiology of tuberculosis. Enferm Infecc Microbiol Clin 2011; 29 Suppl 1:8-13. [DOI: 10.1016/s0213-005x(11)70012-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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