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Arvidsson Å, Lafta G, Sönnerbrandt M, Sundelin K, Paues J. The cascade of care for pregnant women with latent tuberculosis infection in a high-income country. Infect Dis (Lond) 2023; 55:635-645. [PMID: 37389825 DOI: 10.1080/23744235.2023.2228406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In Östergötland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in Östergötland county. METHODS Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in Östergötland County between 2013 and 2018. The Public Health Agency of Sweden's national database for active TB was used to analyse if any women developed active TB up to two years after the screening process. RESULTS A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects. CONCLUSION Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.
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Affiliation(s)
- Åsa Arvidsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gihan Lafta
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Karin Sundelin
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
| | - Jakob Paues
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
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2
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Russo G, Marchese V, Formenti B, Cimaglia C, Di Rosario G, Cristini I, Magro P, El-Hamad I, Cirillo DM, Girardi E, Matteelli A. Screening for Tuberculosis Infection among Migrants: A Cost-Effectiveness Analysis in the Italian Context. Antibiotics (Basel) 2023; 12:antibiotics12040631. [PMID: 37106992 PMCID: PMC10135261 DOI: 10.3390/antibiotics12040631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Screening of tuberculosis infection (TBI) among migrants from high-incidence countries is a cornerstone of tuberculosis control in low-incidence countries. However, the optimal screening strategy has not been defined yet. METHODS A quasi-experimental study involving migrants residing in the province of Brescia was carried out that aimed at assessing the completion rate, time to completion, preventive treatment initiation rate, and cost-effectiveness of two strategies for TBI screening. They underwent TBI screening with the IGRA-only strategy (arm 1) or with the sequential strategy (tuberculin skin test, TST, followed by IGRA in case of a positive result-arm 2). The two strategies were compared in terms of screening completion, time to complete the screening process, therapy initiation, and cost-effectiveness. RESULTS Between May 2019 and May 2022, 657 migrants were evaluated, and 599 subjects were included in the study, with 358 assigned to arm 1 and 237 to arm 2. Screening strategy was the only factor associated with screening completion in a multivariable analysis, with the subjects assigned to the IGRA-only strategy more likely to complete the screening cascade (n = 328, 91.6% vs. n = 202, 85.2%, IRR 1.08, 95% CI (1.01-1.14), p = 0.019). The time to complete the screening process was significantly longer for patients assigned to the sequential strategy arm (74 days vs. 46 days, p = 0.002). Therapy initiation did not significantly differ between the two arms, and cost-effectiveness was higher for the sequential strategy. CONCLUSION Sequential strategy implementation for TBI screening among migrants may be justified by its higher cost-effectiveness in spite of the lower completion of the screening cascade.
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Affiliation(s)
- Giulia Russo
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, WHO Collaborating Centre for Tuberculosis Prevention, University of Brescia, 25123 Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), 20359 Hamburg, Germany
| | - Beatrice Formenti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- UNESCO Chair "Training and Empowering Human Resources for Health Development in Resource-Limited Countries", Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Claudia Cimaglia
- Clinical Epidemiology Unit, Lazzaro Spallanzani National Institute for Infectious Diseases-IRCCS, 00149 Rome, Italy
| | - Gianluca Di Rosario
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Irene Cristini
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Paola Magro
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Issa El-Hamad
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, Lazzaro Spallanzani National Institute for Infectious Diseases-IRCCS, 00149 Rome, Italy
| | - Alberto Matteelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, WHO Collaborating Centre for Tuberculosis Prevention, University of Brescia, 25123 Brescia, Italy
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Kota NT, Shrestha S, Kashkary A, Samina P, Zwerling A. The Global Expansion of LTBI Screening and Treatment Programs: Exploring Gaps in the Supporting Economic Evidence. Pathogens 2023; 12:pathogens12030500. [PMID: 36986422 PMCID: PMC10054594 DOI: 10.3390/pathogens12030500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The global burden of latent TB infection (LTBI) and the progression of LTBI to active TB disease are important drivers of ongoing TB incidence. Addressing LTBI through screening and TB preventive treatment (TPT) is critical in order to end the TB epidemic by 2035. Given the limited resources available to health ministries around the world in the fight against TB, we must consider economic evidence for LTBI screening and treatment strategies to ensure that limited resources are used to achieve the biggest health impact. In this narrative review, we explore key economic evidence around LTBI screening and TPT strategies in different populations to summarize our current understanding and highlight gaps in existing knowledge. When considering economic evidence supporting LTBI screening or evaluating different testing approaches, a disproportionate number of economic studies have been conducted in high-income countries (HICs), despite the vast majority of TB burden being borne in low- and middle-income countries (LMICs). Recent years have seen a temporal shift, with increasing data from low- and middle-income countries (LMICs), particularly with regard to targeting high-risk groups for TB prevention. While LTBI screening and prevention programs can come with extensive costs, targeting LTBI screening among high-risk populations, such as people living with HIV (PLHIV), children, household contacts (HHC) and immigrants from high-TB-burden countries, has been shown to consistently improve the cost effectiveness of screening programs. Further, the cost effectiveness of different LTBI screening algorithms and diagnostic approaches varies widely across settings, leading to different national TB screening policies. Novel shortened regimens for TPT have also consistently been shown to be cost effective across a range of settings. These economic evaluations highlight key implementation considerations such as the critical nature of ensuring high rates of adherence and completion, despite the costs associated with adherence programs not being routinely assessed and included. Digital and other adherence support approaches are now being assessed for their utility and cost effectiveness in conjunction with novel shortened TPT regimens, but more economic evidence is needed to understand the potential cost savings, particularly in settings where directly observed preventive therapy (DOPT) is routinely conducted. Despite the growth of the economic evidence base for LTBI screening and TPT recently, there are still significant gaps in the economic evidence around the scale-up and implementation of expanded LTBI screening and treatment programs, particularly among traditionally hard-to-reach populations.
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Affiliation(s)
| | - Suvesh Shrestha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Abdulhameed Kashkary
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Public Health Authority, Riyadh 13351, Saudi Arabia
| | - Pushpita Samina
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Alice Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
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Delgado RI, De la Rosa M, Picado MA, Ayoub-Rodriguez L, Gonzalez CE, Gemoets L. Cost of care for asylum seekers and refugees entering the United States: The case of volunteer medical providers in El Paso, Texas. PLoS One 2022; 17:e0278386. [PMID: 36454915 PMCID: PMC9714800 DOI: 10.1371/journal.pone.0278386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Between October 2018, and February 2020, the United States saw an unprecedented increase in the number of asylum seekers and refugees arriving unexpectedly at international crossings along the US-Mexico Border. Many of these migrants needed proper medical attention, and consequently created significant pressure on local health systems. In El Paso, Texas, volunteer clinicians, collaborating closely with religious organizations and non-governmental organizations, provided outpatient medical care for the new arrivals; the county hospital provided in-patient care at local tax payers' expense. The objective of this study was to estimate costs of healthcare services offered by these volunteers in order to formulate sustainable and appropriate healthcare policies to address the needs of refugees and asylum seekers in the United States. METHODS A mixed methods approach was used including personal interviews with stakeholders, and follow up surveys with volunteer clinicians. The cost analysis was done from the payer perspective using Medicaid reimbursement rates. RESULTS Total costs of care provided to asylum seekers and refugees varied between $1.9MM to $4.4MM during the study period. The number of patient visits was estimated at 15,736 to 19,236, and cost per patient ranged between $99 and $281. Most common conditions treated by volunteer providers were abdominal pain, dermatological conditions, headaches, dehydration and hypertension. CONCLUSIONS This is the first study looking at the cost of healthcare for refugees and asylum seekers provided by volunteer clinicians, in a binational context. The resources invested by volunteer providers were significant, and essential to meet medical needs of migrant populations. Without appropriate financial support, a strategy relying on volunteer and local community resources will prove unsustainable in the long term. Findings from this study will help formulate federal and local policies to support local health systems along the US-Mexico Border in providing care to future migrations into the United States.
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Affiliation(s)
- Rigoberto I. Delgado
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail:
| | - Manuel De la Rosa
- Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Marlon A. Picado
- Department of Accounting and Information Systems, The University of Texas at El Paso, El Paso, Texas, United States of America
| | - Lisa Ayoub-Rodriguez
- Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States of America
| | - Celia E. Gonzalez
- Department of Accounting and Information Systems, The University of Texas at El Paso, El Paso, Texas, United States of America
| | - Leopold Gemoets
- Department of Accounting and Information Systems, The University of Texas at El Paso, El Paso, Texas, United States of America
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5
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Campbell JR, Schwartzman K. Invited Commentary: The Role of Tuberculosis Screening Among Migrants to Low-Incidence Settings in (Not) Achieving Elimination. Am J Epidemiol 2022; 191:271-274. [PMID: 34216207 DOI: 10.1093/aje/kwab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
The cost-effectiveness of migrant tuberculosis prevention programs is highly relevant to many countries with low tuberculosis incidence as they attempt to eliminate the disease. Dale et al. (Am J Epidemiol. 2022;191(2):255-270) evaluated strategies for tuberculosis infection screening and treatment among new migrants to Australia. Screening for infection before migration, and then administering preventive treatment after arrival, was more cost-effective than performing both screening and treatment after arrival. From the Australian health payer perspective, the improved cost-effectiveness of premigration screening partly reflected the shift of screening costs to migrants, which may raise ethical concerns. Key sensitivity analyses highlighted the influence of health disutility associated with tuberculosis preventive treatment, and of posttreatment sequelae of tuberculosis disease. Both considerations warrant greater attention in future research. For all strategies, the impact on tuberculosis incidence among migrants was modest (<15%), suggesting enhanced migrant screening will not achieve tuberculosis elimination in low-incidence settings. This emphasizes the need to increase investment and effort in global tuberculosis prevention and care, which will ultimately reduce the prevalence of tuberculosis infection and therefore the risk of tuberculosis disease among migrants. Such efforts will benefit high and low tuberculosis incidence countries alike, and advance all countries further toward tuberculosis elimination.
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Verma S, Pacheco C, Carter EJ, Szkwarko D. Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island. J Prim Care Community Health 2022; 13:21501319221111106. [PMID: 35850568 PMCID: PMC9310062 DOI: 10.1177/21501319221111106] [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] [Indexed: 11/24/2022] Open
Abstract
Objectives: Within the United States (US), significant racial and ethnic disparities
exist in the rates of latent TB infection (LTBI) and active TB disease. A
disproportionate number of TB disease cases result from untreated LTBI among
individuals born outside the US. This study evaluates LTBI treatment
outcomes among an underserved, at-risk population in Rhode Island. Methods: A quantitative retrospective chart review of adult patients with a positive
screening test assessed LTBI care cascade outcomes including referral,
treatment initiation, and completion. Results: Seventy-four percent of patients found to have positive screening TB tests
were born outside of the US; 80% identified as Hispanic or Black and 45%
spoke a preferred language other than English. Twenty-one percent of
potential candidates for LTBI treatment initiated treatment. Conclusions: Major gaps were identified in referral success and treatment initiation.
Expanding LTBI treatment access into primary care settings could be a
solution to improve outcomes and decrease health inequities among at-risk
communities.
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Affiliation(s)
- Shelly Verma
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Blackstone Valley Community Health Care, Pawtucket, RI, USA
| | - Cristina Pacheco
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Blackstone Valley Community Health Care, Pawtucket, RI, USA
| | - E Jane Carter
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daria Szkwarko
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,UMass Chan Medical School, Worcester, MA, USA
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7
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Byun JY, Kim HL, Lee EK, Kwon SH. A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments. Front Pharmacol 2021; 12:736986. [PMID: 34966276 PMCID: PMC8710595 DOI: 10.3389/fphar.2021.736986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce. Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model. Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries. Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.
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Affiliation(s)
- Joo-Young Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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8
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Marx FM, Hauer B, Menzies NA, Haas W, Perumal N. Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries - a model-based cost-effectiveness analysis. BMC Public Health 2021; 21:2172. [PMID: 34836526 PMCID: PMC8622109 DOI: 10.1186/s12889-021-12142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
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Affiliation(s)
- Florian M Marx
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany. .,Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Barbara Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Walter Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Nita Perumal
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany.,Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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9
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Spruijt I, Joren C, van den Hof S, Erkens C. Tailored approaches facilitate high completion of tuberculosis infection treatment among migrants. Eur Respir J 2021; 59:13993003.02077-2021. [PMID: 34561296 DOI: 10.1183/13993003.02077-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/14/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Chantal Joren
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Epidemiology and Surveillance, Bilthoven, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
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10
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Pires A, Poletto-Neto V, Chisini LA, Schwendicke F, Pereira-Cenci T. Post-retained Restorations: A Cost-minimization Analysis Nested in a Randomized Clinical Trial. Oper Dent 2021; 46:255-262. [PMID: 34192327 DOI: 10.2341/20-056-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to assess four post-retained restorative strategies for endodontically treated teeth using cost-minimization analysis. METHODS AND MATERIALS The cost-minimization analysis was based on primary data from a randomized clinical trial and followed the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Two hundred twenty-five teeth (141 patients) restored using four strategies-teeth with ferrules+ restored with either glass fiber posts or direct composite or crowns, and teeth without ferrules- restored with either glass fiber or cast metal posts with crowns-were evaluated annually between 2009 and 2018. Initial costs and incremental costs per year were calculated. Survival curves were created using the Kaplan-Meier method and log-rank test. Kruskal-Wallis analysis was followed by Dunn's test, which was used to compare restorative treatments, with a significance level of 5%. RESULTS Initial costs were greater for cast metal posts without crowns (US$153.14). Glass fiber posts with composite (US$27.11) were least costly; the most failures occurred in this group, but they were primarily repairable restoration fractures. The number of extractions, and thus cost, was greater for glass fiber posts with crowns. The mean annual cost was significantly lower for teeth restored with composite (p<0.001). Ferrule presence did not significantly impact annual costs. CONCLUSIONS The use of glass fiber posts and direct composite incurred significantly lower annual costs than did other alternatives involving crowns or metal posts.
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11
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García-Aguinaga ML, Sabado-Angngasing E, Tamiri Rodríguez-González C, Belda-Bilbao L, Cuenca-Abarca A. [The importance of the health system in the control of tuberculosis. Case of Venezuela]. Semergen 2021; 47:e25-e27. [PMID: 34034981 DOI: 10.1016/j.semerg.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/16/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- M L García-Aguinaga
- Servicio de Medicina Interna, Hospital El Escorial, San Lorenzo del Escorial, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España.
| | - E Sabado-Angngasing
- Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España; Medicina Familiar y Comunitaria, Hospital El Escorial, San Lorenzo del Escorial, Madrid, España
| | - C Tamiri Rodríguez-González
- Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España; Medicina Familiar y Comunitaria, Hospital El Escorial, San Lorenzo del Escorial, Madrid, España
| | - L Belda-Bilbao
- Servicio de Medicina Interna, Hospital El Escorial, San Lorenzo del Escorial, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España
| | - A Cuenca-Abarca
- Servicio de Medicina Interna, Hospital El Escorial, San Lorenzo del Escorial, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España
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12
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Shedrawy J, Deogan C, Öhd JN, Hergens MP, Bruchfeld J, Jonsson J, Siroka A, Lönnroth K. Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:445-454. [PMID: 33559787 PMCID: PMC7954754 DOI: 10.1007/s10198-021-01265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/13/2021] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. METHODS A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). RESULTS Screening migrants in the age group 13-19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20-34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. CONCLUSION Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20-34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
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Affiliation(s)
- Jad Shedrawy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Charlotte Deogan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Joanna Nederby Öhd
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Maria-Pia Hergens
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Goscé L, Girardi E, Allel K, Cirillo DM, Barcellini L, Stancanelli G, Matteelli A, Hagphrast-Bidgoli H, Abubakar I. Tackling TB in migrants arriving at Europe's southern border. Int J Infect Dis 2021; 113 Suppl 1:S28-S32. [PMID: 33713814 DOI: 10.1016/j.ijid.2021.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants.
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Affiliation(s)
- Lara Goscé
- Institute for Global Health, University College London, United Kingdom.
| | - Enrico Girardi
- Istituto Nazionale per le Malattie Infettive "L. Spallanzani"- IRCCS, Italy.
| | - Kasim Allel
- Institute for Global Health, University College London, United Kingdom.
| | | | | | | | - Alberto Matteelli
- WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, Brescia, Italy.
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, United Kingdom.
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14
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Interventions to reduce the burden of vaccine-preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006-2018. Vaccine 2020; 38:7217-7225. [PMID: 33008670 DOI: 10.1016/j.vaccine.2020.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/21/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Disparities in vaccine-preventable disease (VPD) burden and immunisation coverage between migrants and refugees and their host populations have been described in numerous countries worldwide. Effective strategies are required to reduce the health disparities and immunisation inequities experienced by migrants and refugees. METHODS Using Arksey and O'Malley's framework, we conducted a scoping review to identify available literature on interventions aimed at reducing VPD burden among migrants and refugees worldwide. We searched for relevant empirical, peer-reviewed literature published in English between 2006 and 2018 using MEDLINE, Ovid EMBASE, CINAHL, Sociological Abstracts, and Web of Science databases. Relevant information from the studies, including intervention type, details and outcomes, were charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Seventy studies met the inclusion criteria. The number of published studies increased over the years. The majority of studies were conducted in high-income countries. More studies were conducted among migrants (not including refugees) (n = 48, 66%) than specifically among refugees (n = 25, 34%). Interventions were implemented in a variety of settings, including health care (n = 31, 42%), community (n = 29, 39%), off-shore (n = 7, 9%), national (n = 4, 5%), school (n = 2, 3%), and workplace (n = 1, 1%). Studies reported interventions focused at the individual (to facilitate uptake of health services) (n = 4, 5%), community (to raise awareness) (n = 25, 34%), provider (to offer health services) (n = 12, 16%) and/or system (to increase compliance with recommendations) (n = 33, 45%) level. To be effective, interventions were designed to overcome commonly identified barriers to accessing services related to language, culture, distance and cost. Engagement with community members and organisations was an effective way to co-design interventions that address migrants' specific needs. CONCLUSIONS Studies emphasised the importance of interventions that address the heterogeneity within and between migrant and refugee populations. Considerable variation in practice remains, therefore more evaluation of interventions is needed to inform policy and programme decision-making.
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15
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Hargreaves S, Nellums LB, Johnson C, Goldberg J, Pantelidis P, Rahman A, Friedland FMedSci JS. Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study. Travel Med Infect Dis 2020; 36:101611. [PMID: 32126293 PMCID: PMC7493708 DOI: 10.1016/j.tmaid.2020.101611] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/06/2019] [Accepted: 02/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. METHODS We did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. RESULTS 96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18-73]; mean time in the UK 4.8 years [SD 3.2; range 0-10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. CONCLUSION Multi-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.
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Affiliation(s)
- Sally Hargreaves
- Institute for Infection & Immunity, St. George's, University of London, United Kingdom.
| | - Laura B Nellums
- Institute for Infection & Immunity, St. George's, University of London, United Kingdom; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Catherine Johnson
- Section of Infectious Diseases & Immunity, Imperial College London, United Kingdom
| | - Jacob Goldberg
- Section of Infectious Diseases & Immunity, Imperial College London, United Kingdom
| | | | - Asif Rahman
- Imperial College Healthcare NHS Trust, London, United Kingdom
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16
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Shetty AK. Infectious Diseases among Refugee Children. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E129. [PMID: 31783605 PMCID: PMC6955676 DOI: 10.3390/children6120129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 12/24/2022]
Abstract
In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics and Office of Global Health, Wake Forest School of Medicine and Brenner Children's Hospital, Medical Center Blvd, Winston-Salem, NC 27157, USA
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17
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Zellweger JP. Screening migrants for tuberculosis and latent TB infection: the reward will come later. Eur Respir J 2019; 54:54/4/1901719. [PMID: 31672908 DOI: 10.1183/13993003.01719-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/05/2022]
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18
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Zammarchi L, Angheben A, Fantoni T, Chiappini E, Mantella A, Galli L, Marchese V, Zavarise G, Bisoffi Z, Bartoloni A. Screening for neurocysticercosis in internationally adopted children: yield, cost and performance of serological tests, Italy, 2001 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30301492 PMCID: PMC6178589 DOI: 10.2807/1560-7917.es.2018.23.40.1700709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.
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Affiliation(s)
- Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Teresa Fantoni
- Health Human Sciences School, Medicine and Surgery Degree Course, University of Florence, Florence, Italy
| | - Elena Chiappini
- Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB elimination, University of Brescia, Brescia, Italy.,Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Giorgio Zavarise
- Department of Pediatrics, Hospital Sacro Cuore - Don Calabria, Negrar, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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19
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Buonfrate D, Gobbi F, Marchese V, Postiglione C, Badona Monteiro G, Giorli G, Napoletano G, Bisoffi Z. Extended screening for infectious diseases among newly-arrived asylum seekers from Africa and Asia, Verona province, Italy, April 2014 to June 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29692316 PMCID: PMC5915973 DOI: 10.2807/1560-7917.es.2018.23.16.17-00527] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Management of health issues presented by newly-arrived migrants is often limited to communicable diseases even though other health issues may be more prevalent. We report the results of infectious disease screening proposed to 462 recently-arrived asylum seekers over 14 years of age in Verona province between April 2014 and June 2015. Methods: Screening for latent tuberculosis (TB) was performed via tuberculin skin test (TST) and/or QuantiFERON-TB Gold in-tube assay and/or chest X-ray. An ELISA was used to screen for syphilis. Stool microscopy was used to screen for helminthic infections, and serology was also used for strongyloidiasis and schistosomiasis. Screening for the latter also included urine filtration and microscopy. Results: Most individuals came from sub-Saharan Africa (77.5%), with others coming from Asia (21.0%) and North Africa (1.5%). The prevalence of viral diseases/markers of human immunodeficiency virus (HIV) infection was 1.3%, HCV infection was 0.85% and hepatitis B virus surface antigen was 11.6%. Serological tests for syphilis were positive in 3.7% of individuals. Of 125 individuals screened for TB via the TST, 44.8% were positive and of 118 screened via the assay, 44.0% were positive. Of 458 individuals tested for strongyloidiasis, 91 (19.9%) were positive, and 76 of 358 (21.2%) individuals from sub-Saharan Africa were positive for schistosomiasis. Conclusions: The screening of viral diseases is questionable because of low prevalence and/or long-term, expensive treatments. For opposing reasons, helminthic infections are probably worth to be targeted by screening strategies in asylum seekers of selected countries of origin.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Federico Gobbi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.,Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Chiara Postiglione
- Prevention Department, Unità Locale Socio Sanitaria (ULSS) 9, Verona, Italy
| | | | - Giovanni Giorli
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | | | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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20
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Shete PB, Boccia D, Dhavan P, Gebreselassie N, Lönnroth K, Marks S, Matteelli A, Posey DL, van der Werf MJ, Winston CA, Lienhardt C. Defining a migrant-inclusive tuberculosis research agenda to end TB. Int J Tuberc Lung Dis 2019; 22:835-843. [PMID: 29991390 DOI: 10.5588/ijtld.17.0503] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pillar 3 of the End TB Strategy calls for the promotion of research and innovation at the country level to facilitate improved implementation of existing and novel interventions to end tuberculosis (TB). In an era of increasing cross-border migration, there is a specific need to integrate migration-related issues into national TB research agendas. The objective of the present review is to provide a conceptual framework to guide countries in the development and operationalization of a migrant-inclusive TB research agenda. METHODS We conducted a literature review, complemented by expert opinion and the previous articles in this State of the Art series, to identify important themes central to migration-related TB. We categorized these themes into a framework for a migration-inclusive global TB research agenda across a comprehensive spectrum of research. We developed this conceptual framework taking into account: 1) the biomedical, social and structural determinants of TB; 2) the epidemiologic impact of the migration pathway; and 3) the feasibility of various types of research based on a country's capacity. DISCUSSION The conceptual framework presented here is based on the key principle that migrants are not inherently different from other populations in terms of susceptibility to known TB determinants, but that they often have exacerbated or additional risks related to their country of origin and the migration process, which must be accounted for in developing comprehensive TB prevention and care strategies. A migrant-inclusive research agenda should systematically consider this wider context to have the highest impact.
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Affiliation(s)
- P B Shete
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - D Boccia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - P Dhavan
- International Organization of Migration, Geneva, Switzerland
| | - N Gebreselassie
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
| | - K Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - S Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - A Matteelli
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV collaborative activities and for the TB elimination strategy, University of Brescia, Brescia, Italy
| | - D L Posey
- Division Global Quarantine and Migration, CDC, Atlanta, Georgia, USA
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C A Winston
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - C Lienhardt
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland, Institut de Recherche pour le Développement, Unité Mixte de Recherche 233, Montpellier, France
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21
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Schrier L, Wyder C, Del Torso S, Stiris T, von Both U, Brandenberger J, Ritz N. Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments. Eur J Pediatr 2019; 178:1449-1467. [PMID: 31240389 DOI: 10.1007/s00431-019-03405-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.
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Affiliation(s)
- Lenneke Schrier
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Corinne Wyder
- Kinderaerzte KurWerk, Poststrasse 9, 3400, Burgdorf, Switzerland
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | | | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site, Munich, Germany
- Paediatric Infection and Immunity, Section of Paediatric, Department of Medicine, Imperial College London, London, UK
| | - Julia Brandenberger
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
- Infectious Diseases and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
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22
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Ronald LA, Campbell JR, Balshaw RF, Romanowski K, Roth DZ, Marra F, Cook VJ, Johnston JC. Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study. CMAJ 2019; 190:E209-E216. [PMID: 29483329 DOI: 10.1503/cmaj.170817] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Canadian tuberculosis (TB) guidelines recommend targeting postlanding screening for and treatment of latent tuberculosis infection (LTBI) in people migrating to Canada who are at increased risk for TB reactivation. Our objectives were to calculate robust longitudinal estimates of TB incidence in a cohort of people migrating to British Columbia, Canada, over a 29-year period, and to identify groups at highest risk of developing TB based on demographic characteristics at time of landing. METHODS We included all individuals (n = 1 080 908) who became permanent residents of Canada between Jan. 1, 1985, and Dec. 31, 2012, and were resident in BC at any time between 1985 and 2013. Multiple administrative databases were linked to the provincial TB registry. We used recursive partitioning models to identify populations with high TB yield. RESULTS Active TB was diagnosed in 2814 individuals (incidence rate 24.2/100 000 person-years). Demographic factors (live-in caregiver, family, refugee immigration classes; higher TB incidence in country of birth; and older age) were strong predictors of TB incidence in BC, with elevated rates continuing many years after entry into the cohort. Recursive partitioning identified refugees 18-64 years of age from countries with a TB incidence greater than 224/100 000 population as a high-yield group, with 1% developing TB within the first 10 years. INTERPRETATION These findings support recommendations in Canadian guidelines to target postlanding screening for and treatment of LTBI in adult refugees from high-incidence countries. Because high-yield populations can be identified at entry via demographic data, screening at this point may be practical and high-impact, particularly if the LTBI care cascade can be optimized.
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Affiliation(s)
- Lisa A Ronald
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Jonathon R Campbell
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Robert F Balshaw
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Kamila Romanowski
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - David Z Roth
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Fawziah Marra
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - Victoria J Cook
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
| | - James C Johnston
- Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC
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23
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Insights on the Mycobacterium tuberculosis population structure associated with migrants from Portuguese-speaking countries over a three-year period in Greater Lisbon, Portugal: Implications at the public health level. INFECTION GENETICS AND EVOLUTION 2019; 71:159-165. [PMID: 30928606 DOI: 10.1016/j.meegid.2019.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
Tuberculosis among foreign-born patients is a key indicator of country-level epidemiological profiles and, of an increasing concern in Europe given the more intensified migratory waves of refugees. Since Portugal presents a lower immigrant-associated TB incidence rate when compared to other European countries, we sought to characterize the epidemiology and transmission dynamics among the foreign-born population coming from Portuguese-speaking countries that are associated with higher TB incidences. In the present study we analyzed 133 Mycobacterium tuberculosis isolates obtained from foreign-born individuals over a three-year period in Lisbon, Portugal, using molecular epidemiological methods such as spoligotyping and 24-loci MIRU-VNTR. Moreover, all strains were subjected to drug susceptibility testing. The genetic profiles obtained suggest that strain importation from Portuguese speaking countries plays a less important role in TB epidemiology but instead argue in favor of a high degree of penetrance of Portuguese endemic strains to the migrant population, including multidrug resistant strains, which is particularly relevant to active screening programs.
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24
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Öhd JN, Lönnroth K, Abubakar I, Aldridge RW, Erkens C, Jonsson J, Marchese V, Matteelli A, Menezes D, Zenner D, Hergens MP. Building a European database to gather multi-country evidence on active and latent TB screening for migrants. Int J Infect Dis 2019; 80S:S45-S49. [PMID: 30826482 PMCID: PMC7615139 DOI: 10.1016/j.ijid.2019.02.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND AIM Screening for active and latent TB among migrants in low TB incidence countries may constitute an important contribution to TB elimination. E-DETECT TB, a European multi-county collaboration, aims to address the present lack of evidence on effectiveness of migrant TB screening by collating data in an international database and perform cross-country pooled and comparative analyses of screening coverage, results and linkage to care. METHOD A database was established using migrant TB screening data from participating countries' national screening programs, national screening pilots and local research projects. All partner countries contributed to a common agreed protocol with standardized variables, pooling available numerator and denominator screening data from participating countries and sites. RESULTS All collaborating members drafted and agreed upon a data sharing accord as well as a protocol that clearly defined responsibilities and data governance principles. The database has been created and data transfer is ongoing. CONCLUSION By persistence and focus the project has overcome considerable administrative, practical and legal challenges. This international collaboration provides greater power of analysis of harmonized data and thereby a unique opportunity to contribute migrant TB screening evidence. E-DETECT TB has started to invite other countries to contribute data to the database.
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Affiliation(s)
- Joanna Nederby Öhd
- Department of Public Health Science, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Communicable Disease Prevention and Control, Stockholm County Council, Smittskydd Stockholm, Box 17533, 118 91 Stockholm, Sweden.
| | - Knut Lönnroth
- Department of Public Health Science, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Robert W Aldridge
- Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 1DA, UK
| | - Connie Erkens
- KNCV Tuberculosis Foundation, Benoordenhoutseweg 46, 2596 BC Den Haag, the Netherlands
| | | | - Valentina Marchese
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - Alberto Matteelli
- Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV and TB Elimination, University of Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - Dee Menezes
- Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 1DA, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Maria-Pia Hergens
- Department of Public Health Science, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Communicable Disease Prevention and Control, Stockholm County Council, Smittskydd Stockholm, Box 17533, 118 91 Stockholm, Sweden
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25
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Jessup RL, O'Connor DA, Putrik P, Rischin K, Nezon J, Cyril S, Shepperd S, Buchbinder R. Alternative service models for delivery of healthcare services in high-income countries: a scoping review of systematic reviews. BMJ Open 2019; 9:e024385. [PMID: 30700481 PMCID: PMC6352783 DOI: 10.1136/bmjopen-2018-024385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Costs associated with the delivery of healthcare services are growing at an unsustainable rate. There is a need for health systems and healthcare providers to consider the economic impacts of the service models they deliver and to determine if alternative models may lead to improved efficiencies without compromising quality of care. The aim of this protocol is to describe a scoping review of the extent, range and nature of available synthesised research on alternative delivery arrangements for health systems relevant to high-income countries published in the last 5 years. DESIGN We will perform a scoping review of systematic reviews of trials and economic studies of alternative delivery arrangements for health systems relevant to high-income countries published on 'Pretty Darn Quick' (PDQ)-Evidence between 1 January 2012 and 20 September 2017. All English language systematic reviews will be included. The Cochrane Effective Practice and Organisation of Care taxonomy of health system interventions will be used to categorise delivery arrangements according to: how and when care is delivered, where care is provided and changes to the healthcare environment, who provides care and how the healthcare workforce is managed, co-ordination of care and management of care processes and information and communication technology systems. This work is part of a 5-year Partnership Centre for Health System Sustainability aiming to investigate and create interventions to improve health-system-performance sustainability. ETHICS AND DISSEMINATION No primary data will be collected, so ethical approval is not required. The study findings will be published and presented at relevant conferences.
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Affiliation(s)
- Rebecca L Jessup
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Allied Health, Northern Health, Melbourne, Victoria, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Polina Putrik
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kobi Rischin
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Janet Nezon
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheila Cyril
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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26
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Chiappini E, Bortone B, Borgi S, Sollai S, Matucci T, Galli L, de Martino M. Infectious Diseases in Internationally Adopted Children and Intercountry Discrepancies Among Screening Protocols, A Narrative Review. Front Pediatr 2019; 7:448. [PMID: 31788456 PMCID: PMC6853896 DOI: 10.3389/fped.2019.00448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
Internationally adopted children (IAC) require thorough health assessments at time of arrival in the host country. As these children are at higher risk for infectious diseases, such as gastrointestinal parasites, tuberculosis, hepatitis, syphilis, and human immunodeficiency virus, early diagnosis of infectious diseases is fundamental for the optimal management of the child and, also, to reduce the risk of transmission to the adopting community. Comparative analysis of the screening protocols adopted in Europe, the United States, and Canada revealed different approaches to the adopted children. A homogeneous and internationally shared standard of care in the management of IAC should be provided.
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Affiliation(s)
- Elena Chiappini
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Barbara Bortone
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Borgi
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Sara Sollai
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Tommaso Matucci
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Science, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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27
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Milinkovic DA, Birch S, Scott F, Newbold KB, Hopkins J, Saffie M, Essue BM. Low prioritization of latent tuberculosis infection-A systemic barrier to tuberculosis control: A qualitative study in Ontario, Canada. Int J Health Plann Manage 2018; 34:384-395. [PMID: 30402949 DOI: 10.1002/hpm.2670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Eliminating tuberculosis (TB) in low-incidence countries is an important global health priority, and Canada has committed to achieve this goal. The elimination of TB in low-incidence countries requires effective management and treatment of latent tuberculosis infection (LTBI). This study aimed to understand and describe the system-level barriers to LTBI treatment for immigrant populations in the Greater Toronto and Hamilton Area, Ontario, Canada. METHODS A qualitative study that used purposive sampling to recruit and interview health system advisors and planners (n = 10), providers (n = 13), and clients of LTBI health services (n = 9). Data were recorded, transcribed verbatim, and analyzed using content analysis. RESULTS Low prioritization of LTBI was an overarching theme that impacted four dimensions of LTBI care: management, service delivery, health literacy, and health care access. These factors explained, in part, inequities in the system that were linked to variations in health care quality and health care access. While some planners and providers at the local level were attempting to prioritize LTBI care, there was no clear pathway for information sharing. CONCLUSIONS This multiperspective study identified barriers beyond the typical socioeconomic determinants and highlighted important upstream factors that hinder treatment initiation and adherence. Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings.
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Affiliation(s)
- Deborah A Milinkovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Stephen Birch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia.,Centre for Health Economics, University of Manchester, Manchester, UK
| | - Fran Scott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - K Bruce Newbold
- School of Geography and Earth Sciences (SGES), McMaster University, Hamilton, Canada
| | - Jessica Hopkins
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Region of Peel Public Health, Mississauga, Canada
| | - Muntasir Saffie
- Division of Respirology, McMaster University, Hamilton, Canada
| | - Beverley M Essue
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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28
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Dobler CC, Fox GJ, Douglas P, Viney KA, Ahmad Khan F, Temesgen Z, Marais BJ. Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives. Eur Respir J 2018; 52:13993003.00591-2018. [PMID: 29794133 DOI: 10.1183/13993003.00591-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
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Affiliation(s)
- Claudia C Dobler
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Mayo Clinic Center for Tuberculosis, Rochester, MN, USA
| | - Greg J Fox
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Kerri A Viney
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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29
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How effective are approaches to migrant screening for infectious diseases in Europe? A systematic review. THE LANCET. INFECTIOUS DISEASES 2018; 18:e259-e271. [PMID: 29778396 DOI: 10.1016/s1473-3099(18)30117-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/26/2018] [Accepted: 02/06/2018] [Indexed: 12/20/2022]
Abstract
Rates of migration to Europe, and within Europe, have increased in recent years, with considerable implications for health systems. Migrants in Europe face a disproportionate burden of tuberculosis, HIV, and hepatitis B and C, yet experience a large number of barriers to accessing statutory health care on arrival. A better understanding of how to deliver effective and cost-effective screening, vaccination, and health services to this group is now crucial. We did a systematic review to document and assess the effectiveness and cost-effectiveness of approaches used for infectious diseases screening, and to explore facilitators and barriers experienced by migrants to accessing screening programmes. Following PRISMA guidelines, we searched Embase, PubMed, PsychINFO, the Cochrane Library, and Web of Science (1989 to July 1, 2015, updated on Jan 1, 2018), with no language restrictions, and systematically approached experts across the European Union (EU) for grey literature. Inclusion criteria were primary research studies assessing screening interventions for any infectious disease in the migrant (foreign-born) population residing in EU or European Economic Area (EEA) countries. Primary outcomes were the following effectiveness indicators: uptake of screening, coverage, infections detected, and treatment outcomes. Of 4112 unique records, 47 studies met our inclusion criteria, from ten European countries (Belgium, Denmark, France, Italy, the Netherlands, Norway, Spain, Sweden, Switzerland, and the UK) encompassing 248 402 migrants. We found that most European countries screening migrants focus on single diseases only-predominantly active or latent tuberculosis infection-and specifically target asylum seekers and refugees, with 22 studies reporting on other infections (including HIV and hepatitis B and C). An infection was detected in 3·74% (range 0·00-95·16) of migrants. Latent tuberculosis had the highest prevalence across all infections (median 15·02% [0·35-31·81]). Uptake of screening by migrants was high (median 79·50% [18·62-100·00]), particularly in primary health-care settings (uptake 96·77% [76·00-100·00]). However, in 24·62% (0·12-78·99) of migrants screening was not completed and a final diagnosis was not made. Pooled data highlight high treatment completion in migrants (83·79%, range 0·00-100·00), yet data were highly heterogeneous for this outcome, masking important disparities between studies and infections, with only 54·45% (35·71-72·27) of migrants with latent tuberculosis ultimately completing treatment after screening. Coverage of the migrant population in Europe is low (39·29% [14·53-92·50]). Data on cost-effectiveness were scarce, but suggest moderate to high cost-effectiveness of migrant screening programmes depending on migrant group and disease targeted. European countries have adopted a variety of approaches to screening migrants for infections; however, these are limited in scope to single diseases and a narrow subset of migrants, with low coverage. More emphasis must be placed on developing innovative and sustainable strategies to facilitate screening and treatment completion and improve health outcomes, encompassing multiple key infections with consideration given to a wider group of high-risk migrants. Policy makers and researchers involved with global migration need to ensure a longer-term view on improving health outcomes in migrant populations as they integrate into health systems in host countries.
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Mueller-Hermelink M, Kobbe R, Methling B, Rau C, Schulze-Sturm U, Auer I, Ahrens F, Brinkmann F. Universal screening for latent and active tuberculosis (TB) in asylum seeking children, Bochum and Hamburg, Germany, September 2015 to November 2016. Euro Surveill 2018; 23:17-00536. [PMID: 29589578 PMCID: PMC6205260 DOI: 10.2807/1560-7917.es.2018.23.12.17-00536] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundIn Germany, the incidence of tuberculosis (TB) in children has been on the rise since 2009. High numbers of foreign-born asylum seekers have contributed considerably to the disease burden. Therefore, effective screening strategies for latent TB infection (LTBI) and active TB in asylum seeking children are needed. Aim: Our aim was to investigate the prevalence of LTBI and active TB in asylum seeking children up to 15 years of age in two geographic regions in Germany. Methods: Screening for TB was performed in children in asylum seeker reception centres by tuberculin skin test (TST) or interferon gamma release assay (IGRA). Children with positive results were evaluated for active TB. Additionally, country of origin, sex, travel time, TB symptoms, TB contact and Bacille Calmette-Guérin (BCG) vaccination status were registered. Results: Of 968 screened children 66 (6.8%) had TB infection (58 LTBI, 8 active TB). LTBI prevalence was similar in children from high (Afghanistan) and low (Syria) incidence countries (8.7% vs 6.4%). There were no differences regarding sex, age or travel time between infected and non-infected children. Children under the age of 6 years were at higher risk of progression to active TB (19% vs 2% respectively, p=0,07). Most children (7/8) with active TB were asymptomatic at the time of diagnosis. None of the children had been knowingly exposed to TB. Conclusions: Asylum seeking children from high and low incidence countries are both at risk of developing LTBI or active TB. Universal TB screening for all asylum seeking children should be considered.
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Affiliation(s)
- Maya Mueller-Hermelink
- Altona Children’s Hospital, Department of Pulmonology, Hamburg, Germany,These authors contributed equally to this article
| | - Robin Kobbe
- These authors contributed equally to this article,University Medical Centre Hamburg-Eppendorf, Department of Pediatrics, Hamburg, Germany
| | - Benedikt Methling
- University Children`s Hospital Bochum- Germany, Department of Pulmonology, Bochum, Germany
| | - Cornelius Rau
- Altona Children’s Hospital, Department of Pulmonology, Hamburg, Germany
| | - Ulf Schulze-Sturm
- University Medical Centre Hamburg-Eppendorf, Department of Pediatrics, Hamburg, Germany
| | - Isa Auer
- German Red Cross, Chapter Hamburg-Harburg, Hamburg, Germany,Center of Applied Sciences of Health (CASH), Leuphana University, Lueneburg, Germany
| | - Frank Ahrens
- Altona Children’s Hospital, Department of Pulmonology, Hamburg, Germany
| | - Folke Brinkmann
- University Children`s Hospital Bochum- Germany, Department of Pulmonology, Bochum, Germany
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31
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Rendon A, Centis R, Zellweger JP, Solovic I, Torres-Duque C, Robalo Cordeiro C, de Queiroz Mello F, Manissero D, Sotgiu G. Migration, TB control and elimination: Whom to screen and treat. Pulmonology 2018; 24:99-105. [DOI: 10.1016/j.rppnen.2017.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023] Open
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Loutet MG, Burman M, Jayasekera N, Trathen D, Dart S, Kunst H, Zenner D. National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area. Eur Respir J 2018; 51:51/1/1701226. [PMID: 29326327 PMCID: PMC5898937 DOI: 10.1183/13993003.01226-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/06/2017] [Indexed: 12/18/2022]
Abstract
Latent tuberculosis infection (LTBI) screening is an important intervention for tuberculosis (TB) elimination in low-incidence countries and is, therefore, a key component of England's TB control strategy. This study describes outcomes from a LTBI screening programme in a high-incidence area to inform national LTBI screening in England and other low-incidence countries.We conducted a retrospective cohort study of LTBI screening among eligible migrants (from high-incidence countries and entered the UK within the last 5 years), who were identified at primary-care clinics in Newham, London between August 2014 and August 2015. Multivariable logistic regression was used to identify factors associated with LTBI testing uptake, interferon-γ release assay (IGRA) positivity and treatment uptake.40% of individuals offered LTBI screening received an IGRA test. The majority of individuals tested were 16-35 years old, male and born in India, Bangladesh or Pakistan. Country of birth, smoking status and co-morbidities were associated with LTBI testing uptake. IGRA positivity was 32% among those tested and was significantly associated with country of birth, age, sex and co-morbidities.This study identifies factors associated with screening uptake, IGRA positivity and treatment uptake, and improves understanding of groups that should be supported to increase acceptability of LTBI testing and treatment in the community.
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Affiliation(s)
| | - Matthew Burman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK.,Dept of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | | | - Susan Dart
- Dept of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK.,Dept of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Dominik Zenner
- National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK
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Abstract
Tuberculosis (TB) is a major global public health problem and is the leading cause of death linked to a single pathogen, ranking above human immunodeficiency virus (HIV).1 Clinically, TB has been categorised as active disease (patients who are generally symptomatic and may be infectious if pulmonary involvement is present) and latent infection (asymptomatic and not infectious, but at variable risk for progression to active TB disease). It is increasingly being recognised that latent TB infection (LTBI) reflects diverse responses to infection with Mycobacterium tuberculosis and may lead to heterogeneous clinical outcomes. In an expert interview, Jean-Pierre Zellweger discusses the latest World Health Organisation (WHO) guidelines on the management of LTBI.
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34
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Park JS. The Prevalence and Risk Factors of Latent Tuberculosis Infection among Health Care Workers Working in a Tertiary Hospital in South Korea. Tuberc Respir Dis (Seoul) 2018; 81:274-280. [PMID: 30238715 PMCID: PMC6148103 DOI: 10.4046/trd.2018.0020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/04/2018] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background The risk of tuberculosis (TB) infection among health care workers (HCWs) is higher than as noted among workers in the general population. The prevalence and risk factors of TB infection among HCWs were assessed in a tertiary hospital in South Korea, resulting in a conclusion of an intermediate TB burden within the country. Methods This cross-sectional study enrolled HCWs who underwent a QuantiFERON-TB Gold In-Tube (QFT-GIT) test to detect the presence of a latent TB infection (LTBI), in patients admitted to a tertiary hospital in South Korea in 2017. The departments of the hospital were divided into TB-related and TB-unrelated departments, which were based on the risk of exposure to TB patients. In this sense, the risk factors for LTBI, including current working in the TB-related departments, were analyzed. Results In this case, a total of 499 HCWs (54 doctors, 365 nurses and 80 paramedical personnel) were enrolled in this study. The median age of the subjects was 31 years (range, 20–67 years), 428 (85.8%) were female, and 208 (41.7%) were working in the TB-related departments. The prevalence of LTBI was 15.8% based on the QFT-GIT. Additionally, the prevalence of experience of exposure to pre-treatment TB patents was higher among HCWs working in the TB-related departments, than among HCWs working in the TB-unrelated departments (78.8% vs. 61.9%, p<0.001). However, there was no significant difference in the prevalence of LTBI between the two groups (17.3% vs. 14.8%, p=0.458). On a review of the multivariate analysis, only the factor of age was independently associated with an increased risk of LTBI (p=0.006). Conclusion Broadly speaking, the factor of age was associated with an increased risk of LTBI among the HCWs in South Korea. However, those workers current working in the TB-related departments was not associated with an increased risk of LTBI.
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Affiliation(s)
- Jae Seuk Park
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
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35
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Sánchez-Montalvá A, Salvador F, Molina-Morant D, Molina I. Tuberculosis and immigration. Enferm Infecc Microbiol Clin 2017; 36:446-455. [PMID: 29221825 DOI: 10.1016/j.eimc.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 11/20/2022]
Abstract
Tuberculosis continues to be a major public health problem in Spain. The incidence of tuberculosis in the native population has declined steadily in recent years. Migration flows have changed drastically since the beginning of the 21st century, with Spain becoming a recipient country for immigrants. Because most of the immigrants comes from countries with high incidence of tuberculosis, the contribution of the migrant population to new cases of tuberculosis is higher in relative terms than its weight in the total population. Tuberculosis programs must address the cultural, economic and medical aspects of the disease, and particularly target groups at risk, including the migrant population. In this paper, we will review the epidemiology and dynamics of tuberculosis in the migrant population, their differentiating clinical characteristics and the programmatic actions to address the problem.
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Affiliation(s)
- Adrián Sánchez-Montalvá
- Departamento de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Programa de Salud Internacional del ICS (PROSICS), Barcelona, España.
| | - Fernando Salvador
- Departamento de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Programa de Salud Internacional del ICS (PROSICS), Barcelona, España
| | - Daniel Molina-Morant
- Departamento de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Programa de Salud Internacional del ICS (PROSICS), Barcelona, España
| | - Israel Molina
- Departamento de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Programa de Salud Internacional del ICS (PROSICS), Barcelona, España
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Campbell JR, Johnston JC, Sadatsafavi M, Cook VJ, Elwood RK, Marra F. Cost-effectiveness of post-landing latent tuberculosis infection control strategies in new migrants to Canada. PLoS One 2017; 12:e0186778. [PMID: 29084227 PMCID: PMC5662173 DOI: 10.1371/journal.pone.0186778] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of tuberculosis in migrants to Canada occurs due to reactivation of latent TB infection. Risk of tuberculosis in those with latent tuberculosis infection can be significantly reduced with treatment. Presently, only 2.4% of new migrants are flagged for post-landing surveillance, which may include latent tuberculosis infection screening; no other migrants receive routine latent tuberculosis infection screening. To aid in reducing the tuberculosis burden in new migrants to Canada, we determined the cost-effectiveness of using different latent tuberculosis infection interventions in migrants under post-arrival surveillance and in all new migrants. METHODS A discrete event simulation model was developed that focused on a Canadian permanent resident cohort after arrival in Canada, utilizing a ten-year time horizon, healthcare system perspective, and 1.5% discount rate. Latent tuberculosis infection interventions were evaluated in the population under surveillance (N = 6100) and the total cohort (N = 260,600). In all evaluations, six different screening and treatment combinations were compared to the base case of tuberculin skin test screening followed by isoniazid treatment only in the population under surveillance. Quality adjusted life years, incident tuberculosis cases, and costs were recorded for each intervention and incremental cost-effectiveness ratios were calculated in relation to the base case. RESULTS In the population under surveillance (N = 6100), using an interferon-gamma release assay followed by rifampin was dominant compared to the base case, preventing 4.90 cases of tuberculosis, a 4.9% reduction, adding 4.0 quality adjusted life years, and saving $353,013 over the ensuing ten-years. Latent tuberculosis infection screening in the total population (N = 260,600) was not cost-effective when compared to the base case, however could potentially prevent 21.8% of incident tuberculosis cases. CONCLUSIONS Screening new migrants under surveillance with an interferon-gamma release assay and treating with rifampin is cost saving, but will not significantly impact TB incidence. Universal latent tuberculosis infection screening and treatment is cost-prohibitive. Research into using risk factors to target screening post-landing may provide alternate solutions.
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Affiliation(s)
- Jonathon R. Campbell
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - James C. Johnston
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria J. Cook
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - R. Kevin Elwood
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Chernet A, Utzinger J, Sydow V, Probst-Hensch N, Paris DH, Labhardt ND, Neumayr A. Prevalence rates of six selected infectious diseases among African migrants and refugees: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2017; 37:605-619. [PMID: 29080108 DOI: 10.1007/s10096-017-3126-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/16/2017] [Indexed: 12/27/2022]
Abstract
The objective of this paper was to systematically review the literature on the prevalence of selected infectious diseases among migrants/refugees of African origin and to provide policy makers and health care professionals with evidence-based information. We pursued a systematic review and meta-analysis to determine the prevalence of six selected infectious diseases (i.e., syphilis, helminthiasis, schistosomiasis, intestinal protozoa infections, hepatitis B, and hepatitis C) among migrants/refugees of African origin. Three electronic databases (i.e., PubMed, EMBASE, and ISI Web of Science) were searched without language restrictions. Relevant data were extracted and random-effects meta-analyses conducted. Only adjusted estimates were analyzed to help account for heterogeneity and potential confounding. We assessed the quality of evidence using the GRADE approach. The results were stratified by geographical region. Ninety-six studies were included. The evidence was of low quality due to the small numbers of countries, infectious diseases, and participants included. African migrants/refugees had median (with 95% confidence interval [95% CI]) prevalence for syphilis, helminthiasis, schistosomiasis, intestinal protozoa infection, hepatitis B, and hepatitis C of 6.0% [95% CI: 2.0-7.0%], 13.0% [95% CI: 9.5-14.5%], 14.0% [95% CI: 13.0-17.0%], 15.0% [95% CI: 10.5-21.0%], 10.0% [95% CI: 6.0-14.0%], and 3.0% [95% CI: 1.0-4.0%], respectively. We found high heterogeneity regardless of the disease (I 2; minimum 97.5%, maximum 99.7%). The relatively high prevalence of some infectious diseases among African migrants/refugees warrants for systematic screening. The large heterogeneity of the available published data does not allow for stratifying such screening programs according to the geographical origin of African migrants/refugees.
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Affiliation(s)
- A Chernet
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - J Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - V Sydow
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N Probst-Hensch
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - D H Paris
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - N D Labhardt
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Disease and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A Neumayr
- Swiss Tropical and Public Health Institute, P.O. Box CH-4002, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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Maltezou HC, Elhadad D, Glikman D. Monitoring and managing antibiotic resistance in refugee children. Expert Rev Anti Infect Ther 2017; 15:1015-1025. [PMID: 29027495 DOI: 10.1080/14787210.2017.1392853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The past decade the Middle East and Southeastern Europe have witnessed an enormous movement of refugees due to the Syrian war and conflicts in Asia and Africa. Although carriage of and infections with multi-drug resistant (MDR) pathogens in refugees have been reported, pediatric data are scarce. Areas covered: MDR bacterial carriage and infections, and MDR-tuberculosis (TB) in refugee children from 2010. Expert commentary: High MDR carriage rates in refugee children are attributed to high pre-civil war MDR rates, war-damaged infrastructure and healthcare systems, and poor hygiene conditions. Currently there are no international guidelines about MDR screening in refugee children. Given the medical importance of MDRs, challenging therapeutics and risk of importation in non/low-endemic countries, we recommend routine screening and contact isolation upon hospitalization of refugees. TB, including MDR-TB, is highly-endemic in many Asian and African countries, however, current data in refugee children are lacking. TB Screening in refugees is widely implemented but there is no consensus on methods and target populations. Coordinated TB detection and treatment, use of rapid molecular tests and drug-susceptibility testing, better access to healthcare, cross border TB care collaboration, and protection from deportation while on treatment should be integrated parts of TB control and prevention.
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Affiliation(s)
- Helena C Maltezou
- a Department for Interventions in Health Care Facilities , Hellenic Center for Disease Control and Prevention , Athens , Greece
| | - Dana Elhadad
- b The Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel
| | - Daniel Glikman
- b The Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel.,c Pediatric Infectious Diseases Unit , Galilee Medical Center , Nahariya , Israel
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Pavli A, Maltezou H. Health problems of newly arrived migrants and refugees in Europe. J Travel Med 2017; 24:3095987. [PMID: 28426115 DOI: 10.1093/jtm/tax016] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of migrants and refugees in Europe in the past few years has increased dramatically due to war, violence or prosecutions in their homeland. Migration may affect physical, mental and social health. The objective of this article is to assess migrants and refugees' health problems, and to recommend appropriate interventions. METHODS A PubMed search of published articles on health problems of newly arrived migrants and refugees was conducted from 2003 through 2016, focusing on the current refugee crisis in Europe. RESULTS In addition to communicable diseases, such as respiratory, gastrointestinal and dermatologic infections, non-communicable diseases, including chronic conditions, mental and social problems, account for a significant morbidity burden in newly arrived migrants and refugees. Vaccine-preventable diseases are also of outmost importance. The appropriate management of newly arrived refugees and migrants' health problems is affected by barriers to access to health care including legal, communication, cultural and bureaucratic difficulties. There is diversity and lack of integration regarding health care provision across Europe due to policy differences between health care systems and social services. CONCLUSION There is a notable burden of communicable and non-communicable diseases among newly arrived migrants and refugees. Provision of health care at reception and temporary centres should be integrated and provided by a multidisciplinary team Appropriate health care of migrants and refugees could greatly enhance their health and social status which will benefit also the host countries at large.
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Affiliation(s)
- Androula Pavli
- Travel Medicine Office, Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Marousi, Greece
| | - Helena Maltezou
- Travel Medicine Office, Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Marousi, Greece
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Herzmann C, Golakov M, Malekzada F, Lonnroth K, Kranzer K. Radiological screening of refugees in Germany. Eur Respir J 2017; 49:49/5/1602487. [PMID: 28546271 DOI: 10.1183/13993003.02487-2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/01/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Manja Golakov
- University of Lübeck, Medical Faculty, Lübeck, Germany
| | | | - Knut Lonnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland.,Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Kranzer
- Research Center Borstel, National Reference Center for Mycobacteria, Borstel, Germany
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41
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LoBue PA, Mermin JH. Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA. THE LANCET. INFECTIOUS DISEASES 2017; 17:e327-e333. [PMID: 28495525 DOI: 10.1016/s1473-3099(17)30248-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
Abstract
Since 1989, the USA has been pursuing the goal of tuberculosis elimination. After substantial progress during the past two decades, the rate of tuberculosis cases in the USA each year has now levelled off and remains well above the elimination threshold. Both epidemiological data and modelling underline the necessity of addressing latent tuberculosis infection if further progress is to be made in eliminating the disease. In this Personal View we explore next steps towards elimination. Given the estimated prevalence of latent tuberculosis infection, compared with the limited testing and treatment that currently occur, a major new effort is required. This effort should consist of a surveillance system or registry to monitor progress, scale-up of targeted testing for latent tuberculosis infection in at-risk populations, scale-up of short-course treatment regimens, engagement of affected communities and medical providers who serve those communities, and increased public health staffing for implementation and oversight. Such an effort would benefit greatly from the development of new tools, such as tests that better indicate reactivation risk, and even shorter latent tuberculosis infection treatment regimens than currently exist.
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Affiliation(s)
- Philip A LoBue
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jonathan H Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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de Vries G, van Hest R, Bakker M, Erkens C, van den Hof S, Meijer W, Oud K, Slump E, van Dissel J. Policy and practice of programmatic management of latent tuberculosis infection in The Netherlands. J Clin Tuberc Other Mycobact Dis 2017; 7:40-48. [PMID: 31723700 PMCID: PMC6850226 DOI: 10.1016/j.jctube.2017.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 01/09/2023] Open
Abstract
Latent tuberculosis infection (LTBI) screening and preventive treatment is one of the components of the World Health Organization (WHO) End TB strategy, and particularly relevant for low tuberculosis (TB) incidence countries, i.e. less than 100 TB cases per million population. The Netherlands is such a low-incidence country with traditionally a strong emphasis on programmatic management of LTBI, e.g. examining contacts of infectious TB patients by the public health services. Increasingly, curative services are involved in LTBI management of clinical risk groups. The country recently adopted a five-year strategic national plan recommending LTBI screening of high-risk migrants populations. A monitoring and evaluation system is already in place to measure programme performance and guide policy. Research on LTBI screening of migrants is on-going and results should inform future decisions in scaling-up this intervention. Several challenges remain for programmatic LTBI management, such as securing financial resources and the right professional cadre for implementation; availability of screening tests and drugs; collecting additional data for monitoring and evaluation, in line with the WHO indicators for LTBI programmatic management; developing cultural-sensitive and client-centred education for migrants; reducing patient costs for LTBI screening and preventive treatment; and assessing cost-effectiveness and impact on TB epidemiology.
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Affiliation(s)
- Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rob van Hest
- Department of Tuberculosis Control, Municipal Public Health Service Groningen, Groningen, The Netherlands.,Department of Tuberculosis Control, Municipal Public Health Service Frŷslan, Leeuwarden, The Netherlands
| | - Marleen Bakker
- Pulmonology Department, Erasmus MC, Rotterdam, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands.,Amsterdam Institute for Global Health and Development and Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Wieneke Meijer
- Department of Tuberculosis Control, Municipal Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Karen Oud
- Pulmonology Department, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Erika Slump
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jaap van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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43
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Spinicci M, Zammarchi L, Bartoloni A. Tuberculosis in the Mediterranean Region. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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Sotgiu G, Dara M, Centis R, Matteelli A, Solovic I, Gratziou C, Rendon A, Battista Migliori G. Breaking the barriers: Migrants and tuberculosis. Presse Med 2017; 46:e5-e11. [PMID: 28256381 DOI: 10.1016/j.lpm.2017.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
Tuberculosis (TB) can represent an important clinical and public health in developing and developed countries. Low- and middle-income countries are facing an epidemic which is difficult to address because of the drug-resistance spread and the association of TB with HIV/AIDS. High-income countries, whose TB incidence has decreased in the last decades, can be involved in new TB epidemic waves owing to social, healthcare, and economic hurdles and challenges. In particular, migrants coming from high TB incidence countries can represent a new epidemiological issue in the TB care and control in geographical areas where primary care and specialized centres are not equipped to face the clinical and public health issues associated with the TB disease. The healthcare management of individuals with a latent TB infection or the TB disease is heterogeneous and different policies are in place in Europe, and, specifically, in EU countries. Scientific evidence on how to early and efficiently detect TB cases is missing, as well as diagnostic tools to diagnose those who have latent TB infection do not show adequate accuracy. Countries like Greece and Italy have political difficulties in the management of migrants and the poor living conditions in the migration centres can increase the probability of Mycobacterium tuberculosis transmission. A clear advocacy and political commitment are urgently required. The current migration trends represent a threat from a human and a healthcare perspective. New homogeneous and target-oriented policies and strategies are needed to improve the health of the migrant and of the autochthonous populations.
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Affiliation(s)
- Giovanni Sotgiu
- University of Sassari, Department of Biomedical Sciences, Clinical Epidemiology and Medical Statistics Unit, Sassari, Italy
| | - Masoud Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Rosella Centis
- Maugeri Care and Research Institute, IRCCS, World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy
| | - Alberto Matteelli
- University of Brescia, WHO Collaborating Centre for TB/HIV and TB elimination, Department of Infectious and Tropical Diseases, Piazzale Spedali Civili, 1, 25123 Brescia, Italy
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia
| | - Christina Gratziou
- Evgenidio Hospital, University Respiratory Medicine Unit, Athens, Greece
| | - Adrian Rendon
- University Hospital of Monterrey, Center for Research, Prevention and Treatment of Respiratory Infections, Monterrey, Mexico
| | - Giovanni Battista Migliori
- Maugeri Care and Research Institute, IRCCS, World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy.
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Arrazola de Oñate W, Weber L, Janssens K, Wanlin M, Forier A, Schol S, van Egmond K. Tuberculosis screening yield of asylum seekers in Europe. Eur Respir J 2016; 48:1253-1254. [DOI: 10.1183/13993003.00991-2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/16/2016] [Indexed: 11/05/2022]
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46
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Infectious Diseases in Refugee Children: To Screen or Not to Screen. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Cruz AT, Starke JR. Managing tuberculosis infection in children in the USA: an update. Future Microbiol 2016; 11:669-84. [PMID: 27164182 DOI: 10.2217/fmb-2016-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The rate of tuberculosis (TB) disease has steadily declined in the last two decades in the USA, and over two-thirds of all cases now occur in foreign-born persons. Further declines in the incidence of TB will be most impacted by identifying and treating persons with TB infection. However, difficulties in accessing care, poor specificity of diagnostic tests and long courses of therapy historically have led to suboptimal screening of groups at high risk for infection, false-positive test results from cross-reaction with the bacille Calmette-Guérin vaccine and low treatment completion rates, respectively. This article reviews newer testing and treatment strategies for TB infection emphasizing risk and benefits of testing and treating.
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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48
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van der Werf MJ, Zellweger JP. Impact of migration on tuberculosis epidemiology and control in the EU/EEA. Euro Surveill 2016; 21:30174. [DOI: 10.2807/1560-7917.es.2016.21.12.30174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/23/2016] [Indexed: 11/20/2022] Open
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49
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Pareek M, Greenaway C, Noori T, Munoz J, Zenner D. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review. BMC Med 2016; 14:48. [PMID: 27004556 PMCID: PMC4804514 DOI: 10.1186/s12916-016-0595-5] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/08/2016] [Indexed: 02/08/2023] Open
Abstract
Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.
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Affiliation(s)
- Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. .,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Christina Greenaway
- Division of Infectious Diseases and Department of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jose Munoz
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Dominik Zenner
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.,Centre for Infectious Disease Epidemiology, University College London, London, UK
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