PLoS ONE
Volume 14, Issue 5, 2019

Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany (Article) (Open Access)

Thee S.* , Krüger R. , von Bernuth H. , Meisel C. , Kölsch U. , Kirchberger V. , Feiterna-Sperling C.
  • a Department of Pediatrics, Division of Pneumonology and Immunology with Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany
  • b Department of Pediatrics, Division of Pneumonology and Immunology with Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany
  • c Department of Pediatrics, Division of Pneumonology and Immunology with Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany, Department of Immunology, Labor Berlin, Charité Vivantes GmbH, Berlin, Germany, Berlin Center of Regenerative Therapies, Charité Universitätsmedizin, Berlin, Germany
  • d Department of Immunology, Labor Berlin, Charité Vivantes GmbH, Berlin, Germany
  • e Department of Immunology, Labor Berlin, Charité Vivantes GmbH, Berlin, Germany
  • f Department of Pediatrics, Division of Pneumonology and Immunology with Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany
  • g Department of Pediatrics, Division of Pneumonology and Immunology with Intensive Medicine, Charité Universitätsmedizin, Berlin, Germany

Abstract

Introduction In 2015, 4062 unaccompanied minor refugees were registered in Berlin, Germany. According to national policies, basic clinical examination and tuberculosis (TB) screening is a prerequisite to admission to permanent accommodation and schooling for every refugee. This article evaluates the use of an interferon-γ-release-assay (IGRA) during the initial examination and TB screening of 970 unaccompanied minor refugees. Results IGRA test were obtained during TB screening for 301 (31.0%) of 970 adolescents not previously screened for TB. Positive IGRA results were obtained in 13.9% (42/301). Most of the 42 IGRA-positive refugees originated from Afghanistan or Syria (n?20 and 10 respectively). Two IGRA-positive adolescents were lost to follow-up, 2 were diagnosed with TB and the remaining 38 diagnosed with latent TB infection (LTBI). Demographic features of the 40 patients with positive IGRA result were as follows: 39 male, median age 16.8 years (IQR 16.0–17.2y), none meeting underweight criteria (median BMI 21.3kg/m2). On initial chest X-ray 2/40 participants had signs of active TB, while in 38 active disease was excluded and the diagnosis of latent TB infection (LTBI) made. Active hepatitis B-co-infection was diagnosed in 3/38 patients. All patients with LTBI received Isoniazid and Rifampicin for 3 months without occurrence of severe adverse events. The most frequently observed side effect was transient upper abdominal pain (n = 5). Asymptomatic elevation of liver transaminases was seen in 2 patients. 29 patients completed treatment with no signs of TB disease at the end of chemoprevention and 9 were lost to follow up. Conclusion Screening for TB infection in minor refugees was feasible in our setting with a relatively high rate of TB infection detected. Chemopreventive treatment was tolerated well regardless of underlying hepatitis-B-status. Minor refugees migrating to Germany should be screened for TB infection, instead of TB disease only, regardless of the background TB incidence. © 2019 Thee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Keywords

[No Keywords available]

Index Keywords

Afghanistan patient monitoring Germany refugee virus DNA hemoglobin blood level Syrian Arab Republic follow up human interferon gamma release assay alopecia lung calcification entecavir upper abdominal pain stomach discomfort body weight loss Iran screening aminotransferase patient counseling disease surveillance tuberculous lymphadenitis Lebanon treatment duration anemia lung tuberculosis Adolescent male latent tuberculosis female tuberculosis Article feasibility study minor (person) patient compliance major clinical study isoniazid drug tolerability pleura effusion coughing thorax radiography virus load drug monitoring asymptomatic disease hemoglobin cohort analysis chemoprophylaxis hepatitis B body mass rifampicin Fatigue mixed infection hepatitis C
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85065995437&doi=10.1371%2fjournal.pone.0216234&partnerID=40&md5=f6fe525635a4044e22562f6f02f9a028
DOI: 10.1371/journal.pone.0216234
ISSN: 19326203
Original Language: English