The Lancet Infectious Diseases
Volume 17, Issue 7, 2017, Pages 770-779

Post-migration follow-up of migrants identified to be at increased risk of developing tuberculosis at pre-migration screening: a systematic review and meta-analysis (Article)

Chan I.H.Y. , Kaushik N. , Dobler C.C.*
  • a Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  • b Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  • c Department of Respiratory Medicine, Liverpool Hospital, Liverpool, Sydney, NSW, Australia, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

Abstract

Background Post-migration follow-up of migrants considered at increased risk of developing tuberculosis based on pre-migration screening abnormalities (high-risk migrants) is implemented in several low-incidence countries. We aimed to determine the rate of tuberculosis in this population to inform cross-border tuberculosis control policies. Methods We searched MEDLINE and Embase (since inception to Jan 12, 2017) for studies evaluating post-migration follow-up of high-risk migrants. Outcomes evaluated were the number of tuberculosis cases occurring post-migration, expressed as the tuberculosis incidence per 100 000 person-years of follow-up, as cumulative incidence of tuberculosis per 100 000 persons, and the cumulative incidence of tuberculosis at the first post-migration follow-up visit. Random-effects models were used to summarise outcomes across studies. Findings We identified 20 publications (describing 23 study cohorts) reporting the pre-migration screening outcomes of 8 355 030 migrants processed between Jan 1, 1981, and May 1, 2014, with 222 375 high-risk migrants identified. The pooled cumulative incidence of tuberculosis post-migration in our study population from 22 cohorts was 2794 per 100 000 persons (95% CI 2179–3409; I2=99%). The pooled cumulative incidence of tuberculosis at the first follow-up visit from ten cohorts was 3284 per 100 000 persons (95% CI 2173–4395; I2=99%). The pooled tuberculosis incidence from 15 cohorts was 1249 per 100 000 person-years of follow-up (95% CI 924-1574; I2=98%). Interpretation The high rate of tuberculosis in high-risk migrants suggests that tuberculosis control measures in this population, including more sensitive pre-migration screening, preventive treatment of latent tuberculosis infection, or post-migration follow-up, are potentially effective cross-border tuberculosis control strategies in low-incidence countries. Funding Australian National Health and Medical Research Council. © 2017 Elsevier Ltd

Author Keywords

[No Keywords available]

Index Keywords

Australia health care policy Follow-Up Studies follow up human infection rate priority journal screening Humans migrant tuberculosis risk factor Risk Factors high risk population Incidence Article meta analysis (topic) migration tuberculosis control cohort analysis Emigration and Immigration Transients and Migrants systematic review
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85017469105&doi=10.1016%2fS1473-3099%2817%2930194-9&partnerID=40&md5=07658ada8ecd94c2456b696c7d4366ec
DOI: 10.1016/S1473-3099(17)30194-9
ISSN: 14733099
Cited by: 16
Original Language: English