International Journal of Tuberculosis and Lung Disease
Volume 21, Issue 6, 2017, Pages 624-636

Tuberculosis in migrants in low-incidence countries: Epidemiology and intervention entry points (Article)

Lonnroth K.* , Mor Z. , Erkens C. , Bruchfeld J. , Nathavitharana R.R. , Van Der Werf M.J. , Lange C.
  • a Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, 171 77, Sweden
  • b Research Branch, Tel Aviv Department of Health, Tel Aviv, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • c KNCV Tuberculosis Foundation, The Hague, Netherlands
  • d Unit of Infectious Diseases, Department of Medicine Solna, Sweden, Department of Infectious Diseases Karolinska, University Hospital, Stockholm, Sweden
  • e Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States, Division of Infectious Diseases and Immunity, Imperial College, London, United Kingdom
  • f European Centre for Disease Prevention and Control, Stockholm, Sweden
  • g Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany, International Health/Infectious Diseases, University of Lubeck, Lubeck, Germany, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Internal Medicine, University of Namibia, School of Medicine, Windhoek, Namibia

Abstract

As tuberculosis (TB) rates continue to decline in native populations in most low TB incidence countries, the proportion of TB patients born outside their country of residence ('foreign-born') increases. Some low-incidence countries have experienced a substantial increase in TB rates related to recent increases in the number of asylum seekers and other migrants from TB-endemic countries. However, average TB rates among the foreign-born in low-incidence countries declined moderately in 2009' 2015. TB in foreign-born individuals is commonly the result of reactivation of latent infection with Mycobacterium tuberculosis acquired outside the host country. Transmission is generally low in low-incidence countries, and transmission from migrants to the native population is often modest. Variations in levels and trends in TB notifications among the foreign-born are likely explained by differences and fluctuations in the number and profile of migrants, as well as by variations in TB control, health and social policies in the host countries. To optimise TB care and prevention in migrants from endemic to low-incidence countries, we propose a framework for identifying possible TB care and prevention interventions before, during and after migration. Universal access to high-quality care along the entire migration pathway is critical. Screening for active TB and latent tuberculous infection should be tailored to the TB epidemiology, adapted to the needs of specific migrant groups and linked to treatment. Ultimately, the long-term TB elimination goal can be reached only if global health and socio-economic inequalities are dramatically reduced. Low-incidence countries, most of which are among the wealthiest nations, need to contribute through international assistance. © 2017 The Union.

Author Keywords

Migration Asylum seekers tuberculosis Epidemiology policy

Index Keywords

bacterial transmission refugee postprimary tuberculosis mass screening Human Migration health care policy health insurance human Refugees comorbidity travel statistics and numerical data health service priority journal Mycobacterium tuberculosis procedures Health Services Needs and Demand screening asylum seeker Humans migrant latent tuberculosis tuberculosis BCG vaccination socioeconomics stigma isolation and purification Incidence Article Disease Notification migration disease elimination health care access global health endemic disease tuberculosis control Health Policy Transients and Migrants Health Services Accessibility health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018917857&doi=10.5588%2fijtld.16.0845&partnerID=40&md5=010ce4e96310da01e25841c730b6f81f
DOI: 10.5588/ijtld.16.0845
ISSN: 10273719
Cited by: 34
Original Language: English