Recent Travel and Tuberculosis in Migrants: Data From a Low-Incidence Country.
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ABSTRACT:
SUBMITTER: Schwalb A
PROVIDER: S-EPMC10954334 | biostudies-literature | 2024 Mar
REPOSITORIES: biostudies-literature
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Recent Travel and Tuberculosis in Migrants: Data From a Low-Incidence Country.
Schwalb Alvaro A Kayumba Kumvana K Houben Rein M G J RMGJ Bothamley Graham H GH
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20240301 3
Tuberculosis (TB) incidence rates among migrants are higher than those in low-incidence countries. We evaluated smear-positive, pulmonary TB notifications of foreign-born individuals, comparing time since arrival and time since last return travel to the country of origin. TB incidence suggests a time course consistent with recent infection during travel. ...[more]
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Project description:BackgroundAs tuberculosis (TB) incidence rates decrease faster in native than migrant populations in European countries, addressing migrant health becomes increasingly important in TB programmes.AimTo inform European TB prevention and control policies, we analysed data on TB in migrants in low TB-incidence European countries (TB incidence < 10/100,000 population) during 2014-2020 by migrant origin, destination, and recent vs non-recent immigration.MethodsData on migrant TB patients were derived from the European Surveillance System (TESSy) and data on migrant populations from Eurostat or national statistical offices. We calculated annual migrant TB crude incidence rates (CIRs) per country of origin, destination country and year, for all migrants with TB and recently arrived migrants with TB, the latter defined by TB diagnosis within 1 year after arrival in the destination country.ResultsIn 2014-2020, 104,371 migrants with TB were reported to TESSy by 20 destination countries. Average annual migrant CIRs were highest in the United Kingdom (43/100,000). Origin countries of most migrant TB patients were India (n = 9,561), Romania (n = 8,345), and Pakistan (n = 7,300). The highest CIRs were found among migrants from Eritrea (480/100,000), Somalia (414/100,000) and The Gambia (343/100,000), and were higher than estimated World Health Organization incidences for those countries. The CIRs among recently arrived migrants appeared higher than in the overall migrant population.ConclusionsWe found substantially higher CIRs in certain migrant subpopulations than others. TB rates in recent migrants appeared to be up to 11 times higher than in corresponding origin countries. Tailored and regularly adapted TB prevention and control strategies are needed.
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Project description:Immigrants from regions with a high incidence of tuberculosis (TB) are a risk group for TB in low-incidence countries such as Switzerland. In a previous analysis of a nationwide collection of 520 Mycobacterium tuberculosis isolates from 2000 to 2008, we identified 35 clusters comprising 90 patients based on standard genotyping (24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat [MIRU-VNTR] typing and spoligotyping). Here, we used whole-genome sequencing (WGS) to revisit these transmission clusters. Genome-based transmission clusters were defined as isolate pairs separated by ≤12 single nucleotide polymorphisms (SNPs). WGS confirmed 17/35 (49%) MIRU-VNTR typing clusters; the other 18 clusters contained pairs separated by >12 SNPs. Most transmission clusters (3/4) of Swiss-born patients were confirmed by WGS, as opposed to 25% (4/16) of the clusters involving only foreign-born patients. The overall clustering proportion was 17% (90 patients; 95% confidence interval [CI], 14 to 21%) by standard genotyping but only 8% (43 patients; 95% CI, 6 to 11%) by WGS. The clustering proportion was 17% (67/401; 95% CI, 13 to 21%) by standard genotyping and 7% (26/401; 95% CI, 4 to 9%) by WGS among foreign-born patients and 19% (23/119; 95% CI, 13 to 28%) and 14% (17/119; 95% CI, 9 to 22%), respectively, among Swiss-born patients. Using weighted logistic regression, we found weak evidence of an association between birth origin and transmission (adjusted odds ratio of 2.2 and 95% CI of 0.9 to 5.5 comparing Swiss-born patients to others). In conclusion, standard genotyping overestimated recent TB transmission in Switzerland compared to WGS, particularly among immigrants from regions with a high TB incidence, where genetically closely related strains often predominate. We recommend the use of WGS to identify transmission clusters in settings with a low incidence of TB.
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Project description:BackgroundIn Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS).Methods and findingsAll patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000-2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000-2008 was 146 (95% CI 122-173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P?=?0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P?=?0.023).ConclusionsThe clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.
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Project description: Not available
| S-EPMC1123776 | biostudies-literature
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