Consequences of tuberculosis among asylum seekers for health care workers in Germany.

Roland Diel,Albert Nienhaus,Robert Loddenkemper

doi:10.1186/s12995-016-0093-x

Abstract

BackgroundImmigrants have been contributing to the incidence of tuberculosis (TB) in Germany for many years. The current wave of migration of asylum seekers to Germany may increase that figure. Healthcare workers (HCW) who look after refugees not only in hospitals and medical practices but also in aid projects may be exposed to cases of TB.MethodsThe incremental TB cases arising from imported TB as well as from TB cases that developed later in refugees were calculated in a Markov model over a period of 5 years. Infectious and non-infectious susceptible TB and multidrug-resistant TB (MDR-TB) cases were determined separately. In addition, the total amount of latent TB in contact persons and the risk of infection by HCW were estimated. Due to uncertainty of future refugee flows to Europe, different scenarios were considered in univariate and multivariate sensitivity analysis.ResultsAssuming a decrease in immigration by half each year to the bottom line of 2014, and in light of the current number of 800,000 asylum seekers, we calculated an additional 10,090 TB cases by the end of the fifth year (5976 cases of infectious pulmonary TB and 143 cases of pulmonary MDR-TB). In case of an unchanging influx of asylum seekers over the 5-year period, 19,031 TB cases would arise, 377 of which infectious MDR-TB. Eighty -seven ensuing TB cases would develop in HCW in the same period, 3 of which MDR-TB cases.ConclusionsAlthough the total number of TB cases in HCW expected to ensue from the current influx of asylum seekers is rather small, the 3 MDR-TB cases we calculated have to be taken seriously. We consider it essential to increase awareness of protective measures such as respiratory masks and, in the event of documented exposure, of supply-oriented occupational health screening.

Highlights

Immigrants have been contributing to the incidence of tuberculosis (TB) in Germany for many years
Transmission of TB from immigrants to persons born in Germany is statistically rare [3], but with the expected arrival of TB disease with refugees the incidence of TB infections leading to illness can be expected to rise among healthcare workers (HCW), who are often the first point of contact with immigrants and most exposed
There are three different scenarios taken into consideration: The base analysis shows 10,090 cases of tuberculosis by the end of the fifth year, of which 5976 are cases of infectious drug-susceptible pulmonary TB and 143 are cases of infectious pulmonary multidrug-resistant TB (MDR-TB)

Summary

Introduction

Immigrants have been contributing to the incidence of tuberculosis (TB) in Germany for many years. Is there a comparatively high frequency among first-generation immigrants, but a cross-sectional study conducted in 2012 in Berlin found TB incidence in the second. Many of these asylum seekers arrive after a dangerous journey on which they have suffered hunger, exposure, overcrowded accommodation and intolerable sanitary. Transmission of TB from immigrants to persons born in Germany is statistically rare [3], but with the expected arrival of TB disease with refugees the incidence of TB infections leading to illness can be expected to rise among healthcare workers (HCW), who are often the first point of contact with immigrants and most exposed. This study models the possible development over the 5 years and discusses the associated consequences

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