Abstract
Migrants arriving from high tuberculosis (TB)-incidence countries may pose a significant challenge to TB control programmes in the host country. TB surveillance data for 2007-2013 submitted to the European Surveillance System were analysed. Notified TB cases were stratified by origin and reporting country. The contribution of migrant TB cases to the TB epidemiology in EU/EEA countries was analysed. Migrant TB cases accounted for 17.4% (n = 92,039) of all TB cases reported in the EU/EEA in 2007-2013, continuously increasing from 13.6% in 2007 to 21.8% in 2013. Of 91,925 migrant cases with known country of origin, 29.3% were from the Eastern Mediterranean, 23.0% from south-east Asia, 21.4% from Africa, 13.4% from the World Health Organization European Region (excluding EU/EEA), and 12.9% from other regions. Of 46,499 migrant cases with known drug-susceptibility test results, 2.9% had multidrug-resistant TB, mainly (51.7%) originating from the European Region. The increasing contribution of TB in migrants from outside the EU/EEA to the TB burden in the EU/EEA is mainly due to a decrease in native TB cases. Especially in countries with a high proportion of TB cases in non-EU/EEA migrants, targeted prevention and control initiatives may be needed to progress towards TB elimination.
Highlights
The tuberculosis (TB) notification rate in the European Union and European Economic Area (EU/EEA) declined from 16.8 per 100,000 population in 2007 to 12.7 per 100,000 in 2013 [1]
Of 527,467 TB cases notified in the EU/EEA from 2007 to 2013, 399,613 (75.8%) were reported as originating from EU/EEA countries, 92,039 (17.4%) as originating from non-EU/EEA countries, and for 35,815 (6.8%), country of origin was not reported
The proportion of TB cases with reported non-EU/EEA origin increased from 13.6% (n = 11,403) in 2007 to 21.8% (n = 14,050) in 2013, the proportion of TB cases with reported EU/EEA origin decreased from 77.8% (n = 65,390) in 2007 to 73.4% (n = 47,185) in 2013, while the proportion of TB cases with unknown or unspecified origin decreased from 8.6% (n = 7,221) to 4.8% (n = 3,092) in the same period (p < 0.001) (Figure 1)
Summary
The tuberculosis (TB) notification rate in the European Union and European Economic Area (EU/EEA) declined from 16.8 per 100,000 population in 2007 to 12.7 per 100,000 in 2013 [1]. In some low-incidence countries, the decline in TB notification rate has slowed down, especially in countries reporting a high proportion of TB cases in individuals of foreign origin, i.e. migrants. A considerable proportion of these migrants are coming from countries with a high TB burden such as Bangladesh, Brazil, China, India, Morocco, Pakistan, Russian Federation, Somalia and Ukraine [5]. They may arrive in the EU/EEA with active TB disease, or with latent TB infection (LTBI). To detect TB disease in migrants, several EU/EEA countries have introduced (pre-)entry screening programmes [6,7,8]. Migrants frequently travel back to their country of origin where they may be (re-) infected with TB [10]
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