Ongoing tuberculosis transmission among second-generation Ethiopian immigrants.

H Bishara,D Chemtob,L Zelikman,M Green,D Weiler-Ravell,A Saffouri

doi:10.1017/s0950268820001715

Abstract

Despite considerable efforts to control tuberculosis (TB) among Ethiopian immigrants in Israel, an outbreak of TB among second-generation Ethiopian immigrants that involved native Israelis occurred between January 2011 and December 2019. The aim of this article is to report on this outbreak and discuss the patient and health system barriers that led to its propagation. Overall, 13 culture-positive TB patients were diagnosed in this outbreak. An additional 36 cases with identical mycobacterium tuberculosis genotypes were identified through cross-checking with the National TB Laboratory Registry. Among the 32 close contacts of the index case, 18 (56.3%) reported for screening and treatment of latent TB infection (LTBI) was recommended for 11 (61.1%) of them. However, none completed treatment and eight eventually developed TB. Of the 385 close contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) were recommended LTBI treatment, but only 26 (16.9%) completed the treatment. Routine contact investigation and treatment practice measures failed to contain the cascade of infection and disease, leading to the spread of the infecting strain of TB. This report highlights the challenges to identify the high-risk group and address barriers to care among such a vulnerable population.

Highlights

During the last three decades, Ethiopians of Jewish descent immigrated to Israel and subsequently, the second generation of Jewish Ethiopian descendants were born in Israel
Of the 385 contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) had a positive TST and 135 (87.7%) started latent TB infection (LTBI) treatment, only 26 (16.9%) completed treatment
All 13 culture-positive cases were infected with an identical M. tuberculosis strain known as Clade T1 SIT 926 (SITVIT database, Institute Pasteur, guadeloupe.fr)

Summary

Introduction

During the last three decades, Ethiopians of Jewish descent immigrated to Israel and subsequently, the second generation of Jewish Ethiopian descendants were born in Israel.Ethiopian immigrants (EI’s) have to undergo screening for active tuberculosis (TB) and latent TB infection (LTBI) while in Ethiopia before their departure to Israel. The screening consists of a tuberculin skin test (TST) and chest X-ray Those with a positive TST or abnormal chest X-ray are referred upon arrival in Israel to one of the TB clinics for further evaluation and treatment. The index case was a 20-years-old male, Israeli-born EI descendant. He sought medical care for cough and fatigue that had continued for 4 months. He had smear-positive, culture-positive, bilateral pulmonary TB susceptible to first-line treatment medications. He had a history of alcohol and illicit substance abuse. The most recent case was a 17-year-old, a close contact of an active TB patient in this outbreak, diagnosed in December 2019

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