Abstract
Background: Although tuberculosis (TB) incidence has been decreasing in the European Union/European Economic Area (EU/EEA) in the last decades, specific subgroups of the population, such as migrants, remain at high risk of TB. This study is based on the report ‘Key Infectious Diseases in Migrant Populations in the EU/EEA’ commissioned by The European Centre for Disease Prevention and Control. Methods: We collected, critically appraised and summarized the available evidence on the TB burden in migrants in the EU/EEA. Data were collected through: (i) a comprehensive literature review; (ii) analysis of data from The European Surveillance System (TESSy) and (iii) evidence provided by TB experts during an infectious disease workshop in 2012. Results: In 2010, of the 73 996 TB cases notified in the EU/EEA, 25% were of foreign origin. The overall decrease of TB cases observed in recent years has not been reflected in migrant populations. Foreign-born people with TB exhibit different socioeconomic and clinical characteristics than native sufferers. Conclusion: This is one of the first studies to use multiple data sources, including the largest available European database on infectious disease notifications, to assess the burden and provide a comprehensive description and analysis of specific TB features in migrants in the EU/EEA. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA.
Highlights
Tuberculosis (TB) is a major public health concern
Within the European Union/European Economic Area (EU/EEA), TB notification rates have been declining over the last decades, reaching 14.2 per 100 000 population in 2011.2 Despite this decline, specific subgroups of the population, such as homeless people, migrants, people living in urban settings and prisoners, remain at an increased risk of acquiring TB infection and developing active disease; this representing a challenge for TB control programmes.[3,4]
Data are collected from national surveillance institutions,[10] and data from EU/EEA countries are validated by European Centre for Disease Prevention and Control (ECDC).[4]
Summary
Tuberculosis (TB) is a major public health concern. In 2013, there were an estimated 8.9 million (range 8.6–9.4 million) incident cases of TB globally, corresponding to 126 cases per 100 000 population. The World Health Organization (WHO) estimates that 4% of TB cases in 2013 occurred in the WHO European Region, with Eastern Europe affected by the TB epidemic.[1] Within the European Union/European Economic Area (EU/EEA), TB notification rates have been declining over the last decades, reaching 14.2 per 100 000 population in 2011.2 Despite this decline, specific subgroups of the population, such as homeless people, migrants, people living in urban settings and prisoners, remain at an increased risk of acquiring TB infection and developing active disease; this representing a challenge for TB control programmes.[3,4] In particular, in many EU/ EEA settings the contribution of cases among foreign-born individuals to the total TB burden is increasing each year.[5] The pathways through which migrants are at higher risk for both transmission of TB infection and development of disease might include coming from high TB burden countries as well as being more exposed to socioeconomic and behavioural risk factors in their host countries. Strengthened information about health determinants and factors for migrants’ vulnerability is needed to plan, implement and evaluate targeted TB care and control interventions for migrants in the EU/EEA
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