Tuberculosis and Latent Tuberculosis Infection Among Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis

Abstract

Background: In 2017, there were 68·5 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Tuberculosis prevalence in the country of origin and adverse conditions endured during their journey may increase their risk for tuberculosis. We summarized the prevalence of active and latent tuberculosis infection (LTBI) among refugees and asylum seekers through a literature systematic review and meta-analysis by country of origin. Methods: Articles published in Medline, EMBASE, Web of Science and LILACS from 2000 to August 2017 were searched for, without language restriction. Two independent reviewers performed all review steps. Random effect models were used to estimate pooled measures of active and latent tuberculosis infection (LTBI) prevalence. Sub-group analyses were performed according to the country of origin and host continent. Findings: Sixty-seven out of 767 identified papers were included, of which 16 entered the meta-analysis. Pooled prevalence by contry of origin of active and latent tuberculosis were 0·01 [95% confidence interval (CI)=0·00-0·02] and 0·41 (95% CI=0·25-0·57), respectively, both with high level of heterogeneity (I2=98·2% and 99·8%). Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Interpretation: Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention. The high prevalence of active and latent tuberculosis indicates the need for ensuring access to healthcare for early detection, treatment and prevention of the disease, aiming protection of this vulnerable population. Funding: Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). RP has had a study grant from the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). CAPES is not responsible for any statement in this manuscript. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The authors declare: Not applicable.