Tuberculosis in migrants \u2013 screening, surveillance and ethics

Gabriella Scandurra,Chris Degeling,Claudia C Dobler,Ben Marais,Paul Douglas

doi:10.1186/s41479-020-00072-5

Abstract

Tuberculosis (TB) is the leading infectious cause of human mortality and is responsible for nearly 2 million deaths every year. It is often regarded as a ‘silent killer’ because it predominantly affects the poor and marginalized, and disease outbreaks occur in ‘slow motion’ compared to Ebola or coronavirus 2 (COVID-19). In low incidence countries, TB is predominantly an imported disease and TB control in migrants is pivotal for countries to progress towards TB elimination in accordance with the World Health Organisations (WHO’s) End TB strategy. This review provides a brief overview of the different screening approaches and surveillance processes that are in place in low TB incidence countries. It also includes a detailed discussion of the ethical issues related to TB screening of migrants in these settings and the different interests that need to be balanced. Given recognition that a holistic approach that recognizes and respects basic human rights is required to end TB, the review considers the complexities that require consideration in low-incidence countries that are aiming for TB elimination.

Highlights

Tuberculosis (TB), is one of the oldest airborne pathogens; found in human remains from nearly 10,000 years ago [1]
Mycobacterium tuberculosis, the causative organism of TB disease, is approximately 50 times slower to grow than other common bacteria, and TB disease develops more slowly than high profile viral epidemics such as Ebola or coronavirus 2 (COVID-19)
A holistic approach is essential to effectively tackle the many challenges posed by global TB control [10], including careful consideration of TB in migrants

Summary

Introduction

Tuberculosis (TB), is one of the oldest airborne pathogens; found in human remains from nearly 10,000 years ago [1]. The importance of new tools, and better ways of finding and treating all people with TB are well recognized, as is the need to address the many social, financial, ethical, and cultural barriers that limit access to TB prevention, diagnosis and care [2]. In low TB incidence countries where TB transmission is limited and most latent TB infection [LTBI] (as well as active disease) is imported from high incidence settings [19], preventing re-activation of LTBI is a major TB control strategy in migrant populations [20, 21].

Results

Conclusion