title: Tuberculosis transmission between foreign- and native-born populations in the EU/EEA: a systematic review.
abstract: Tuberculosis (TB) control programmes of many low TB incidence countries of the European Union/European Economic Area (EU/EEA) perceive challenges in controlling TB due to high numbers of TB in migrants from high-incidence countries. To assess the extent of TB transmission from the foreign-born to the native-born population, we quantitatively investigated the dynamics of TB transmission between these populations in the EU/EEA, using published molecular epidemiological studies. We searched PubMed and EMBASE databases from 1990 to August 2012. We identified 15 studies performed during 1992-2007 covering 12,366 cases, of which median (range) 49.2% (17.7%-86.4%) were foreign-born. The proportion of clustered isolates ranged between 8.5% and 49.1% of the total number of TB cases genotyped and among these, foreign-born cases were equally or more likely to have unique isolates compared to native-born cases. One third of the clusters were "mixed", i.e. composed of foreign- and native-born cases, involving 0-34.2% of all genotyped cases. Cross-transmission among foreign and native populations was bidirectional, with wide differences across studies. This systematic review provides evidence that TB in a foreign-born population does not have a significant influence on TB in the native population in EU/EEA.
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sandgren
authors.forename: Monica Sañé
authors.initials: MS
authors.lastname: Schepisi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.forename: Emma
authors.initials: E
authors.lastname: Huitric
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.forename: Davide
authors.initials: D
authors.lastname: Manissero
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
mesh_terms: D054242:Emigrants and Immigrants; D005062:European Union; D005838:Genotype; D006801:Humans; D015994:Incidence; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology