title: The impact of migration on tuberculosis epidemiology and control in high-income countries: a review.
abstract: Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. mp426@le.ac.uk.|Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK. mp426@le.ac.uk.
authors.forename: Manish
authors.identifier: http://orcid.org/0000-0003-1521-9964
authors.initials: M
authors.lastname: Pareek
authors.affiliation: Division of Infectious Diseases and Department of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Greenaway
authors.affiliation: European Centre for Disease Prevention and Control, Solna, Sweden.
authors.forename: Teymur
authors.initials: T
authors.lastname: Noori
authors.affiliation: Barcelona Institute for Global Health, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Munoz
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.|Centre for Infectious Disease Epidemiology, University College London, London, UK.
authors.forename: Dominik
authors.initials: D
authors.lastname: Zenner
mesh_terms: D003140:Communicable Disease Control / Q000706:statistics & numerical data; D019049:Developed Countries; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D012307:Risk Factors; D014195:Travel / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control
keywords: Migration; Review; Screening; Tuberculosis