Multidrug-resistant tuberculosis and migration to Europe.
Multidrug-resistant tuberculosis (MDR-TB) in low-incidence countries in Europe is more prevalent among migrants than the native population. The impact of the recent increase in migration to EU and EEA countries with a low incidence of TB (<20 cases per 100 000) on MDR-TB epidemiology is unclear. This narrative review synthesizes evidence on MDR-TB and migration identified through an expert panel and database search. A significant proportion of MDR-TB cases in migrants result from reactivation of latent infection. Refugees and asylum seekers may have a heightened risk of MDR-TB infection and worse outcomes. Although concerns have been raised around 'health tourists' migrating for MDR-TB treatment, numbers are probably small and data are lacking. Migrants experience significant barriers to testing and treatment for MDR-TB, exacerbated by increasingly restrictive health systems. Screening for latent MDR-TB is highly problematic because current tests cannot distinguish drug-resistant latent infection, and evidence-based guidance for treatment of latent infection in contacts of MDR patients is lacking. Although there is evidence that transmission of TB from migrants to the general population is low-it predominantly occurs within migrant communities-there is a human rights obligation to improve the diagnosis, treatment and prevention of MDR-TB in migrants. Further research is needed into MDR-TB and migration, the impact of screening on detection or prevention, and the potential consequences of failing to treat and prevent MDR-TB among migrants in Europe. An evidence-base is urgently needed to inform guidelines for effective approaches for MDR-TB management in migrant populations in Europe.
International Health Unit, Infectious Diseases & Immunity, Imperial College London, UK.
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S
Hargreaves
Karolinska Institutet, Stockholm, Sweden; Global TB Programme, WHO, Geneva, Switzerland.
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K
Lönnroth
International Health Unit, Infectious Diseases & Immunity, Imperial College London, UK.
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LB
Nellums
Division of Clinical Infectious Diseases, Research Centre, Borstel, Germany; German Centre for Infection Research, Clinical Tuberculosis Centre, Borstel, Germany.
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ID
Olaru
International Health Unit, Infectious Diseases & Immunity, Imperial College London, UK; Beth Israel Deaconess Medical Center, Boston, MA, USA.
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RR
Nathavitharana
Danish Research Centre for Migration Ethnicity and Health, University of Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital, Hvidovre, Denmark.
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M
Norredam
International Health Unit, Infectious Diseases & Immunity, Imperial College London, UK. Electronic address: j.friedland@imperial.ac.uk.
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JS
Friedland
D000995:Antitubercular Agents / Q000627:therapeutic use; D003955:Diagnostic Tests, Routine; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004641:Emigration and Immigration; D005060:Europe / Q000453:epidemiology; D006801:Humans; D017053:Infection Control; D055118:Medication Adherence; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*
D000995:Antitubercular Agents
Delivery; Drug resistance; Europe; Health service delivery; Latent tuberculosis; Multidrug-resistant tuberculosis; Screening; Tuberculosis; migration