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Open Access Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points

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As tuberculosis (TB) rates continue to decline in native populations in most low TB incidence countries, the proportion of TB patients born outside their country of residence (‘foreign-born') increases. Some low-incidence countries have experienced a substantial increase in TB rates related to recent increases in the number of asylum seekers and other migrants from TB-endemic countries. However, average TB rates among the foreign-born in low-incidence countries declined moderately in 2009–2015. TB in foreign-born individuals is commonly the result of reactivation of latent infection with Mycobacterium tuberculosis acquired outside the host country. Transmission is generally low in low-incidence countries, and transmission from migrants to the native population is often modest. Variations in levels and trends in TB notifications among the foreign-born are likely explained by differences and fluctuations in the number and profile of migrants, as well as by variations in TB control, health and social policies in the host countries. To optimise TB care and prevention in migrants from endemic to low-incidence countries, we propose a framework for identifying possible TB care and prevention interventions before, during and after migration. Universal access to high-quality care along the entire migration pathway is critical. Screening for active TB and latent tuberculous infection should be tailored to the TB epidemiology, adapted to the needs of specific migrant groups and linked to treatment. Ultimately, the long-term TB elimination goal can be reached only if global health and socio-economic inequalities are dramatically reduced. Low-incidence countries, most of which are among the wealthiest nations, need to contribute through international assistance.
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Keywords: asylum seekers; epidemiology; migration; policy; tuberculosis

Document Type: Research Article

Affiliations: 1: Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 2: Research Branch, Tel Aviv Department of Health, Tel Aviv, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 3: KNCV Tuberculosis Foundation, The Hague, The Netherlands 4: Unit of Infectious Diseases, Department of Medicine Solna, Department of Infectious Diseases Karolinska University Hospital, Stockholm, Sweden 5: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, Division of Infectious Diseases and Immunity, Imperial College, London, UK 6: European Centre for Disease Prevention and Control, Stockholm, Sweden 7: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research, Clinical Tuberculosis Center, Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia

Publication date: 01 June 2017

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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