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Migrant crisis in Europe compounded by MDR-TB
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Evidence-based strategies are urgently needed for detecting, preventing and treating multidrug-resistant tuberculosis among migrant populations in low-incidence countries in Europe, according to a narrative review published in Clinical Microbiology and Infection.
“Although there is evidence that transmission of TB from migrants to the general population is low — it predominantly occurs between migrants — there is a risk of transmission for both migrants and the native population,” Jonathan S. Friedland, PhD, chair of infectious diseases and immunity at Imperial College London, said in a press release.
Friedland and colleagues identified the need to create an evidence-base to inform guidelines for effective approaches to multidrug-resistant (MDR)-TB management. In their review, the researchers synthesized existing evidence on MDR-TB and migration in the EU identified through a database search and an expert panel and considered its implications for public health policy and practice.
MDR-TB is widespread globally, with an estimated 480,000 cases documented in 2014. Rates of MDR-TB are extremely low in Western European countries with a low overall incidence of TB, but the rates are much higher among migrant populations in those countries. For example, researchers reviewed data showing that 100% of the MDR-TB cases diagnosed in Austria, the Netherlands and Norway were among migrant populations. Rates attributable to migrants were approximately 90% in the United Kingdom, 89% in France and 94% in Germany.
The researchers wrote that migrants may be at increased risk for contracting MDR-TB due to factors related to conflict and violence in their home country, including destitution, poor social conditions — such as overcrowding, homelessness or incarceration — and a lack of access to health care. Many of these same factors place them at continued risk after arriving in Europe.
A significant proportion of MDR-TB cases in migrants result from reactivation of latent infection. This, researchers noted, presents a particular challenge because current tests cannot distinguish drug-resistant latent infection, and treatment guidelines for treating latent infection for patients with MDR-TB are lacking.
Compounding these factors, migrants are often unable to take advantage of screening, diagnosis and treatment opportunities because of restrictions set by health care systems or fear of deportation.
The researchers additionally noted concerns about the issue of “health tourists” migrating or traveling to Europe for MDR-TB treatment, but concluded that, though data on this issue are scarce, the impact of health tourism is probably relatively small.
Friedland and colleagues presented a series of detailed recommendations for addressing the problem of MDR-TB among migrants. These included:
- changing health care policy so migrants can use available TB screening, diagnosis and treatment options;
- providing better social and financial support to migrants;
- developing consistent screening methods across Europe;
- developing evidence-based guidelines for preventing and treating MDR-TB; and
- conducting new research aimed at developing a diagnostic test for latent MDR-TB and at predicting the risk for disease reactivation.
Researchers noted that, although these strategies may be expensive, “screening cannot be meaningful without linkage to high-quality care, which ultimately is necessary to reduce migrant mortality and morbidity, as well as transmission to the wider population.”
Friedland added that “there is a human rights obligation to improve the diagnosis, treatment and prevention of MDR-TB in migrants.” – by Sarah Kennedy
Disclosure: Friedland reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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