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Multidrug-resistant tuberculosis and migration to Europe.

Hargreaves, S; Lönnroth, K; Nellums, LB; Olaru, ID; Nathavitharana, RR; Norredam, M; Friedland, JS (2017) Multidrug-resistant tuberculosis and migration to Europe. Clin Microbiol Infect, 23 (3). pp. 141-146. ISSN 1469-0691 https://doi.org/10.1016/j.cmi.2016.09.009
SGUL Authors: Nellums, Laura Bruff

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Abstract

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.

Item Type: Article
Additional Information: © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Delivery, Drug resistance, Europe, Health service delivery, Latent tuberculosis, Multidrug-resistant tuberculosis, Screening, Tuberculosis, migration, Antitubercular Agents, Diagnostic Tests, Routine, Disease Transmission, Infectious, Emigration and Immigration, Europe, Humans, Infection Control, Medication Adherence, Tuberculosis, Multidrug-Resistant, Microbiology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Clin Microbiol Infect
ISSN: 1469-0691
Language: eng
Dates:
DateEvent
March 2017Published
23 September 2016Published Online
18 September 2016Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
001World Health Organizationhttp://dx.doi.org/10.13039/100004423
PubMed ID: 27665703
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110119
Publisher's version: https://doi.org/10.1016/j.cmi.2016.09.009

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