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Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017.

Hayward, SE; Rustage, K; Nellums, LB; van der Werf, MJ; Noori, T; Boccia, D; Friedland, JS; Hargreaves, S (2021) Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017. Clin Microbiol Infect, 27 (9). 1347.e1-1347.e7. ISSN 1469-0691 https://doi.org/10.1016/j.cmi.2020.12.006
SGUL Authors: Hargreaves, Sally Friedland, Jonathan Samuel

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Abstract

OBJECTIVES: The proportion of tuberculosis (TB) cases occurring in migrants in Europe is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin. METHODS: We carried out a cross-sectional secondary database analysis, utilizing 23 years of data collected between 1995 and 2017 from the European Surveillance System of the European Centre for Disease Prevention and Control for 32 EU/EFTA countries. RESULTS: In total, 1 270 896 TB cases were included, comprising 326 987 migrants (25.7%) and 943 909 non-migrants (74.3%). Of TB cases among migrants, 45.2% (n = 147 814) were extrapulmonary compared to 21.7% (n = 204 613) among non-migrants (p < 0.001). Lymphatic, bone/joint and peritoneal/digestive TB were more common among migrant than non-migrant extrapulmonary cases. A lower proportion of extrapulmonary TB was seen in Eastern Europe (17.4%, n = 98 656 of 566 170) and Southern Europe (29.6%, n = 62 481 of 210 828) compared with Western (35.7%, n = 89 498 of 250 517) and Northern Europe (41.8%, n = 101 792 of 243 381). Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary disease, with 62.0% (n = 55 401 of 89 353) and 54.5% (n = 38 327 of 70 378) of cases, respectively, being extrapulmonary. CONCLUSIONS: Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than in non-migrants. There is a need to improve clinical awareness of extrapulmonary TB and to integrate its detection into screening programmes.

Item Type: Article
Additional Information: © 2020 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Europe, Extrapulmonary tuberculosis, Health services research, Migrant, Tuberculosis, Europe, Health services research, Tuberculosis, extrapulmonary tuberculosis, migrant, 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
September 2021Published
19 December 2020Published Online
10 December 2020Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
NIHR300072Department of Healthhttp://dx.doi.org/10.13039/501100000276
MR/N013638/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MR/V027549/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
M775Rosetrees Trusthttp://dx.doi.org/10.13039/501100000833
SBF005∖1111Academy of Medical Scienceshttp://dx.doi.org/10.13039/501100000691
SBF005∖1047Academy of Medical Scienceshttp://dx.doi.org/10.13039/501100000691
MR/T046732/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
PubMed ID: 33352301
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112736
Publisher's version: https://doi.org/10.1016/j.cmi.2020.12.006

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