World tuberculosis day 2023 - Reflections on the spread of drug-resistant tuberculosis by travellers and reducing risk in forcibly displaced populations

Perspectives on tuberculosis in migrants, refugees, and displaced populations in Europe

Finding and treating all forms of tuberculosis (TB) (latent, drug-susceptible, drug-resistant, multidrug-resistant, and extensively drug-resistant tuberculosis) among migrants, displaced populations, and refugees are important challenges facing TB control programs in Europe. Many of these populations live in poor conditions, with limited access to healthcare and TB services. Ever-increasing armed conflicts in Europe and other parts of the world continue to exacerbate rates of migration to and within Europe, with considerable implications for health services. TB in Europe is more prevalent in migrants from high TB-endemic areas, as well as those with social risk factors, including poverty and poor housing or homelessness. We provide our perspectives on recent data on TB in Europe from the World Health Organization, the European Centre for Disease Prevention and Control, the United Kingdom Health Security Agency, and other 2023-2024 reports. Despite advancements in TB screening and prevention strategies, and treatment regimens including community-based and integrated multi-disease approaches, significant challenges remain. These include variations in national policies, resource limitations, and barriers to accessing healthcare. To help address these challenges, there is a need for clearer guidance through national policies, enhanced surveillance, and proactive community engagement There is also an urgent need for more investment into TB health services in Europe for refugees, migrants, and other displaced populations.

Epidemiological Analysis of Tuberculosis Infection and Trend Changes - 152 Belt and Road Partner Countries, 2013-2021

What is already known about this topic?

The Belt and Road Initiative promotes increased interactions among participating countries, which concurrently elevates the risk of infectious diseases such as tuberculosis (TB). Since TB infection can significantly contribute to the disease burden, it is crucial to delineate the epidemic status and identify the change trends in TB infection among the countries involved in the initiative.

What is added by this report?

TB infection was prevalent in 152 countries along the Belt and Road initiative. Most of these countries had an infection prevalence between 10% and 30%, among which were 9 countries (5.92%) with a prevalence below 10% and 8 countries (5.26%) with a reported prevalence of 40% and higher. From 2013 to 2021, a notable reduction in TB infection prevalence was observed in 149 countries (98.03%). In contrast, Sri Lanka and the Philippines exhibited an increasing trend, while no significant change was detected in Timor-Leste.

What are the implications for public health practice?

Addressing TB surveillance, prevention, and management, as well as collaboration among these countries, is a proposed key strategy for achieving the global end TB strategy.

Mapping Bovine Tuberculosis in Colombia, 2001-2019

INTRODUCTION

Bovine tuberculosis is a zoonotic disease of significant impact, particularly in countries where a pastoral economy is predominant. Despite its importance, few studies have analysed the disease's behaviour in Colombia, and none have developed maps using geographic information systems (GIS) to characterise it; as such, we developed this study to describe the temporal-spatial distribution of bovine tuberculosis in Colombia over a period of 19 years.

METHODS

A retrospective cross-sectional descriptive study, based on reports by the Colombian Agricultural Institute (ICA), surveillance of tuberculosis on cattle farms in Colombia from 2001 to 2019 was carried out. The data were converted into databases using Microsoft Access 365®, and multiple epidemiological maps were generated with the QGIS® version 3.36 software coupled to shape files of all the country's departments.

RESULTS

During the study period, 5273 bovine tuberculosis cases were identified in multiple different departments of Colombia (with a mean of 278 cases/year). Regarding its temporal distribution, the number of cases varied from a maximum of 903 cases (17.12% of the total) in 2015 to a minimum of 0 between 2001 and 2004 and between 2017 and 2019 (between 2005 and 2016, the minimum was 46 cases, 0.87%).

CONCLUSIONS

GIS are essential for understanding the temporospatial behaviour of zoonotic diseases in Colombia, as is the case for bovine tuberculosis, with its potential implications for the Human and One Health approaches.

Screening for latent tuberculosis in migrants-status quo and future challenges

OBJECTIVES

To review the evidence that migrants from tuberculosis (TB) high-incidence countries migrating to TB low-incidence countries significantly contribute to active TB cases in the counties of destination, primarily through reactivation of latent TB.

METHODS

This is a narrative review. The different screening programs in the countries of destination are reviewed either based on screening and preventive treatment of latent TB pre or more commonly - post arrival.

RESULTS

Screening can be performed using interferon-gamma release assays (IGRA) or tuberculin skin tests (TST). Preventive treatment of latent TB is using either monotherapy with isoniazid, or in combination with rifampicin or rifapentine. We discuss the ethical issues of preventive treatment in asymptomatic individuals and how these are addressed in different screening programs.

CONCLUSION

Screening migrants from TB high endemic countries to TB low endemic countries is beneficial. There is a lack of standardization and agreement on screening protocols, follow up and treatment.