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Laycock KM, Enane LA, Steenhoff AP. Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People. Trop Med Infect Dis 2021; 6:148. [PMID: 34449722 PMCID: PMC8396328 DOI: 10.3390/tropicalmed6030148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023] Open
Abstract
Adolescents and young adults (AYA, ages 10-24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.
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Affiliation(s)
- Katherine M. Laycock
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
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Rustage K, Lobe J, Hayward SE, Kristensen KL, Margineanu I, Stienstra Y, Goletti D, Zenner D, Noori T, Pareek M, Greenaway C, Friedland JS, Nellums LB, Hargreaves S. Initiation and completion of treatment for latent tuberculosis infection in migrants globally: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:1701-1712. [PMID: 34363771 PMCID: PMC8612939 DOI: 10.1016/s1473-3099(21)00052-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 01/01/2023]
Abstract
Background Latent tuberculosis infection (LTBI) is one of the most prevalent infections globally and can lead to the development of active tuberculosis disease. In many low-burden countries, LTBI is concentrated within migrant populations often because of a higher disease burden in the migrant's country of origin. National programmes consequently focus on screening and treating LTBI in migrants to prevent future tuberculosis cases; however, how effective these programmes are is unclear. We aimed to assess LTBI treatment initiation and outcomes among migrants, and the factors that influence both. Methods For this systematic review and meta-analysis, we searched Embase, MEDLINE, and Global Health, and manually searched grey literature from Jan 1, 2000, to April 21, 2020. We included primary research articles reporting on LTBI treatment initiation or completion, or both, in migrants and excluded articles in which data were not stratified by migrant status, or in which the data were related to outcomes before 2000. There were no geographical or language restrictions. All included studies were quality appraised using recognised tools depending on their design, and we assessed the heterogeneity of analyses using I2. We extracted data on the numbers of migrants initiating and completing treatment. Our primary outcomes were LTBI treatment initiation and completion in migrants (defined as foreign-born). We used random-effects meta-regression to examine the influence of factors related to these outcomes. The study is registered with PROSPERO (CRD42019140338). Findings 2199 publications were retrieved screened, after which 39 publications from 13 mostly high-income, low-burden countries were included in our analyses, with treatment initiation and completion data reported for 31 598 migrants positive for LTBI, with not all articles reporting the full pathway from initiation to completion. The pooled estimate for the true proportion of migrants testing positive who initiated treatment was 69% (95% CI 51–84; I2= 99·62%; 4409 of 8764). The pooled estimate for the true proportion of migrants on treatment in datasets, who subsequently completed it was 74% (95% CI = 66–81; I2= 99·19%; 15 516 of 25 629). Where data were provided for the entire treatment pathway, the pooled estimate for the true proportion of migrants who initiated and completed treatment after a positive test was only 52% (95% CI 40–64; I2= 98·90%; 3289 of 6652). Meta-regression showed that LTBI programmes are improving, with more recent reported data (2010–20) associated with better rates of treatment initiation and completion, with multiple complex factors affecting treatment outcomes in migrants. Interpretation Although our analysis highlights that LTBI treatment initiation and completion in migrants has improved considerably from 2010–20, there is still room for improvement, with drop out reported along the entire treatment pathway. The delivery of these screening and treatment programmes will require further strengthening if the targets to eradicate tuberculosis in low-incidence countries are to be met, with greater focus needed on engaging migrants more effectively in the clinic and understanding the diverse and unique barriers and facilitators to migrants initiating and completing treatment. Funding European Society of Clinical Microbiology and Infectious Diseases, the Rosetrees Trust, the National Institute for Health Research, and the Academy of Medical Sciences.
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Affiliation(s)
- Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Jessica Lobe
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristina L Kristensen
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Ioana Margineanu
- Department of Internal Medicineand Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ymkje Stienstra
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Delia Goletti
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Dominik Zenner
- Institute for Population Health Sciences, Queen Mary University of London, London, UK
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada; Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jon S Friedland
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Laura B Nellums
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.
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Hargreaves S, Nellums LB, Johnson C, Goldberg J, Pantelidis P, Rahman A, Friedland FMedSci JS. Delivering multi-disease screening to migrants for latent TB and blood-borne viruses in an emergency department setting: A feasibility study. Travel Med Infect Dis 2020; 36:101611. [PMID: 32126293 PMCID: PMC7493708 DOI: 10.1016/j.tmaid.2020.101611] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/06/2019] [Accepted: 02/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Screening for latent tuberculosis infection (LTBI) in migrants is important for elimination of tuberculosis in low-incidence countries, alongside the need to detect blood-borne infections to align with new guidelines on migrant screening for multiple infections in European countries. However, feasibility needs to be better understood. METHODS We did a feasibility study to test an innovative screening model offering combined testing for LTBI (QuantiFERON), HIV, hepatitis B/C in a UK emergency department, with two year follow-up. RESULTS 96 economic migrants, asylum seekers and refugees from 43 countries were screened (46 [47.9%] women; mean age 35.2 years [SD 11.7; range 18-73]; mean time in the UK 4.8 years [SD 3.2; range 0-10]). 14 migrants (14.6%) tested positive for LTBI alongside HIV [1], hepatitis B [2], and hepatitis C [1] Of migrants with LTBI, 5 (35.7%) were successfully engaged in treatment. 74 (77.1%) migrants reported no previous screening since migrating to the UK. CONCLUSION Multi-disease screening in this setting is feasible and merits being further tested in larger-scale studies. However, greater emphasis must be placed on ensuring successful treatment outcomes. We identified major gaps in current screening provision; most migrants had been offered no prior screening despite several years since migration, which holds relevance to policy and practice in the UK and other European countries.
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Affiliation(s)
- Sally Hargreaves
- Institute for Infection & Immunity, St. George's, University of London, United Kingdom.
| | - Laura B Nellums
- Institute for Infection & Immunity, St. George's, University of London, United Kingdom; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Catherine Johnson
- Section of Infectious Diseases & Immunity, Imperial College London, United Kingdom
| | - Jacob Goldberg
- Section of Infectious Diseases & Immunity, Imperial College London, United Kingdom
| | | | - Asif Rahman
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Noori T, Hargreaves S, Greenaway C, van der Werf M, Driedger M, Morton RL, Hui C, Requena-Mendez A, Agbata E, Myran DT, Pareek M, Campos-Matos I, Nielsen RT, Semenza J, Nellums LB, Pottie K. Strengthening screening for infectious diseases and vaccination among migrants in Europe: What is needed to close the implementation gaps? Travel Med Infect Dis 2020; 39:101715. [PMID: 32389827 DOI: 10.1016/j.tmaid.2020.101715] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/14/2022]
Abstract
Migration to the European Union (EU)/European Economic Area (EEA) affects the epidemiology of infectious diseases, including tuberculosis (TB), HIV, hepatitis B/C, and parasitic diseases. Some sub-populations of migrants are also considered to be an under-immunised group and thus at risk of vaccine-preventable diseases. Providing high-risk migrants access to timely and efficacious screening and vaccination, and understanding how best to implement more integrated screening and vaccination programmes into European health systems ensuring linkage to care and treatment, is key to improving the health of migrants and their communities, alongside meeting national and regional targets for infection surveillance, control, and elimination. The European Centre for Disease Prevention and Control (ECDC) has responded to calls to action to improve migrant health and strengthen universal health coverage by developing evidence-based guidance for policy makers, public health experts, and front-line healthcare professionals on how to approach screening and vaccination in newly arrived migrants within the EU/EEA. In this Commentary, we provide a perspective towards developing efficacious screening and vaccination of newly arrived migrants, with a focus on defining implementation challenges and evidence gaps in high-migrant receiving EU/EEA countries. There is a need now to leverage the increasing momentum around migrant health to both strengthen the evidence-base and to advocate for universal access to health care for all migrants in the EU/EEA, including undocumented migrants. This should include voluntary, confidential, and non-stigmatising screening and vaccination that should be free of charge and facilitate linkage to appropriate care and treatment.
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Affiliation(s)
- Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | - Sally Hargreaves
- Institute for Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada; Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital. JD MacLean Centre for Tropical Diseases at McGill, McGill University Health Centre, McGill University, Canada
| | | | - Matt Driedger
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | - Ana Requena-Mendez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Eric Agbata
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain; Faculty of Health Science, University of Roehampton London, London, SW15 5PU, United Kingdom
| | - Daniel T Myran
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Ines Campos-Matos
- Health Improvement Directorate, Public Health England, London, United Kingdom
| | - Rikke Thoft Nielsen
- Department of Clinical Microbiology, University Hospital Hvidovre, Denmark; Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Semenza
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Kevin Pottie
- Department of Family Medicine and School of Epidemiology and Public Health, University of Ottawa, Canada
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Spruijt I, Haile DT, Erkens C, van den Hof S, Goosen S, Ten Kate A, Teshome H, Karels M, Koenders M, Suurmond J. Strategies to reach and motivate migrant communities at high risk for TB to participate in a latent tuberculosis infection screening program: a community-engaged, mixed methods study among Eritreans. BMC Public Health 2020; 20:315. [PMID: 32164637 PMCID: PMC7068882 DOI: 10.1186/s12889-020-8390-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background In the Netherlands, migrant populations with a high tuberculosis (TB) incidence are an important target group for TB prevention. However, there is a lack of insight in effective community-engaged strategies to reach and motivate these migrants to participate in latent TB infection (LTBI) screening and treatment programs. Methods In cocreation with Eritrean key figures and TB staff, we designed and executed six strategies to reach and motivate Eritrean communities to participate in LTBI programs, in five regions in the Netherlands. We registered participation in LTBI education and screening, and LTBI treatment uptake and completion. We used semi-structured group and individual interviews with Eritrean participants, key figures, and TB staff to identify facilitators and barriers. Results Uptake of LTBI education (13–75%) and consequent screening (10–124%) varied between strategies. LTBI screening uptake > 100% resulted from educated participants motivating others to participate in screening. Two strategies, using face-to-face promotion and targeting smaller groups, were the most successful. The program resulted in high LTBI treatment initiation and completion (both 97%). Reported program barriers included: competing priorities in the target group, perceived good health, poor risk perception, and scepticism towards the program purpose. TB staff perceived the program as useful but demanding in terms of human resources. Conclusions Eritrean migrant communities can be successfully reached and motivated for LTBI screening and treatment programs, when sufficient (human) resources are in place and community members, well-connected to and trusted by the community, are engaged in the design and execution of the program.
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Affiliation(s)
- Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands. .,Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Dawit Tesfay Haile
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Susan van den Hof
- KNCV Tuberculosis Foundation, The Hague, The Netherlands.,Present Address: National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Simone Goosen
- Netherlands Association of Community Health Services, Utrecht, The Netherlands
| | - Andrea Ten Kate
- Department of Tuberculosis Control, Public Health Service IJsselland, Zwolle, The Netherlands
| | - Hewan Teshome
- Department of Tuberculosis Control, Public Health Service Haaglanden, Den Haag, The Netherlands
| | - Marja Karels
- Department of Tuberculosis Control, Public Health Service Hollands Noorden, Alkmaar, The Netherlands
| | - Marga Koenders
- Department of Tuberculosis Control, Public Health Service Gelderland Zuid, Nijmegen, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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Davidson JA, Thomas HL, Maguire H, Brown T, Burkitt A, Macdonald N, Campbell CNJ, Lalor MK. Understanding Tuberculosis Transmission in the United Kingdom: Findings From 6 Years of Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats Strain Typing, 2010-2015. Am J Epidemiol 2018; 187:2233-2242. [PMID: 29878041 DOI: 10.1093/aje/kwy119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Genotyping provides the opportunity to better understand tuberculosis (TB) transmission. We utilized strain typing data to assess trends in the proportion of clustering and identify the characteristics of individuals and clusters associated with recent United Kingdom (UK) transmission. In this retrospective cohort analysis, we included all culture-confirmed strain-typed TB notifications from the UK between 2010 and 2015 to estimate the proportion of patients that clustered over time. We explored the characteristics of patients in a cluster using multivariable logistic regression. Overall, 58.5% of TB patients were concentrated in 2,701 clusters. The proportion of patients in a cluster decreased between 2010 (58.7%) and 2015 (55.3%) (P = 0.001). Being a clustered patient was associated with being male and UK-born, having pulmonary disease, having a previous TB diagnosis, and having a history of drug misuse or imprisonment. Our results suggest that TB transmission in the UK decreased between 2010 and 2015, during which time TB incidence also decreased. Targeted cluster investigation and extended contact tracing should be aimed at persons at risk of being in a transmission chain, including UK-born individuals with social risk factors in clusters with a high proportion of patients having pulmonary disease.
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Affiliation(s)
- Jennifer A Davidson
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
| | - H Lucy Thomas
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Helen Maguire
- Field Service, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Timothy Brown
- National Mycobacterium Reference Service South, National Infection Service, Public Health England, London, United Kingdom
| | - Andy Burkitt
- Field Service, National Infection Service, Public Health England, Newcastle, United Kingdom
| | - Neil Macdonald
- Field Service, National Infection Service, Public Health England, London, United Kingdom
| | - Colin N J Campbell
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Maeve K Lalor
- Tuberculosis Unit, National Infection Service, Public Health England, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
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Dobler CC, Fox GJ, Douglas P, Viney KA, Ahmad Khan F, Temesgen Z, Marais BJ. Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives. Eur Respir J 2018; 52:13993003.00591-2018. [PMID: 29794133 DOI: 10.1183/13993003.00591-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
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Affiliation(s)
- Claudia C Dobler
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Mayo Clinic Center for Tuberculosis, Rochester, MN, USA
| | - Greg J Fox
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Kerri A Viney
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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8
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Thomas HL, Harris RJ, Muzyamba MC, Davidson JA, Lalor MK, Campbell CNJ, Anderson SR, Zenner D. Reduction in tuberculosis incidence in the UK from 2011 to 2015: a population-based study. Thorax 2018; 73:769-775. [PMID: 29674389 DOI: 10.1136/thoraxjnl-2017-211074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Following nearly two decades of increasing tuberculosis in the UK, TB incidence decreased by 32% from 2011 to 2015. Explaining this reduction is crucial to informing ongoing TB control efforts. METHODS We stratified TB cases notified in the UK and TB cases averted in the UK through pre-entry screening (PES) between 2011 and 2015 by country of birth and time since arrival. We used population estimates and migration data to establish denominators, and calculated incidence rate ratios (IRRs) between 2011 and 2015. We calculated the contribution of changing migrant population sizes, PES and changes in TB rates to the reduction in TB notifications. RESULTS TB IRRs fell in all non-EU migrant and UK-born populations between 2011 and 2015 (0.61; 95% CI 0.59 to 0.64 and 0.78; 0.73 to 0.83 respectively), with the greatest decrease in recent non-EU migrants (0.54; 0.48 to 0.61). 61.9% of the reduction in TB notifications was attributable to decreases in TB rates, 33.4% to a fall in the number of recent/mid-term non-EU migrants and 11.4% to PES. A small increase in notifications in EU-born migrants offset the reduction by 6.6%. CONCLUSIONS Large decreases in TB rates in almost all populations accounted for the majority of the reduction in TB notifications, providing evidence of the impact of recent interventions to improve UK TB control. The particularly large decrease in TB rates in recent non-EU migrants provides evidence of the effectiveness of screening interventions that target this population. These findings will inform ongoing improvements to TB control.
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Affiliation(s)
- H Lucy Thomas
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Ross J Harris
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Morris C Muzyamba
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Jennifer A Davidson
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Maeve K Lalor
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Colin N J Campbell
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
| | - Sarah R Anderson
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK
| | - Dominik Zenner
- Respiratory Diseases Department, National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
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9
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Walker CL, Duffield K, Kaur H, Dedicoat M, Gajraj R. Acceptability of latent tuberculosis testing of migrants in a college environment in England. Public Health 2018; 158:55-60. [PMID: 29567507 DOI: 10.1016/j.puhe.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The majority of tuberculosis (TB) cases in England occur from reactivation of latent tuberculosis infection (LTBI) in the settled migrant population. The National Institute for Health and Clinical Excellence recommends that new entrants from high-incidence countries are screened to detect LTBI. This article seeks to describe an outreach programme and testing for LTBI in an innovative setting-ESOL (English for Speakers of Other Languages) classes at a community college (CC) with evaluation of acceptability. STUDY DESIGN Partnership working with mixed methods used for evaluation of acceptability. METHODS A pre-existing network from the local TB partnership designed an outreach intervention and screening for LTBI among students from an ESOL programme at a CC. Screening for LTBI with interferon gamma release assay was the culmination of a programme of health improvement activities across the college. Any student on the ESOL programme younger than the age of 35 years and resident in the UK for less than 5 years was eligible for testing. LTBI testing was carried out on-site, and the experience was evaluated by questionnaires to staff, students and partners. A facilitated debrief among the partners gave further data. RESULTS A total of 440 eligible students were tested. One hundred and seventy-two student feedback questionnaires were completed, and 36 partner questionnaires were received with 18 CC staff responding. Students, tutors and healthcare professionals found the setting acceptable with some concerns about insufficient resource for timely follow-up. CONCLUSIONS Students, tutors, community organisations and health professionals found the exercise worthwhile and the method and setting acceptable. There were resource issues for the clinical team in follow-up of students with positive results for such a large screening event. Unexpected barriers were found by the CC as this kind of activity was not recognised for external quality review purposes. There were concerns about reputational loss and stigma of being involved in a TB project. As current initiatives aim to divert workload from stretched general practice surgeries, this may be an important addition to primary care screening.
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Affiliation(s)
- C-L Walker
- Public Health England, Health Protection Team, West Midlands East, 5, St Philips Place, Birmingham, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - K Duffield
- Public Health England, Health Protection Team, West Midlands East, 5, St Philips Place, Birmingham, United Kingdom
| | - H Kaur
- Birmingham & Solihull TB Service, Heart of England National Health Service Trust, Birmingham, United Kingdom
| | - M Dedicoat
- Department of Infection, Heart of England Foundation Trust, Birmingham, United Kingdom
| | - R Gajraj
- Public Health England, Health Protection Team, West Midlands East, 5, St Philips Place, Birmingham, United Kingdom
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