Post- #migration #followup of migrants identified to be at increased #risk of developing #tuberculosis at pre-migration screening… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Post-migration follow-up of migrants identified to be at increased risk of developing tuberculosis at pre-migration screening: a systematic review and meta-analysis

Isaac H Y Chan, BMed, Nishta Kaushik, BMed, Dr Claudia C Dobler, MD

Published: 11 April 2017 / Article has an altmetric score of 1 / DOI: http://dx.doi.org/10.1016/S1473-3099(17)30194-9

© 2017 Elsevier Ltd. All rights reserved.

 

Summary

Background

Post-migration follow-up of migrants considered at increased risk of developing tuberculosis based on pre-migration screening abnormalities (high-risk migrants) is implemented in several low-incidence countries. We aimed to determine the rate of tuberculosis in this population to inform cross-border tuberculosis control policies.

Methods

We searched MEDLINE and Embase (since inception to Jan 12, 2017) for studies evaluating post-migration follow-up of high-risk migrants. Outcomes evaluated were the number of tuberculosis cases occurring post-migration, expressed as the tuberculosis incidence per 100 000 person-years of follow-up, as cumulative incidence of tuberculosis per 100 000 persons, and the cumulative incidence of tuberculosis at the first post-migration follow-up visit. Random-effects models were used to summarise outcomes across studies.

Findings

We identified 20 publications (describing 23 study cohorts) reporting the pre-migration screening outcomes of 8 355 030 migrants processed between Jan 1, 1981, and May 1, 2014, with 222 375 high-risk migrants identified. The pooled cumulative incidence of tuberculosis post-migration in our study population from 22 cohorts was 2794 per 100 000 persons (95% CI 2179–3409; I2=99%). The pooled cumulative incidence of tuberculosis at the first follow-up visit from ten cohorts was 3284 per 100 000 persons (95% CI 2173–4395; I2=99%). The pooled tuberculosis incidence from 15 cohorts was 1249 per 100 000 person-years of follow-up (95% CI 924-1574; I2=98%).

Interpretation

The high rate of tuberculosis in high-risk migrants suggests that tuberculosis control measures in this population, including more sensitive pre-migration screening, preventive treatment of latent tuberculosis infection, or post-migration follow-up, are potentially effective cross-border tuberculosis control strategies in low-incidence countries.

Funding

Australian National Health and Medical Research Council.

Keywords: Tuberculosis; Migrants.

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#Antimicrobial Drug #Resistance among #Refugees from #Syria, #Jordan (@CDC_EIDjournal, edited)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Edited.]

Volume 23, Number 5—May 2017 / Letter

Antimicrobial Drug Resistance among Refugees from Syria, Jordan

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To the Editor: The Kassem et al. article regarding high rates of multidrug-resistant (MDR) bacteria colonizing Syrian children highlights the challenge of choosing empiric antimicrobial drugs to treat war-injured refugees from Syria (1). The findings mirror other reports (2–3) and our own experience in a charitable hospital in Amman, Jordan, which manages war-injured refugees from Syria. As part of a program of antimicrobial drug stewardship and infection prevention and control, empiric antimicrobial drug protocols were introduced. For antimicrobial drug–naive patients, the first-line choice for prophylaxis and treatment of skin and soft-tissue infections, including those involving open fractures, was a narrow-spectrum cephalosporin, as recommended by the Infectious Diseases Society of America guidelines (4); however, clinical failure was common.

We retrospectively reviewed the clinical microbiology data of 75 patients admitted in January 2015 with a history of suspected post-trauma infection. All these patients were first treated in field hospitals in Syria; 82.7% were male, and 33% were <16 years old. Twenty-four percent had multiple injuries, 20% had osteomyelitis, and 53% had metal prosthetic implants.

Thirty bacterial isolates were identified, mostly from deep wound swabs of 21 (28%) injured patients; 9/21 were infected with 2 isolates. Twenty-nine (97%) isolates were gram-negative bacteria: 10 Proteus spp., 10 Escherichia coli, 5 Pseudomonas spp., and 4 Klebsiella spp. Disk diffusion susceptibility testing showed that 20 (66%) isolates were MDR and 11 (36.7%) were carbapenem resistant.

The hospital laboratory did not have the capacity to perform further testing and confirmation of the resistant strains in line with international quality standards because they lacked suitable equipment and financial resources. Preventing further dissemination of MDR organisms among war-injured refugees from Syria at hosting healthcare facilities requires an effective surveillance system, investment in infection prevention and control, appropriate antimicrobial drug stewardship, and urgent laboratory capacity building inside Syria and in the refugee-host countries.

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Aula Abbara, Nizar Al-Harbat, Nabil Karah, Bashar Abo-Yahya, Wael El-Amin, James Hatcher, and Omar Gabbar

Author affiliations: Imperial College, London, UK (A. Abbara); Syrian American Medical Society, Canfield, Ohio, USA (A. Abbara); Al Maqased Charity Hospital, Amman, Jordan (N. Al-Harbat, B. Abo-Yahya); Umea University, Umea, Sweden (N. Karah); Broomfield Hospital, Chelmsford, Essex, UK (W. El-Amin); Imperial College Healthcare National Health Service Trust, London (J. Hatcher); University Hospital Leicester, Leicester, UK (O. Gabbar)

 

References

  1. Kassem DF, Hoffmann Y, Shahar N, Ocampo S, Salomon L, Zonis Z, et al. Multidrug-resistant pathogens in hospitalized Syrian children. Emerg Infect Dis. 2017;23:166–8.
  2. Reinheimer C, Kempf VAJ, Göttig S, Hogardt M, Wichelhaus TA, O’Rourke F, et al. Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015. Euro Surveill. 2016;21:30110.
  3. Teicher CL, Ronat JB, Fakhri RM, Basel M, Labar AS, Herard P, et al. Antimicrobial drug-resistant bacteria isolated from Syrian war-injured patients, August 2011-March 2013. Emerg Infect Dis. 2014;20:1949–51.
  4. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al.; Infectious Diseases Society of America; Surgical Infection Society. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011;71(Suppl 2):S210–34.

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Suggested citation for this article: Abbara A, Al-Harbat N, Karah N, Abo-Yahya B, El-Amin W, Hatcher J, et al. Antimicrobial drug resistance among refugees from Syria, Jordan. Emerg Infect Dis. 2017 May [date cited]. http://dx.doi.org/10.3201/eid2305.170117

DOI: 10.3201/eid2305.170117

Keywords: Antibiotics; Drugs Resistance; Jordan Syria; Migrants.

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#Meningococci of Serogroup X Clonal Complex 181 in #Refugee #Camps, #Italy (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 23, Number 5—May 2017 / Research Letter

Meningococci of Serogroup X Clonal Complex 181 in Refugee Camps, Italy

Paola Stefanelli, Arianna Neri, Paola Vacca, Damiano Picicco, Laura Daprai, Giulia Mainardi, Gian Maria Rossolini, Alessandro Bartoloni, Anna Anselmo, Andrea Ciammaruconi, Antonella Fortunato, Anna Maria Palozzi, Silvia Fillo, Marino Faccini, Sabrina Senatore, Florigio Lista, and Cecilia Fazio

Author affiliations: Istituto Superiore di Sanità, Rome, Italy (P. Stefanelli, A. Neri, P. Vacca, C. Fazio); Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (D. Picicco, L. Daprai); Agenzia di Tutela della Salute, Milan (G. Mainardi, M. Faccini, S. Senatore); Università degli Studi di Siena, Siena, Italy, and Università degli Studi di Firenze, Florence, Italy; Careggi University Hospital, Florence (G.M. Rossolini); Università degli Studi di Firenze, Florence (A. Bartoloni); Centro Studi e Ricerche di Sanità e Veterinaria dell’Esercito, Rome (A. Anselmo, A. Ciammaruconi, A. Fortunato, A.M. Palozzi, S. Fillo, F. Lista)

 

Abstract

Four cases of infection with serogroup X meningococci (MenX) (1 in 2015 and 3 in 2016) occurred in migrants living in refugee camps or reception centers in Italy. All MenX isolates were identified as clonal complex 181. Our report suggests that serogroup X represents an emerging health threat for persons arriving from African countries.

Keywords: Neisseria Meningitidis; N. M. sg X; Italy; Migrants.

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Where #economics and #epidemics collide: #migrant #workers and #emerging #infections (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary.]

Correspondence

Where economics and epidemics collide: migrant workers and emerging infections

Clarence C Tam, Mishal S Khan, Helena Legido-Quigley

DOI: http://dx.doi.org/10.1016/S0140-6736(16)31645-2

© 2016 Elsevier Ltd. All rights reserved.

 

Summary

Following widespread criticism about inadequate action during the Ebola epidemic in west Africa,1 the global response is once again being tested by two re-emerging infectious disease threats in the form of Zika and yellow fever viruses. The public health and scientific responses to these challenges have been unprecedented.

Keywords: Research; Migrants; Society; Public Health; Infectious Diseases.

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#Pathogens, #prejudice, and #politics: the role of the #globalhealth #community in the #European #refugee #crisis (Lancet ID., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Personal View

Pathogens, prejudice, and politics: the role of the global health community in the European refugee crisis

Mishal S Khan, PhD, Anna Osei-Kofi, MSc, Abbas Omar, MSc, Hilary Kirkbride, MD, Prof Anthony Kessel, MD, Aula Abbara, MD, Prof David Heymann, MD, Prof Alimuddin Zumla, FRCP, Dr Osman Dar, FFPH

Published Online: 20 June 2016 / Article has an altmetric score of 10 / DOI: http://dx.doi.org/10.1016/S1473-3099(16)30134-7

© 2016 Elsevier Ltd. All rights reserved.

 

Summary

Involuntary migration is a crucially important global challenge from an economic, social, and public health perspective. The number of displaced people reached an unprecedented level in 2015, at a total of 60 million worldwide, with more than 1 million crossing into Europe in the past year alone. Migrants and refugees are often perceived to carry a higher load of infectious diseases, despite no systematic association. We propose three important contributions that the global health community can make to help address infectious disease risks and global health inequalities worldwide, with a particular focus on the refugee crisis in Europe. First, policy decisions should be based on a sound evidence base regarding health risks and burdens to health systems, rather than prejudice or unfounded fears. Second, for incoming refugees, we must focus on building inclusive, cost-effective health services to promote collective health security. Finally, alongside protracted conflicts, widening of health and socioeconomic inequalities between high-income and lower-income countries should be acknowledged as major drivers for the global refugee crisis, and fully considered in planning long-term solutions.

Keywords: Research; Abstracts; Global Health; Migrants; Poverty; Society; Infectious Diseases.

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#Migration-related #tuberculosis: #epidemiology and #characteristics of TB cases originating outside #EU/EEA, 2007 to 2013 (@eurosurveillanc, abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Eurosurveillance, Volume 21, Issue 12, 24 March 2016 / Research article

Migration-related tuberculosis: epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013

C Ködmön 1 , P Zucs 1 , MJ van der Werf 1

Author affiliations: 1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Correspondence: Csaba Ködmön (csaba.kodmon@ecdc.europa.eu)

Citation style for this article: Ködmön C, Zucs P, van der Werf MJ. Migration-related tuberculosis: epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013. Euro Surveill. 2016;21(12):pii=30164. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.12.30164

Received:03 February 2015; Accepted:05 November 2015

 

Abstract

Migrants arriving from high tuberculosis (TB)-incidence countries may pose a significant challenge to TB control programmes in the host country. TB surveillance data for 2007–2013 submitted to the European Surveillance System were analysed. Notified TB cases were stratified by origin and reporting country. The contribution of migrant TB cases to the TB epidemiology in EU/EEA countries was analysed. Migrant TB cases accounted for 17.4% (n = 92,039) of all TB cases reported in the EU/EEA in 2007–2013, continuously increasing from 13.6% in 2007 to 21.8% in 2013. Of 91,925 migrant cases with known country of origin, 29.3% were from the Eastern Mediterranean, 23.0% from south-east Asia, 21.4% from Africa, 13.4% from the World Health Organization European Region (excluding EU/EEA), and 12.9% from other regions. Of 46,499 migrant cases with known drug-susceptibility test results, 2.9% had multidrug-resistant TB, mainly (51.7%) originating from the European Region. The increasing contribution of TB in migrants from outside the EU/EEA to the TB burden in the EU/EEA is mainly due to a decrease in native TB cases. Especially in countries with a high proportion of TB cases in non-EU/EEA migrants, targeted prevention and control initiatives may be needed to progress towards TB elimination.

Keywords: Research; Abstracts; EU; Migrants; TB.

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The #effect of #migration within the #EU/EEA on the #distribution of #tuberculosis, 2007 to 2013 (@eurosurveillanc, abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Eurosurveillance, Volume 21, Issue 12, 24 March 2016 / Research article

The effect of migration within the European Union/European Economic Area on the distribution of tuberculosis, 2007 to 2013

V Hollo 1 , SM Kotila 1 , C Ködmön 1 , P Zucs 1 , MJ van der Werf 1

Author affiliations: 1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Correspondence: Vahur Hollo ( vahur.hollo@ecdc.europa.eu)

Citation style for this article: Hollo V, Kotila SM, Ködmön C, Zucs P, van der Werf MJ. The effect of migration within the European Union/European Economic Area on the distribution of tuberculosis, 2007 to 2013. Euro Surveill. 2016;21(12):pii=30171. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.12.30171

Received:10 March 2015; Accepted:04 January 2016

 

Abstract

Immigration from tuberculosis (TB) high-incidence countries is known to contribute notably to the TB burden in low-incidence countries. However, the effect of migration enabled by the free movement of persons within the European Union (EU)/European Economic Area (EEA) on TB notification has not been analysed. We analysed TB surveillance data from 29 EU/EEA countries submitted for the years 2007–2013 to The European Surveillance System. We used place of birth and nationality as proxy indicators for native, other EU/EEA and non-EU/EEA origin of the TB cases and analysed the characteristics of the subgroups by origin. From 2007–2013, a total of 527,467 TB cases were reported, of which 129,781 (24.6%) were of foreign origin including 12,566 (2.4%) originating from EU/EEA countries other than the reporting country. The countries reporting most TB cases originating from other EU/EEA countries were Germany and Italy, and the largest proportion of TB cases in individuals came from Poland (n=1,562) and Romania (n=6,285). At EU/EEA level only a small proportion of foreign TB cases originated from other EU/EEA countries, however, the uneven distribution of this presumed importation may pose a challenge to TB programmes in some countries.

Keywords: Research; Abstracts; European Union; Migrants; TB.

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