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Latent Tuberculosis among Displaced Populations Rapid Diagnosis and Control

Latent Tuberculosis among Displaced Populations Rapid Diagnosis and Control. Nikolaou Aristidis MD, MSc. Migration v s tb. Immigrants :. ↑ risks of transmission infectious diseases ( TB) i ) overcrowded camps ii) poor living conditions iii) poor access to healthcare provision

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Latent Tuberculosis among Displaced Populations Rapid Diagnosis and Control

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  1. Latent Tuberculosis among Displaced PopulationsRapid Diagnosis and Control Nikolaou Aristidis MD, MSc

  2. Migration vstb

  3. Immigrants : • ↑risks of transmission infectious diseases (TB) i) overcrowded camps ii)poor living conditions iii) poor access to healthcare provision • At entry: 40 times more at risk active TB ≠local general population (Figuera-Munoz, 2008) (Rieder, 1994) (Arshad, 2010)

  4. TB incidence • Burden ↓in industrialized countries ≠high in developing • Immigrants carry LTBI →at increased risk of reactivation • EU: up to 82% foreign-born cases (among overall TB cases) • In low-incidence countries → % increasing since 1990s • ↑ risk among foreign-born even 20 yrs after migration (Dasgupta, 2000) (Klinkenberg, 2009)

  5. Factors influencing TB incidence • country of origin • age • sociodemographic factors • exposure and travel to country of origin • access to care • drug resistance • immune incompetence (Klinkenberg, 2009)

  6. Reactivation of prior TB infections • Recent TB infection or reinfection due to travel to the home country • Recent infection or reinfection within the new country (Klinkenberg, 2009)

  7. Special Health Needs/Obstacles • Language • Stigmatization • Poor cultural awareness • Psychological distress • Disruption of families and social networks • Economic difficulties • Difficult to trust doctors (Figuera-Munoz, 2008)

  8. Latent tb infection

  9. LTBI • Exposure to Mycobacterium tuberculosis→ Latent TB Infection • Usually, healthy life without developing active TB disease • 2 billion people LTBI ≠ <10 million a year active TB disease • 5 - 10% infected persons develop active TB disease 50%, within the first two years (CDC, 2010)

  10. LTBI • Usually,Skin Test (Mantoux) or Blood Test (Quantiferon) → TB infection • Normal chest x-ray and Negative sputum test • TB bacteria in body (alive but inactive) • Not feel sick – No symptoms • Cannot spread TB bacteria (CDC, 2010)

  11. screening

  12. Medical Screening • Objective →early preventive or curative intervention • Disease → relatively common and treatable • Test →i) inexpensive ii) easy to administer iii) cause no discomfort to the patient iv) high sensitivity and specificity (Dasgupta, 2005) (Rieder, 1994)

  13. TB screening • Targeted groups: • persons with a high risk of being infected by tuberculosis (curative treatment) • persons at high risk of developing tuberculosis (preventive intervention) • Screening tools : • chest radiography relatively high sensitivity • tuberculin skin-testing limited specificity • Tuberculin skin test =identification of these groups +indicator of need of radiographic examination (Rieder, 1994)

  14. Screening strategies • Pre-entry/ pre-migration screening • Port of arrival screening • Reception/ holding/ transit centre screening • Community post-arrival screening • Occasional screening • Follow-up screening (Klinkenberg, 2009)

  15. Active screening among foreigners → before dispersed in the country • Screening for tuberculosis (before or after arrival) →prevent unnecessary transmission (specifically designed centers) • Targeted screening of immigrants (country of origin) + surveillance for recently arrived populations (Figuera-Munoz, 2008)

  16. TB screening among EU • TB screening in 22/24 (96%) countries Compulsory basis in 12/22 (55%) countries • Only 4 systematically collecting data • The Nordic: to all new asylum seekers The Netherlands: on arrival (again 6, 12, 18, and 24 months) Austria, France, Spain, and Britain: induction or reception centers Italy and Germany: Regional variations in the provision Greece: immigrants who applied for a work permit (Norredam, 2005)

  17. Suggestions • Systematic recording and reporting of screening performance • Preventive strategy : • improving housing conditions (decrease the risk of tuberculosis transmission) • enhancing tuberculosis case finding • setting case management within Directly Observed Treatment program • Good follow-up system (Arshad, 2010) (Klinkenberg, 2009)

  18. Ideal long-term TB control strategy Global investment TB control in high-incidence countries → Global reduction in tuberculosis incidence → ↓ TB risk (migrants from high incidence to low incidence regions) More Humanitarian / More Cost-effective (Dasgupta, 2005)

  19. Equal Rights for health NOT entrance rejection orexpelling and repatriating • Active screening + access to healthcare facilities: • shorten the infectious periods • interfere with the transmission network • reduce risk of developing active TB • improve the control of potential tuberculosis reservoirs (Arshad, 2010) (Rieder, 1994)

  20. Thank you

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