Piecing the puzzle together: foreign-born tuberculosis in an immigrant-receiving country

Langlois-Klassen, Deanne; Wooldrage, Kate; Manfreda, Jure; Sutherland, Karen; Ellis, Edward; Phypers, M; Gushulak, Brian D.; Long, Richard

doi:10.1183/09031936.00196610

Cited by 35 publications

(23 citation statements)

References 22 publications

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“…In contrast with what has been observed among immigrants in other industrialized countries such as the United Kingdom, Denmark, and Canada, where the risk for TB decreases as a function of time elapsed since immigration ( 1 , 2 , 4 ), in our population the risk for active TB did not decrease with time since immigration. The reason for this unexpected finding is unclear but may be explained by an arising difference in exposure to conditions promoting LTBI reactivation.…”

Section: Discussioncontrasting

confidence: 99%

High Rates ofMycobacterium tuberculosisamong Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy

Baussano

Mercadante²,

Pareek³

et al. 2013

Emerg. Infect. Dis.

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Migration from low- and middle-income countries to high-income countries increasingly determines the severity of tuberculosis (TB) cases in the adopted country. Socially marginalized groups, about whom little is known, may account for a reservoir of TB among the immigrant populations. We investigated the rates of and risk factors for Mycobacterium tuberculosis transmission, infection, and disease in a cohort of 27,358 socially marginalized immigrants who were systematically screened (1991–2010) in an area of Italy with low TB incidence. Overall TB and latent TB infection prevalence and annual tuberculin skin testing conversion rates (i.e., incidence of new infection) were 2.7%, 34.6%, and 1.7%, respectively. Prevalence of both TB and latent TB infection and incidence of infection increased as a function of the estimated TB incidence in the immigrants’ countries of origin. Annual infection incidence decreased with time elapsed since immigration. These findings have implications for control policy and immigrant screening in countries with a low prevalence of TB.

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Section: Discussioncontrasting

confidence: 99%

High Rates ofMycobacterium tuberculosisamong Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy

Baussano

Mercadante²,

Pareek³

et al. 2013

Emerg. Infect. Dis.

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“…Furthermore, analysing the effect of age and length of stay in Italy on the likelihood to be HIV positive, we found that after spending 5 years in Italy, TB foreign-born patients have the same risk as Italians to be HIV positive, while the highest risk is found for subjects that have lived in Italy for less than 2 years. Overall, an increase in age was associated with an increased risk to be HIV infected; in the international literature also, both older age and recent arrival in a host country are factors commonly associated with an increased risk to develop TB [68], [69].…”

Section: Discussionmentioning

confidence: 97%

Risk Factors for Tuberculosis in Foreign-Born People (FBP) in Italy: A Systematic Review and Meta-Analysis

et al. 2014

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In Italy, TB notifications in foreign-born people (FBP) are steadily increasing. To investigate this issue we did a meta-analysis on risk factors for FBP people. A systematic search was performed in PubMed and EMBASE from Jan-1980 to Jan-2013. We analysed HIV status, previous TB-treatment, intravenous drug use and alcohol abuse, and multidrug resistant TB. Odd ratio was used as a measure of effect. One and two-stages approaches were used. In the main analysis we used a 2-stages approach to include studies with only aggregate estimates. Among 1996 references, 18 fulfilled inclusion criteria. In TB-affected FBP people positive HIV-status was about 3 times higher than among Italians, after 1996 when combined antiretroviral therapy for HIV was introduced (OR: 2.91; 95%CI: 1.37; 6.17). No association was found between FBP and intravenous drug users in adults; after 1-stage meta-analysis foreign born people from highly endemic countries had a 4 times higher risk to be multidrug resistant TB than Italian people. Finally, TB-affected FBP were less likely than Italians to be alcoholics (OR: 0.10 95%CI: 0.01; 0.84) or of having received previous TB-treatment (OR: 0.55; 95%CI: 0.43; 0.71). An association of multidrug resistant TB with immigrant status as well as an association of Tuberculosis with HIV-positive status in foreign-born people are major findings of this analysis. Drugs and alcohol abuse do not appear to be risk factors for TB in FBP, however they cannot be discharged since may depend on cultural traditions and their role may change in the future along with the migratory waves. An effective control of TB risk factors among migrants is crucial to obtain the goal of TB eradication.

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“…We stratified foreign-born patients into categories of immigration from high or low-moderate TB incidence countries based on WHO definitions [17], and time since immigration based on published studies indicating that TB rates are highest within the first 2 years of arrival [18]. Additional variables included smoking, drug and alcohol abuse history, HIV co-infection, and clinical characteristics (smear and culture results, disease site, TB drug resistance, cavitary and miliary TB, pulmonary and/or systemic symptoms), and method of therapy supervision (directly observed therapy (DOT) or self-administered therapy (SAT)).…”

Section: Methodsmentioning

confidence: 99%

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

et al. 2016

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BackgroundHospitalization is the most costly health system component of tuberculosis (TB) control programs. Our objectives were to identify how frequently patients are hospitalized, and the factors associated with hospitalizations and length-of-stay (LOS) of TB patients in a large Canadian city.MethodsWe extracted data from the Montreal TB Resource database, a retrospective cohort of all active TB cases reported to the Montreal Public Health Department between January 1996 and May 2007. Data included patient demographics, clinical characteristics, and dates of treatment and hospitalization. Predictors of hospitalization and LOS were estimated using logistic regression and Cox proportional hazards regression, respectively.ResultsThere were 1852 active TB patients. Of these, 51% were hospitalized initially during the period of diagnosis and/or treatment initiation (median LOS 17.5 days), and 9.0% hospitalized later during treatment (median LOS 13 days). In adjusted models, patients were more likely to be hospitalized initially if they were children, had co-morbidities, smear-positive symptomatic pulmonary TB, cavitary or miliary TB, and multi- or poly-TB drug resistance. Factors predictive of longer initial LOS included having HIV, renal disease, symptomatic pulmonary smear-positive TB, multi- or poly-TB drug resistance, and being in a teaching hospital.ConclusionsWe found a high hospitalization rate during diagnosis and treatment of patients with TB. Diagnostic delay due to low index of suspicion may result in patients presenting with more severe disease at the time of diagnosis. Earlier identification and treatment, through interventions to increase TB awareness and more targeted prevention programs, might reduce costly TB-related hospital use.

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Piecing the puzzle together: foreign-born tuberculosis in an immigrant-receiving country

Cited by 35 publications

References 22 publications

High Rates ofMycobacterium tuberculosisamong Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy

High Rates ofMycobacterium tuberculosisamong Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy

Risk Factors for Tuberculosis in Foreign-Born People (FBP) in Italy: A Systematic Review and Meta-Analysis

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

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