Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines

Boukamel, Myriam; Fougère, Yves; Gehri, Mario; Surı́s, Joan-Carles; Rochat, Isabelle; Miletto, Damien; Kyrilli, Spyridoula; Fouriki, Athina; Crisinel, Pierre Alex

doi:10.4414/smw.2020.20253

Cited by 8 publications

(5 citation statements)

References 10 publications

(10 reference statements)

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“…( Soriano-Arandes et al., 2020 ) Living conditions including poor housing, poverty, and urban environments are also associated with higher tuberculosis prevalence and transmission. ( Stosic et al., 2019 ; Bekken et al., 2020 ; Boukamel et al., 2020 ; Martinez et al., 2020 ) Unlike adult tuberculosis, there is no gender difference in childhood tuberculosis, ( Marais et al., 2004 ; Nelson and Wells, 2004 ; Swaminathan and Rekha, 2010 ) and in this study we did not find gender differences in either PTB or EPTB.…”

Section: Discussionsupporting

confidence: 53%

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

Wang²,

Huang³

et al. 2022

Front. Cell. Infect. Microbiol.

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The research of childhood tuberculosis is inadequate in china. The cross-priming amplification (CPA) of specific DNA in clinical samples is increasingly adopted for the diagnosis of childhood tuberculosis. In this study, a multicenter research was performed to investigate the incidence and characteristics of childhood tuberculosis in suspected populations mainly by CPA method. 851 children suspected of tuberculosis were enrolled in seven centers across China. All samples were tested by a CPA method and 159 subjects were tested by Xpert MTB/RIF and liquid culture method in parallel to assess the reliability of the CPA method. A positive result in any one of the three methods provided a definitive diagnosis of Mycobacterium tuberculosis complex (MTBC) infection. The MTBC-positive rate was 9.5% (81/851) by the combined methods; 93.8% of the cases were detected by CPA technology (76/81). The rate of pulmonary infection was significantly higher than that of extrapulmonary infection (7.1%, 60/851 vs 2.5%, 21/851; P < 0.001). Scrofula was the predominant type of extrapulmonary tuberculosis. The MTBC positive rates in 12-18-year-old group (middle school), was 28.4% (23/81), higher than in those under-six-year-old (preschool; 39/525) and the 6~11-year-old (primary school; 18/235) groups combined (P < 0.001). The MTBC positive rate in patients with a clear history of tuberculosis exposure was significantly higher than in cases in which there was no history of tuberculosis contact(35.3%, 18/51 vs 7.8%, 61/782; P < 0.001). In conclusion, this multicenter investigation showed that pulmonary tuberculosis and extrapulmonary tuberculosis are not uncommon in children in China, with teenagers being particularly susceptible to infection. The incidence of pulmonary tuberculosis in children is higher than that of extrapulmonary tuberculosis. History of exposure to tuberculosis is a high risk factor for childhood tuberculosis.

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Section: Discussionsupporting

confidence: 53%

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

Wang²,

Huang³

et al. 2022

Front. Cell. Infect. Microbiol.

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“…For example, one study observed that, among 200 migrant children, for protection against HBV, only 118 (59%) had anti-HBs ≥1000 UI/L compared to 23 (11%) having no detectable antibodies (<10 IU/L) [ 57 ]. Some serological studies also noted false-negative results; for instance, some non-tuberculosis patients had false-positive tuberculin skin tests despite being BCG-vaccinated [ 19 ]. Regardless of some variance in accuracy and specificity, serology served as an approximation of protection levels across different migrant groups [ 44 , 45 , 90 ].…”

Section: Resultsmentioning

confidence: 99%

Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

et al. 2022

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Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.

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“…Studies analyzing the impact of the most recent refugee crises on TB in Europe showed that up to 14% of unaccompanied minor refugees had TB infection when screened in Germany [13] and Sweden in 2015 [14]. A Swiss study in newly arrived migrant children shows 7% of screened children had TB infection or TB disease, and an association with origin from a country with moderate to high TB incidence, older age, and contact to a TB index case was found [15]. However, detailed data on incidence rates, associated risk factors, and clinical characteristics in children with TB after migration to Europe are important and lacking in most national and regional reports [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study

et al. 2021

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Background: In Europe, surveillance and monitoring of pediatric tuberculosis (TB) remains important, particularly in the light of migration in recent years. The aim of the study was to evaluate incidence rates of childhood TB and detailed diagnostic pathways and treatment. Methods: Data were collected through the Swiss Pediatric Surveillance Unit (SPSU) from December 2013 to November 2019. Monthly notifications are obtained from the 33 pediatric hospitals in the SPSU, and a detailed questionnaire was sent out upon notification. Inclusion criteria were children and adolescents aged up to 15 years with culture- or molecular-confirmed TB disease or for whom a treatment with ≥3 antimycobacterial drugs had been initiated. Data were compared with age-matched notification data from the Swiss Federal Office of Public Health (FOPH). Results: Of the 172 cases notified to SPSU, a detailed questionnaire was returned for 161 (93%) children, of which 139 met the inclusion criteria. Reasons for exclusion were age >15 years, double reporting, and not fulfilling the criteria for TB disease. During the same time period, 172 pediatric TB cases were reported to the FOPH, resulting in an incidence of 2.1 per 100,000, ranging from 1.4 to 2.8 per year, without a clear trend over time. In the 64 (46.0%) foreign-born children, incidence rates were higher and peaked in 2016, with 13.7 per 100,000 (p = 0.018). The median interval between arrival in Switzerland and TB diagnosis was 5 (IQR 1–21) months, and 80% were diagnosed within 24 months of arrival. In 58% of the cases, TB disease was confirmed by culture or molecular assays. Age >10 years, presence of fever, or weight loss were independent factors associated with confirmed TB. Conclusion: The annual pediatric TB incidence rate only varied among foreign-born children and was highest in 2016 when refugee influx peaked in Europe. Importantly, most foreign-born children with TB were diagnosed within 2 years after arrival in Switzerland. Thus, the early period after arrival in Switzerland is associated with a higher risk of TB disease in children, and this should be considered for screening guidance in refugees.

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Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines

Cited by 8 publications

References 10 publications

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

Pediatric Tuberculosis Disease during Years of High Refugee Arrivals: A 6-Year National Prospective Surveillance Study

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