Screening for active and latent tuberculosis among asylum seekers in Italy: A retrospective cohort analysis

Pontarelli, Agostina; Marchese, Valentina; Scolari, Carla; Capone, Susanna; El-Hamad, Issa; Donato, Francesco; Moioli, R; Girardi, Enrico; Cirillo, Daniela María; Castelli, Francesco; Matteelli, Alberto

doi:10.1016/j.tmaid.2018.10.015

Cited by 23 publications

(18 citation statements)

References 13 publications

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“…Nevertheless, in our study we found a high treatment completion rate among refugees/asylum seekers (91%), which is not in line with another Italian study [25], possibly because of organizational differences and a higher use of an RIF-containing shorter regimen in our study [8].…”

Section: Discussioncontrasting

confidence: 98%

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Villa

Ferrarese

Sotgiu

et al. 2019

JCM

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To tackle the tuberculosis (TB) epidemic, in 2014 the World Health Organization launched the End TB Strategy, which includes action to prevent latent TB infection (LTBI) reactivation. Available preventive treatments (PT) are based on either isoniazid (INH) alone or rifampicin (RIF)-containing regimens. This study aims to assess and compare PT completion rates, the occurrence of adverse events, and the time of dropout among those receiving INH-alone or RIF-containing regimens at Villa Marelli Institute, Milan, Italy, covering the period from 1992 to 2018. A total of 19,670 subjects, belonging to various risk groups—mainly young (median age of 29 years), foreign-born (73.3%), and males (58.8%)—with presumed LTBI were prescribed PT (79.3% INH-alone and 20.7% RIF-containing regimens). The treatment completion rate was 79.4% on average, with higher rates among those receiving RIF-containing regimens (85.6%) compared to those that were prescribed INH-alone (77.8%) (p < 0.0001). Notably, some of the high-risk groups for progression of LTBI were more likely to complete PT from RIF-containing regimens. These groups included recent TB contact (89.9%, p < 0.0001), healthcare workers (93.5%, p < 0.0001), and homeless people (76.6%, p < 0.0001). Irrespectively of the chosen PT regimen, most of the dropouts occurred between the start of the treatment and the first follow-up visit (14.3%, 15.2% for those on INH-alone vs. 11.1% for those on RIF-containing regimens). Further shortening of the PT regimen is therefore an aim to ensure adherence, even though it might need further efforts to enhance the patient’s attitude towards starting and carrying out PT.

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Section: Discussioncontrasting

confidence: 98%

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Villa

Ferrarese

Sotgiu

et al. 2019

JCM

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“…Our study confirms that TB infection frequency is high among migrants in Sicily, but lower than that in other Italian and European realities [12][13][14][15][16].…”

Section: Discussionsupporting

confidence: 85%

“…In our study, the overall prevalence of TB infection was 13.5% (both LTBI and active TB) and the active TB was 1.6%, lower than the prevalence in each country estimated by mathematical modeling [11] (22% for TB infection in the African continent) and lower than other studies among the migrant population in Europe (2% to 5% for active TB) [12,14,15].…”

Section: Discussioncontrasting

confidence: 79%

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Tuberculosis among Migrant Populations in Sicily: A Field Report

Prestileo

Pipitone

Sanfilippo

et al. 2021

Journal of Tropical Medicine

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Background. In the EU, tuberculosis (TB) mainly affects vulnerable people, including migrants. From 2014 to 2017, we have estimated the frequency of both tuberculosis and latent tuberculosis infection (LTBI) among the migrant population hosted in 41 reception centers in western Sicily (ITaCA network). Materials and Methods. All migrants were consecutively recruited for the screening of TB infection with physical examination and TST in 1,020 migrants and with IGRA in the others 2,690. The screening was carried out 4–8 weeks after landing in Sicily. For all migrants with a positive screening test, chest X-ray and smear examination were performed. LTBI was defined by positivity of TST or IGRA with negative X-ray chest, clinical, and smear examination. Active TB was defined by radiological and/or clinical and/or sputum positivity in a patient with a TST or IGRA positivity. Results. We evaluated a total of 3,710 migrants, of which 89% came from Sub-Saharan countries; 2,811 were males, 899 were females, with a median age of 22 years (IQR: 18–25). TB infection was diagnosed in 501 persons (13.5%) of which 440 (11.8%) had LTBI and 61 had active TB (1.6%): 1 had lymph node TB, 1 had intestinal TB, and 59 had pulmonary TB (38 sputum smear positive TB; no drug-resistant TB were observed). Conclusions. TB screening is critical to early diagnosis and treatment.

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“…In this context, screening for tuberculosis (TB) offered the opportunity to provide appropriate treatment of this severe infectious disease [8,9]. Different modes of screening are available for screening for TB, such as medical examination, chest X-ray (CXR), tuberculin skin testing or interferon gamma release essay (IGRA) [11][12][13]. According to the German Protection against Infection Act [14] and the German Asylum Procedure Act [15], refugees or asylum seekers staying in shared-accommodation are obligated to participate in examinations to exclude communicable diseases.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis screening during the 2015 European refugee crisis

et al. 2020

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Background: The purpose of our study was to describe and evaluate management, performance and results of Tuberculosis (TB)-screening among refugees and asylum seekers in a rural area in Germany in 2015.Methods: Refugees or asylum seekers, staying in shared-accommodation are obligated to participate on screening chest X-ray (CXR) in order to screen for signs of potentially infectious pulmonary TB (German Protection against Infection Act and German Asylum Procedure Act). n = 705 individuals underwent screening chest X-ray (CXR) to detect pulmonary TB in September and October 2015 on site. One experienced radiologist interpreted and reported each CXR within 24 h after the enrollment in the screening program and results were sent to the local Public Health Department for potential further medical care. Image abnormalities suggestive for TB were defined according to established radiographic criteria such as pleural effusion, cavitation, consolidation, fibrous scarring or calcification. Only in case of TB-suggestive findings on CXR, further diagnostics were arranged (pulmonological examination, follow-up CXR, sputum culture, interferon-gamma release assay, bronchoscopy). Follow-up data was collected in collaboration with the local Public Health Department. Descriptive statistics were calculated using GraphPad Prism software.Results: n = 637 CXR examinations (90%) did not show abnormal findings, n = 54 CXR (8%) showed incidental findings, and n = 14 CXR (2%) were suspicious for acute TB. Of these, n = 14 individuals, eight underwent further TB diagnostics. Active TB was confirmed in one individual (0.001% of the screening cohort). Conclusions:Our cohort reflects current immigrations statistics in Europe and illustrates an overall low TB prevalence amongst individuals entering Germany in 2015. However, our findings support the improvement of diagnostic algorithms.

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Screening for active and latent tuberculosis among asylum seekers in Italy: A retrospective cohort analysis

Cited by 23 publications

References 13 publications

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Tuberculosis among Migrant Populations in Sicily: A Field Report

Tuberculosis screening during the 2015 European refugee crisis

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