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

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.

Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

“…This is not consistent with data reported at EU level: the countries reporting most TB cases originating from other EU/EEA were Germany and Italy [26]. …”

Letter to the editor: Trends in tuberculosis notification rates by country of origin in the metropolitan area of Rome, 2010 to 2015

“…This notification rate is lower than that of migrants to other European countries such as the United Kingdom, as reported previously in the literature [5]. It could be thus hypothesised that in comparison with Italy, EU/EEA countries with higher percentages of migrants from countries with a higher TB burden might have persistently higher TB notification rates among foreign born TB cases [6]. …”

An overview of tuberculosis and migration

“…24,32 The most systematic evidence of the TB burden, including that for TB and MDR-TB disease among migrants, comes from low TB incidence countries in Europe and North America, where foreign-born persons sometimes account for more than half of the TB incidence; migrants also often have higher rates of MDR-TB. 38,[49][50][51][52][53][54][55][56][57] Studies have also reported a high prevalence of tuberculous infection or active TB disease in migrant children, as well as among immigrants and migrant workers in low TB incidence countries in other regions, such as the Middle East. 58,59 In Lebanon, the increasing TB burden in recent years has been associated with increased numbers of migrants, including from high TB burden countries, and large numbers of refugees displaced by the conflict in neighbouring Syria; some studies have shown that despite their origins in a low TB incidence setting, Syrian refugees in Jordan have higher rates of disease.…”