Tuberculosis among asylum seekers in Milan, Italy: epidemiological analysis and evaluation of interventions

Abstract

In countries of the European Union, tuberculosis (TB) mainly affects marginalised people, including asylum seekers. Migratory flows from high-incidence countries to Italy have increased up to 2017, posing challenges to the national health system. This study sought to assess TB and latent TB infection (LTBI) prevalence among asylum seekers in Milan during the biennium 2016–2017 and to evaluate interventions in place.A two-level active surveillance and screening system was developed for both TB and LTBI. Asylum seekers underwent an initial screening with a tuberculin skin test (TST) and a questionnaire at the receiving sites. At the Regional TB Reference Centre, those with a positive result underwent chest radiography. People aged <35 years with negative chest radiography results underwent further testing by interferon-γ release assay. If results of the assay were positive, LTBI treatment was offered. TB and LTBI prevalence were compared with literature data.A total of 5324 asylum seekers, mostly young (10–39 years; 98%), male (84%) and from sub-Saharan Africa (69%), were enrolled in the study. 69 active TB cases were diagnosed and 863 LTBI-positive individuals were detected. TB prevalence was high (1236 per 100 000 population) and LTBI prevalence was 28%. Despite losses (41%) during the transition from initial screening sites and the diagnostic centre, a good TB cure rate (84%) and optimal LTBI treatment completion (94%) were achieved.Our study shows that TB incidence is high among asylum seekers in Milan and that well-coordinated screening measures are critical for early diagnosis and treatment. It also proves that rolling out successful at-scale interventions for both prophylaxis and disease management is feasible.

Tuberculosis-Related Hospitalizations in a Low-Incidence Country: A Retrospective Analysis in Two Italian Infectious Diseases Wards

“…The increased TB-related hospitalization rate, shown in the two reference Italian clinical centers in the same period of 2013-2017, was mainly attributed to the increased arrival of asylum seekers and political/economic migrants who escaped from geographical areas with conflicts and governmental instability [20]. The demographic and epidemiological characteristics of foreign-born patients with TB in our study are similar to those described by other European studies [13][14][15][16][17][18][19].…”

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

“…Notably, the least implemented action so far is TB preventive treatment. Such a practice takes on even more importance for high-income countries where reactivation of LTBI is estimated to be responsible of most TB cases, especially affecting those who are marginalized [8,18].…”

“…Immigration from South America occurred when PT was only based on INH, while inflows from Africa happened after the implementation of shortened RIF-based regimens. Furthermore, as a consequence of the European resettlement scheme's introduction for asylum seekers/refugees in 2015 (European Agenda on Migration of 13th May 2015), we preferred shortened schemes [8] in order to end PT before dislocation.…”

“…In settings with a low annual TB incidence (<10 cases per 100,000 population) current WHO guidelines recommend preventive therapy (PT)-which can decrease TB occurrence by 60-90% [5]-for people living with HIV, for adult contacts of TB patients, and for other clinical risk groups (e.g., homeless persons) [6]. Furthermore, depending on the migratory flows, a country may implement screening programs and LTBI PT for those who had recently arrived (e.g., asylum seekers/refugees) [7,8].…”

Screening migrants for tuberculosis and latent TB infection: the reward will come later

“…In the current issue of the European Respiratory Journal, VILLA et al [3] report the experience gathered in Milan, Italy, by the Health Protection Agency and the Regional TB Reference Centre. Between 2016 and 2017, 360 000 migrants entered in Italy, most of them from countries with a high TB incidence.…”