Crisis-Affected Populations and Tuberculosis

Abstract

By definition, humanitarian crises can severely affect human health, directly through violence or indirectly through breakdown of infrastructure or lack of provision for basic human needs, such as safe shelter, food, clean water, and suitable clothing. After the initial phase, these indirect effects are the most important determinants of morbidity and mortality in humanitarian emergencies, and infectious diseases are among the most significant causes of ill health. Tuberculosis (TB) incidence in humanitarian emergencies varies depending on a number of factors, including the country background epidemiology, but will be elevated compared with precrisis levels. TB morbidity and mortality are associated with access to appropriate care and medications, and will also be elevated due to barriers to access to diagnosis and appropriate treatment, including robust TB drug supplies. While reestablishment of TB control is challenging in the early phases, successful treatment programs have been previously established, and the WHO has issued guidance on establishing such successful programs. Such programs should be closely linked to other health programs and established in close collaboration with the country's national treatment program. Individuals who flee the emergency also have a higher TB risk and can face difficulties accessing care en route to or upon arrival in host countries. These barriers, often associated with treatment delays and worse outcomes, can be the result of uncertainties around legal status, other practical challenges, or lack of health care worker awareness. It is important to recognize and mitigate these barriers with an increasing number of tools now available and described.

Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany

“…These higher numbers of TB found in the study by Bennet et al as well as in our study are likely attributable to a high risk for both, TB infection and progression to disease, under conditions of conflict or humanitarian crisis in the country of origin as well as during transit to Europe [13]. Depending on many factors like background TB incidence, access to health care, nutrition, overcrowding, transit time, migration route and others, estimates of TB incidence can often dramatically exceed TB incidence of the country of origin [13] [14]. Transit time was asked for in all refugee minors of our cohort, but responds were often very imprecise or refused.…”

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

“…Migrant AYA, including refugees and other displaced AYA, have heterogeneous experiences that are poorly captured in surveillance data, complicating efforts to measure their TB risk and outcomes [32][33][34][35][36]. However, displaced people of all ages often face a disproportionately high risk for TB due to a combination of overcrowding, malnutrition, poverty, psychological stressors, and healthcare system disruptions that lead to delayed diagnosis and treatment [32,37,38]. Birth in a country with high TB prevalence consistently predicts an increased risk for TB infection and disease [32,37].…”

“…Birth in a country with high TB prevalence consistently predicts an increased risk for TB infection and disease [32,37]. Risk also increases for migrant AYA who have longer transit times from their country of origin and who spend time in informal settlements (e.g., camps, detention centers), which may act as bottlenecks that support TB transmission [32,[34][35][36][37][38][39]. AYA living in cross-border regions, such as Papua New Guinea and the United States-Mexico border, experience additional systems challenges while navigating semipermeable borders that can prevent equitable access to TB care and compound their risk [40][41][42].…”