“Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy”

Abstract

IntroductionBy the summer of 2014, the Syrian crisis resulted in a regional humanitarian emergency with 2.9 million refugees, including 608,000 in Jordan. These refugees access United Nations High Commissioner for Refugees (UNHCR)-sponsored clinics or Jordan Ministry of Health clinics, including tuberculosis diagnosis and treatment. Tuberculosis care in Syria has deteriorated with destroyed health infrastructure and drug supply chain. Syrian refugees may have undiagnosed tuberculosis; therefore, the UNHCR, the International Organization for Migration (IOM), the National Tuberculosis Program (NTP), and the Centers for Disease Control and Prevention developed the Public Health Strategy for Tuberculosis among Syrian Refugees in Jordan. This case study presents that strategy, its impact, and recommendations for other neighboring countries.Case descriptionUNHCR determined that World Health Organization (WHO) criteria for implementing a tuberculosis program in an emergency were met for the Syrian refugees in Jordan. Jordan NTP assessed their tuberculosis program and found that access to Syrian refugees was the one component of their program missing. Therefore, a strategy for tuberculosis control among Syrian refugees was developed. Since that development through work with IOM, UNHCR, and NTP, tuberculosis case detection among Syrian refugees is almost 40 % greater (74 cases/12 months or 1.01/100,000 monthly through June 2014 vs. 56 cases/16 months or 0.73/100,000 monthly through June 2013) using estimated population figures; more than two fold the 2012 Jordan tuberculosis incidence. Additionally, the WHO objective of curing ≥85 % of newly identified infectious tuberculosis cases was met among Syrian refugees.Discussion and evaluationTuberculosis (TB) rates among displaced persons are high, but increased detection is possible. High TB rates were found among Syrian refugees through active screening and will probably persist as the Syrian crisis continues. Active screening can detect tuberculosis early and reduce risk for transmission. However, this strategy needs sustainable funding to continue and all activities have not been realized.ConclusionsInitial assessment found that tuberculosis among Syrian refugees was at a high incidence rate. Through partnership, a cohesive Jordanian tuberculosis strategy was developed for Syrian refugees and it has potential to inform treatment and control efforts for other regional countries impacted by the Syrian crisis.

Tuberculosis contact-tracing among Syrian refugee populations: lessons from Jordan

“…These findings should be linked with a previous study evaluating the public health strategy implemented in Jordan which found that its implementation led to a 40% increase of TB case detection among Syrians in the country [32]. Nevertheless, this positive picture is somewhat darkened by the low proportion of U5s presenting with a negative TST but in contact with a smear-positive case who were prescribed INH preventive therapy.…”

Pathogens, prejudice, and politics: the role of the global health community in the European refugee crisis

“…Most refugees entering Europe come from Syria, which had a tuberculosis prevalence of 23 people per 100 000 population in 2011, and 19 people per 100 000 population in 2014. 11,12 Tuberculosis prevalence in Syria is thus lower than the average in the European region of 39 people per 100 000 population, 13 and substantially below many European countries (table). 3,4 Furthermore, tuberculosis transmission from refugees to local populations does not occur often because of sparse contact.…”

A Review on Emerging and Reemerging of Infectious Diseases in Jordan: The Aftermath of the Syrian Crises

“…Cookson et al [23] studied that the augmented extent of tuberculosis has adhered among internally displaced individuals throughout the Middle East and European regions. Cookson et al [23] further demonstrated that the rates of tuberculosis were high among the displaced persons, but increased detection is predictable. Higher rates of tuberculosis were observed among the Syrian refugees and would predictably persist as the Syrian crisis endures.…”