Surveillance of tuberculosis and treatment outcomes following screening and therapy interventions among marriage-migrants and labor-migrants from high TB endemic countries in Taiwan

Abstract

Background Tuberculosis (TB) among migrants from high-risk countries and underling interventions were concerned for disease control. This study aimed to assess the TB trends among marriage-migrants with the 1–2-round vs. labor-migrants with the four-round TB screenings in the period of the first four post-entry years; pre-entry screenings by an initial chest X-ray (CXR) were conducted during 2012–2015, and a friendly treatment policy was introduced in 2014. Methods TB data of migrants during 2012–2015 were obtained from the National TB Registry Database and analyzed. The incidences, clinical characteristics, and treatment outcomes were assessed to explore the impact of underlying interventions. Results During post-entry 0–4 years, the TB incidence rates among marriage-migrants ranged 11–90 per 100,000 person-years, with 60.8% bacteria-positive and 28.2% smear-positive cases. Whereas among labor migrants, the incidence rates ranged 67–120 per 100,000 person-years, with 43.6% bacteria-positive and 13.7% smear-positive cases. All migrants originated from Southeast Asia following pre-entry health screening in 2012–2015. The TB cases among marriage-migrants were with a higher proportion of sputum-smear-positivity (SS+) (OR: 4.82, 95% CI [3.7–6.34]) and CXR cavitation (OR: 2.90, 95% CI [2.10–4.01]). Marriage-migrants with TB had treatment completion rate of >90%, which was above the WHO target. For labor-migrants with TB, when compared the period of post- vs. pre-implementation of the friendly therapy policy that eliminated compulsory repatriation, the overall treatment completion rate of those who stayed in Taiwan improved by 30.9% (95% CI [24.3–37.6]) vs. 6.7% (95% CI [3.8–9.7]), which exceeded a 4.88-fold (95% CI: 3.83–6.22) improvement. Additionally, the treatment initiation rate within 30 days of diagnosis for SS- TB and B- TB cases during post- vs. pre-implementation of the therapy policy was increased, that is, 77.1% vs. 70.9% (OR: 1.38, 95% CI [1.12–1.70]) and 78% vs. 77% (OR: 1.64, 95% CI [1.38–1.95]). Conclusion Multiple CXR screenings could identify more TB cases with sputum-smear-negativity (SS-) TB at the early-stage, introducing latent tuberculosis infection (LTBI) screening might save underlying efforts. For those labor-migrants with TB who stayed in the receiving country, the friendly TB therapy policy not only significantly improved the treatment completion but also the early treatment initiation.

Mandatory, voluntary, repetitive, or one-off post-migration follow-up for tuberculosis prevention and control: A systematic review

“…In Taiwan, all 4 rounds of screening were reported to be mandatory to obtain a residency permit. Additionally, when detected with TB disease or multidrug-resistant tuberculosis (MDR) migrants may be repatriated to their countries of origin [ 45 ] (this was later changed to be only true for MDR-tuberculosis [ 46 ]). All other studies, however, do not report what legal consequences the individual may face in the case of non-compliance with the screening regulations or which measures can be taken by the responsible institution in order to ensure compliance with the screening.…”

Epidemiology of tuberculosis in foreign students in Japan, 2015–2019: a comparison with the notification rates in their countries of origin

“…https://doi.org/10.1017/S0950268821001977 Downloaded from https://www.cambridge.org/core. IP address: 44.224.250.200, on 30 Aug 2021 at 02:32:59, subject to the Cambridge Core terms of use, available at related immigrants to Taiwan from China, Indonesia, the Philippines, Thailand, and Viet Nam and the rates were much lower, being about 10 (marriage-related immigrants from China) to 150 (labour-related immigrants from Indonesia) per 100 000 population [34]. This is probably because Taiwan requires visa applicants for internship and foreign spouses of health certificates [35], including chest X-ray findings [36], whereas Japan so far does not require any visa applicants of health certificates.…”

“…We previously investigated the positivity of the interferon- γ release assay (IGRA) among foreigners in Japan and the findings may support our current study: the IGRA positivity was well over 20% in those from Myanmar and Nepal, whereas it was not very high (about 3.0–6.0%) in those from China, the Republic of Korea, Sri Lanka, Taiwan and Vietnam [ 33 ], probably reflecting the variation of TB risks among these countries. Kuan reported the TB notification rates of labour- and marriage-related immigrants to Taiwan from China, Indonesia, the Philippines, Thailand and Vietnam and the rates were much lower, being about 10 (marriage-related immigrants from China) to 150 (labour-related immigrants from Indonesia) per 100 000 population [ 34 ]. This is probably because Taiwan requires visa applicants for internship and foreign spouses of health certificates [ 35 ], including chest X-ray findings [ 36 ], whereas Japan so far does not require any visa applicants of health certificates.…”