Tuberculosis in migrants – screening, surveillance and ethics

Abstract

Tuberculosis (TB) is the leading infectious cause of human mortality and is responsible for nearly 2 million deaths every year. It is often regarded as a 'silent killer' because it predominantly affects the poor and marginalized, and disease outbreaks occur in 'slow motion' compared to Ebola or coronavirus 2 (COVID-19). In low incidence countries, TB is predominantly an imported disease and TB control in migrants is pivotal for countries to progress towards TB elimination in accordance with the World Health Organisations (WHO's) End TB strategy. This review provides a brief overview of the different screening approaches and surveillance processes that are in place in low TB incidence countries. It also includes a detailed discussion of the ethical issues related to TB screening of migrants in these settings and the different interests that need to be balanced. Given recognition that a holistic approach that recognizes and respects basic human rights is required to end TB, the review considers the complexities that require consideration in low-incidence countries that are aiming for TB elimination.

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

“…Thus, the friendly therapy policy in Taiwan has resulted in an improved experience of reducing structural barriers to TB mitigation since its implementation in 2014, which has successfully promoted the anti-TB treatment outcomes including improvement in treatment initiation especially those who with S− TB or B− TB and increasing treatment completion for those migrants with TB stayed in Taiwan. Therefore, based on our observations, there is a need for intensifying health education that promotes TB therapy includes delivering the information of the ongoing availability of free, accessible health services for vulnerable groups such as high-risk migrants; this health education could also be a critical element in increasing treatment success ( Hayward et al, 2018 ; Scandurra et al, 2020 ; Dangisso, Datiko & Lindtjørn, 2015 ) and early therapy for individuals with TB in receiving countries.…”

“…Additionally, because the higher number of SS− or B− TB cases among labor migrants than among marriage migrants was also worried as a potential risk of being delayed or untreated and then, in turn, developing TB dissemination. Since very few bacilli are sufficient to cause infection ( Sepkowitz, 1996 ; Scandurra et al, 2020 ), therapy should not be delayed in labor-migrants with SS− TB according to the WHO guidelines, especially those who were to provide long-term care for vulnerable people or the elderly; therefore, the initiation rate of anti-TB treatment within 30 days of diagnosis was concerned. After introducing the friendly therapy policy, the overall treatment initiation rate within 30 days of diagnosis was significantly increasing (OR: 1.31) among labor migrants.…”

Spatial clustering and temporal trend analysis of international migrants diagnosed with tuberculosis in Brazil

“…These include homeless people, the prison population, indigenous people, slumdwellers, and refugees or migrating individuals. The latter have left their homelands (usually regions with high TB endemicity) due to civil unrest or in search of better living conditions, migrating to other territories, which may contribute to the difficulty in eliminating TB, as already reported by several authors [2][3][4][5].…”

Screening for Tuberculosis in Migrants: A Survey by the Global Tuberculosis Network

“…Compared with other vulnerable groups, such as contacts of patients with TB and persons with immunocompromising conditions, these migrants have the highest risk of developing TB and might benefit from follow-up with TB services [ 40 ]. Reducing barriers for migrants to access health services in the destination country and providing culturally appropriate TB services are important components of migrant TB programmes [ 41 ].…”