RT Journal Article
SR Electronic
T1 Tuberculosis among asylum seekers in Milan, Italy: epidemiological analysis and evaluation of interventions
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1900896
DO 10.1183/13993003.00896-2019
VO 54
IS 4
A1 Simone Villa
A1 Luigi Ruffo Codecasa
A1 Marino Faccini
A1 Mirella Maria Pontello
A1 Maurizio Ferrarese
A1 Paola Francesca Castellotti
A1 Sabrina Senatore
A1 Anna Lamberti
A1 Ester Mazzola
A1 Carlo Federico Perno
A1 Daniela Campisi
A1 Matteo Saporiti
A1 Mario Carlo Raviglione
YR 2019
UL http://erj.ersjournals.com/content/54/4/1900896.abstract
AB 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.Asylum seekers are vulnerable to TB owing to migration-related events and marginalisation in destination countries. Coordinated screening and surveillance programmes using well-informed datasets can reduce TB transmission, improve care and address LTBI. http://bit.ly/2SPp0uZ