Reversing the tide of the UK tuberculosis epidemic

ArticleinThe Lancet 382(9901):1311-2 · October 2013with22 Reads
DOI: 10.1016/S0140-6736(13)62113-3 · Source: PubMed
    • "Upon infection , second generation migrants might incur an increased risk of disease progression compared to native residents due to socio-economic, lifestyle and nutritional factors. The high risk of tuberculosis in individuals with a personal history of immigration to Western Europe, such as asylum seekers, is well documented272829 . We found that most first generation migrants with tuberculosis immigrated to Germany in more recent years, a finding that is consistent with previous studies that have documented a continuous decline but persistently high risk of tuberculosis over time since immigration [1,303132. "
    [Show abstract] [Hide abstract] ABSTRACT: In Western Europe, migrants constitute an important risk group for tuberculosis, but little is known about successive generations of migrants. We aimed to characterize migration among tuberculosis cases in Berlin and to estimate annual rates of tuberculosis in two subsequent migrant generations. We hypothesized that second generation migrants born in Germany are at higher risk of tuberculosis compared to native (non-migrant) residents. A prospective cross-sectional study was conducted. All tuberculosis cases reported to health authorities in Berlin between 11/2010 and 10/2011 were eligible. Interviews were conducted using a structured questionnaire including demographic data, migration history of patients and their parents, and language use. Tuberculosis rates were estimated using 2011 census data. Of 314 tuberculosis cases reported, 154 (49.0%) participated. Of these, 81 (52.6%) were first-, 14 (9.1%) were second generation migrants, and 59 (38.3%) were native residents. The tuberculosis rate per 100,000 individuals was 28.3 (95CI: 24.0-32.6) in first-, 10.2 (95%CI: 6.1-16.6) in second generation migrants, and 4.6 (95%CI: 3.7-5.6) in native residents. When combining information from the standard notification variables country of birth and citizenship, the sensitivity to detect second generation migration was 28.6%. There is a higher rate of tuberculosis among second generation migrants compared to native residents in Berlin. This may be explained by presumably frequent contact and transmission within migrant populations. Second generation migration is insufficiently captured by the surveillance variables country of birth and citizenship. Surveillance systems in Western Europe should allow for quantifying the tuberculosis burden in this important risk group.
    Full-text · Article · Jun 2015
    • "This might be due to those with type 1 diabetes mainly receiving their care in hospital out-patients clinics and notification of TB diagnoses not being returned to general practice. If a large number of cases of TB in the UK are due to reactivation of latent disease from those born in high TB burden countries [2, 1], it might be that incidence of type 1 diabetes in these populations is low, as supported by global incidence studies [34] or that these patients suffer competing risks before possible reactivation of TB infection. Current UK guidelines advise considering treatment for latent TB infection in certain groups of adults where active disease has been ruled out but they show signs of TB infection with Mantoux positivity (≥6 mm) and without prior Bacillus Calmette-Guérin (BCG) vaccination, or strong Mantoux positivity (≥15 mm) or interferongamma release assay (IGRA) positive and with prior BCG vaccination [35]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Previous cohort studies demonstrate diabetes as a risk factor for tuberculosis (TB) disease. Public Health England has identified improved TB control as a priority area and has proposed a primary care-based screening program for latent TB. Methods: Using data from the UK Clinical Practice Research Datalink we constructed a cohort of patients with incident diabetes. We included 222,731 patients with diabetes diagnosed from 1990-2013 and 1,218,616 controls without diabetes at index date who were matched for age, sex and general practice. The effect of diabetes was explored using a Poisson analysis adjusted for age, ethnicity, body mass index, socioeconomic status, alcohol intake and smoking. We explored the effects of age, diabetes duration and severity. The effects of diabetes on risk of incident TB were explored across strata of chronic disease care defined by cholesterol and blood pressure measurement and influenza vaccination rates. Results: During just under 7 million person-years of follow-up, 969 cases of TB were identified. The incidence of TB was higher amongst patients with diabetes compared with the unexposed group: 16.2 and 13.5 cases per 100,000 person-years, respectively. After adjustment for potential confounders the association between diabetes and TB remained (adjusted RR 1.30, 95 % CI 1.01 to 1.67, P?=?0.04). There was no evidence that age, time since diagnosis and severity of diabetes affected the association between diabetes and TB. Diabetes patients with the lowest and highest rates of chronic disease management had a higher risk of TB (P <0.001 for all comparisons). Conclusions: Diabetes as an independent risk factor is associated with only a modest overall increased risk of TB in our UK General Practice cohort and is unlikely to be sufficient cause to screen for latent TB. Across different consulting patterns, diabetes patients accessing the least amount of chronic disease care are at highest risk for TB.
    Full-text · Article · Jun 2015
    • "The issue of vaccination for infectious diseases may also be important for health-care providers to address. There have been calls to strengthen primary-care-based screening programmes, and to place renewed focus on latent tuberculosis screening to tackle the rising tide of tuberculosis [17,18]. However, there remains a paucity of data on barriers to, and acceptability of, screening programmes for infectious diseases specifically in newly arrived migrants, and potential ways forward; addressing these shortfalls remains an important component in the strategy to tackle rising rates of infectious diseases. "
    [Show abstract] [Hide abstract] ABSTRACT: Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants.
    Full-text · Article · Oct 2014
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