Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017

Sally E Hayward; Kieran Rustage; Laura B Nellums; Marieke J van der Werf; Teymur Noori; Delia Boccia; Jon S Friedland; Sally Hargreaves

doi:10.1016/j.cmi.2020.12.006

Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017

Clin Microbiol Infect. 2021 Sep;27(9):1347.e1-1347.e7. doi: 10.1016/j.cmi.2020.12.006. Epub 2020 Dec 19.

Authors

Sally E Hayward¹, Kieran Rustage², Laura B Nellums³, Marieke J van der Werf⁴, Teymur Noori⁴, Delia Boccia⁵, Jon S Friedland², Sally Hargreaves²

Affiliations

¹ Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: shayward@sgul.ac.uk.
² Institute for Infection and Immunity, St George's, University of London, London, UK.
³ Institute for Infection and Immunity, St George's, University of London, London, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
⁴ European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.
⁵ Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.

Abstract

Objectives: The proportion of tuberculosis (TB) cases occurring in migrants in Europe is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin.

Methods: We carried out a cross-sectional secondary database analysis, utilizing 23 years of data collected between 1995 and 2017 from the European Surveillance System of the European Centre for Disease Prevention and Control for 32 EU/EFTA countries.

Results: In total, 1 270 896 TB cases were included, comprising 326 987 migrants (25.7%) and 943 909 non-migrants (74.3%). Of TB cases among migrants, 45.2% (n = 147 814) were extrapulmonary compared to 21.7% (n = 204 613) among non-migrants (p < 0.001). Lymphatic, bone/joint and peritoneal/digestive TB were more common among migrant than non-migrant extrapulmonary cases. A lower proportion of extrapulmonary TB was seen in Eastern Europe (17.4%, n = 98 656 of 566 170) and Southern Europe (29.6%, n = 62 481 of 210 828) compared with Western (35.7%, n = 89 498 of 250 517) and Northern Europe (41.8%, n = 101 792 of 243 381). Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary disease, with 62.0% (n = 55 401 of 89 353) and 54.5% (n = 38 327 of 70 378) of cases, respectively, being extrapulmonary.

Conclusions: Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than in non-migrants. There is a need to improve clinical awareness of extrapulmonary TB and to integrate its detection into screening programmes.

Keywords: Europe; Extrapulmonary tuberculosis; Health services research; Migrant; Tuberculosis.

MeSH terms

Cross-Sectional Studies
Europe / epidemiology
European Union
Humans
Transients and Migrants* / statistics & numerical data
Tuberculosis* / diagnosis
Tuberculosis* / epidemiology

Abstract

MeSH terms

Grants and funding