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Abstract

Background

Germany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities.

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/content/10.2807/1560-7917.ES.2018.23.11.17-00042
2018-03-15
2024-04-26
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.11.17-00042
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References

  1. World Health Organization (WHO). Global tuberculosis report 2017. Geneva: WHO; 2017. Available from: http://apps.who.int/iris/bitstream/10665/259366/1/9789241565516-eng.pdf?ua=1
  2. European Centre for Disease Prevention and Control (ECDC)/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2016. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2016
  3. Robert Koch Institute (RKI). Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2016. [German tuberculosis surveillance report 2016]. Berlin: RKI; 2017. German. Available from: https://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Download/TB2016.pdf;jsessionid=A7701BC5522F7BB961DFA52EB767FFD1.1_cid381?__blob=publicationFile
  4. Fiebig L, Hauer B, Brodhun B, Altmann D, Haas W. Tuberculosis in Germany: a declining trend coming to an end? Eur Respir J. 2016;47(2):667-70.  https://doi.org/10.1183/13993003.01410-2015  PMID: 26493803 
  5. World Health Organization (WHO). The global plan to stop TB 2011-2015: Transforming the fight towards elimination of tuberculosis. Geneva: WHO; 2011. Available from: http://apps.who.int/iris/bitstream/10665/44437/1/9789241500340_eng.pdf
  6. Diel R, Loytved G, Nienhaus A, Castell S, Detjen A, Geerdes-Fenge H, et al. Neue Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose. [New recommendations for contact tracing in tuberculosis. German Central Committee against Tuberculosis]. Pneumologie. 2011;65(6):359-78. German.  https://doi.org/10.1055/s-0030-1256439  PMID: 21560113 
  7. Robert Koch Institute (RKI). Untersuchung von Asylsuchenden und Flüchtlingen auf TB – Onlinebefragung des DZK. [Screening asylum seekers and refugees for tuberculosis – an online survey by the German Central Committee against Tuberculosis (DZK)]. Epid Bulletin.2016;10/11:84-6. German.
  8. Halder G, Zühl J. (Tuberculosis among asylum seekers in Munich). Tuberkulose bei Asylbewerbern in München. J. Gesundheitswesen.2016;78(4):V26.
  9. Robert Koch Institute (RKI). Tuberkulose-Screening im Rahmen der infektionshygienischen Untersuchung Asylbegehrender in Rheinland-Pfalz, Trier. [Tuberculosis screening as part of the entrance examination for asylum seekers in Rhineland –Palatinate, Trier]. Epid Bulletin.2015;11/12:88-90. German.
  10. Schönfeld N. Tuberkulose bei Geflüchteten – was Sie beachten sollten. [Tuberculosis among refugees – what you should consider]. Pneumo News. 2016;8(7S):1-5. German. Available from: https://www.bgw-online.de/DE/Arbeitssicherheit-Gesundheitsschutz/Grundlagen-Forschung/GPR-Medientypen/Downloads/Tb-Fluechtlinge_Download.pdf?__blob=publicationFile
  11. Dreweck C, Kerner E, Gullich K, Halder G. Die soziale Dimension der Tuberkulose in der Stadt München. [The social dimension of tuberculosis in the city of Munich]. Gesundheitswesen. 2013;75(11):689-92. German. Available from: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0033-1357154
  12. Schaberg T, Bauer T, Castell S, Dalhoff K, Detjen A, Diel R, et al. Empfehlungen zur Therapie, Chemoprävention und Chemoprophylaxe der Tuberkulose im Erwachsenen- und Kindesalter. Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose (DZK), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). [Recommendations for therapy, chemoprevention and chemoprophylaxis of tuberculosis in adults and children. German Central Committee against Tuberculosis (DZK), German Respiratory Society (DGP)]. Pneumologie. 2012;66(3):133-71. German.  PMID: 22328186 
  13. Stop TB. Partnership. The paradigm shift 2016-2020. Global plan to end TB. Geneva: Stop TB Partnership; UN OPS; 2015. Available from: http://www.stoptb.org/assets/documents/global/plan/GlobalPlanToEndTB_TheParadigmShift_2016-2020_StopTBPartnership.pdf
  14. Faensen D, Claus H, Benzler J, Ammon A, Pfoch T, Breuer T, et al. SurvNet@RKI--a multistate electronic reporting system for communicable diseases. Euro Surveill. 2006;11(4):614.  https://doi.org/10.2807/esm.11.04.00614-en 
  15. Robert Koch Institute (RKI). Falldefinitionen des Robert Koch-Instituts zur Übermittlung von Erkrankungs- oder Todesfällen und Nachweisen von Krankheitserregern. [Case definitions from the Robert Koch Institute for reporting of disease cases or deaths and of pathogens]. Berlin: RKI; 2015. German. Available from: https://www.rki.de/DE/Content/Infekt/IfSG/Falldefinition/Downloads/Falldefinitionen_des_RKI.pdf?__blob=publicationFile
  16. Robert Koch Institute (RKI). Leitfaden zur Übermittlung von Fallberichten zur Tuberkulose. [Surveillance reporting guidelines for case notifications of tuberculosis]. Berlin: RKI; 2004. German. Available from: http://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Download/TB_Leitfaden.pdf?__blob=publicationFile
  17. Robert Koch Institute (RKI). Thorax-Röntgenuntersuchungen bei Asylsuchenden gemäß § 36 Absatz 4 IfSG. [Chest X-ray examination among asylum seekers according to § 36.4 Protection Against Infection Act]. Berlin: RKI; 2015. German. Available from: http://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Tuberkulose_Roentgen-Untersuchungen_Asylsuchende.html
  18. Robert Koch Institute (RKI). Untersuchung auf Tuberkulose bei asylsuchenden Kindern und Jugendlichen < 15 Jahre. [Tuberculosis diagnostics among asylum seeking children and teens < 15 years of age]. Berlin: RKI; 2015. German. Available from: http://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Tuberkulose-Screening_Kinder.html
  19. Tsuda Y, Matsumoto K, Komukai J, Furukawa K, Saito K, Shimouchi A. Tuberculosis screening by chest radiography among international students at Japanese language schools in Osaka city. Kekkaku. 2015;90(10):677-82. Japanese. PMID: 26821397 
  20. Story A, Aldridge RW, Abubakar I, Stagg HR, Lipman M, Watson JM, et al. Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study. Int J Tuberc Lung Dis. 2012;16(11):1461-7.  https://doi.org/10.5588/ijtld.11.0773  PMID: 22981252 
  21. Kranzer K, Afnan-Holmes H, Tomlin K, Golub JE, Shapiro AE, Schaap A, et al. The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review. Int J Tuberc Lung Dis. 2013;17(4):432-46.  https://doi.org/10.5588/ijtld.12.0743  PMID: 23485377 
  22. Verver S, Bwire R, Borgdorff MW. Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness. Int J Tuberc Lung Dis. 2001;5(5):419-25. PMID: 11336272 
  23. Aldridge RW, Zenner D, White PJ, Williamson EJ, Muzyamba MC, Dhavan P, et al. Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet. 2016;388(10059):2510-8.  https://doi.org/10.1016/S0140-6736(16)31008-X  PMID: 27742165 
  24. Cousins S. Experts sound alarm as Syrian crisis fuels spread of tuberculosis. BMJ. 2014;349(dec03 5):g7397.  https://doi.org/10.1136/bmj.g7397  PMID: 25471893 
  25. Lin S, Melendez-Torres GJ. Systematic review of risk factors for nonadherence to TB treatment in immigrant populations. Trans R Soc Trop Med Hyg. 2016;110(5):268-80.  https://doi.org/10.1093/trstmh/trw025  PMID: 27198210 
  26. Cegolon L, Maguire H, Mastrangelo G, Carless J, Kruijshaar ME, Verlander NQ. Predictors of failure to complete tuberculosis treatment in London, 2003-2006. Int J Tuberc Lung Dis. 2010;14(11):1411-7. PMID: 20937180 
  27. Karo B, Hauer B, Hollo V, van der Werf MJ, Fiebig L, Haas W. Tuberculosis treatment outcome in the European Union and European Economic Area: an analysis of surveillance data from 2002-2011. Euro Surveill. 2015;20(49):30087.  https://doi.org/10.2807/1560-7917.ES.2015.20.49.30087  PMID: 26676247 
  28. Hauer B, Brodhun B, Altmann D, Fiebig L, Loddenkemper R, Haas W. Tuberculosis in the elderly in Germany. Eur Respir J. 2011;38(2):467-70.  https://doi.org/10.1183/09031936.00199910  PMID: 21804163 
  29. Ditah IC, Reacher M, Palmer C, Watson JM, Innes J, Kruijshaar ME, et al. Monitoring tuberculosis treatment outcome: analysis of national surveillance data from a clinical perspective. Thorax. 2008;63(5):440-6.  https://doi.org/10.1136/thx.2006.073916  PMID: 17615085 
  30. Gadoev J, Asadov D, Tillashaykhov M, Tayler-Smith K, Isaakidis P, Dadu A, et al. Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study. PLoS One. 2015;10(6):e0128907.  https://doi.org/10.1371/journal.pone.0128907  PMID: 26075615 
  31. de Faria Gomes NM, da Mota Bastos MC, Marins RM, Barbosa AA, Soares LC, de Oliveira Wilken de Abreu AM, et al. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality. Pulm Med. 2015;2015:546106.
  32. Ducomble T, Tolksdorf K, Karagiannis I, Hauer B, Brodhun B, Haas W, et al. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill. 2013;18(12):20436. PMID: 23557944 
  33. Loytved G, Steidle B, Benz E, Koszczynski W. Tuberkulosebekämpfung in Unterfranken 1995 - 2001 - Fallfindung und Behandlungsergebnisse. [Tuberculosis control in lower Franconia 1995 - 2001. Case-finding and treatment outcome]. Pneumologie. 2002;56(6):349-56.  https://doi.org/10.1055/s-2002-32171  PMID: 12063615 
  34. Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007;4(7):e238.  https://doi.org/10.1371/journal.pmed.0040238  PMID: 17676945 
  35. Abarca Tomás B, Pell C, Bueno Cavanillas A, Guillén Solvas J, Pool R, Roura M. Tuberculosis in migrant populations. A systematic review of the qualitative literature. PLoS One. 2013;8(12):e82440.  https://doi.org/10.1371/journal.pone.0082440  PMID: 24349284 
  36. Lönnroth K, Migliori GB, Abubakar I, D’Ambrosio L, de Vries G, Diel R, et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J. 2015;45(4):928-52. PMID: 25792630 
Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Anna+Kuehne&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuehne Anna</a>, <a href="/search?value1=Barbara+Hauer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hauer Barbara</a>, <a href="/search?value1=Bonita+Brodhun&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brodhun Bonita</a>, <a href="/search?value1=Walter+Haas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haas Walter</a>, <a href="/search?value1=Lena+Fiebig&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fiebig Lena</a></span>. Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(11):pii=17-00042. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.11.17-00042" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.11.17-00042</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 13 Jan 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 12 Nov 2017 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.11.17-00042
/content/10.2807/1560-7917.ES.2018.23.11.17-00042
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