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European-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.


We aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.


The Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.


Data on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.


Country of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.


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  1. Koch R. Die Aetiologie der Tuberkulose.[The etiology of tuberculosis]. Berl Klin Wschr.1882;15:221-30. German.
  2. McAuliffe M, Triandafyllidou A. World Migration Report 2022. Geneva: International Organization for Migration (IOM); 2021. Available from: https://publications.iom.int/books/world-migration-report-2022
  3. Dhavan P, Dias HM, Creswell J, Weil D. An overview of tuberculosis and migration. Int J Tuberc Lung Dis. 2017;21(6):610-23.  https://doi.org/10.5588/ijtld.16.0917  PMID: 28482955 
  4. European Centre for Disease Prevention and Control (ECDC), and World Health Organization Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 – 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2022-2020-data
  5. World Health Organization (WHO). Global Tuberculosis Report. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240037021
  6. Lönnroth K, Raviglione M. The WHO’s new End TB Strategy in the post-2015 era of the Sustainable Development Goals. Trans R Soc Trop Med Hyg. 2016;110(3):148-50.  https://doi.org/10.1093/trstmh/trv108  PMID: 26884490 
  7. Hollo V, Beauté J, Ködmön C, van der Werf MJ. Tuberculosis notification rate decreases faster in residents of native origin than in residents of foreign origin in the EU/EEA, 2010 to 2015. Euro Surveill. 2017;22(12):30486.  https://doi.org/10.2807/1560-7917.ES.2017.22.12.30486  PMID: 28367798 
  8. Lönnroth K, Mor Z, Erkens C, Bruchfeld J, Nathavitharana RR, van der Werf MJ, et al. Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points. Int J Tuberc Lung Dis. 2017;21(6):624-37.  https://doi.org/10.5588/ijtld.16.0845  PMID: 28482956 
  9. Matteelli A, Rendon A, Tiberi S, Al-Abri S, Voniatis C, Carvalho ACC, et al. Tuberculosis elimination: where are we now? Eur Respir Rev. 2018;27(148):180035. . Available from: https://err.ersjournals.com/content/27/148/180035 https://doi.org/10.1183/16000617.0035-2018  PMID: 29898905 
  10. Styblo K. The elimination of tuberculosis in The Netherlands. Bull Int Union Tuberc Lung Dis. 1990;65(2-3):49-55. PMID: 2257359 
  11. D’Ambrosio L, Dara M, Tadolini M, Centis R, Sotgiu G, van der Werf MJ, et al. , European national programme representatives. Tuberculosis elimination: theory and practice in Europe. Eur Respir J. 2014;43(5):1410-20.  https://doi.org/10.1183/09031936.00198813  PMID: 24389868 
  12. European Centre for Disease Prevention and Control (ECDC). Programmatic management of latent tuberculosis infection in the European Union. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/programmatic-management-latent-tuberculosis-infection-european-union
  13. Lorenz M, Aisch G, Kokkelink D. Datawrapper. Enrich your stories with charts, maps, and tables. [Accessed: 19 Sep 2023]. Available from: https://www.datawrapper.de/
  14. SankeyMATIC. Make beautiful flow diagrams. [Accessed: 1 Aug 2022]. Available from: https://sankeymatic.com/
  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7.  https://doi.org/10.1016/S0140-6736(07)61602-X  PMID: 18064739 
  16. World Health Organization (WHO). Tuberculosis prevention and care among refugees and other populations in humanitarian settings: an interagency field guide. Geneva: WHO; 2 Mar 2022. Available from: https://www.who.int/publications/i/item/9789240042087
  17. Ködmön C, Zucs P, van der Werf MJ. Migration-related tuberculosis: epidemiology and characteristics of tuberculosis cases originating outside the European Union and European Economic Area, 2007 to 2013. Euro Surveill. 2016;21(12):30164.  https://doi.org/10.2807/1560-7917.ES.2016.21.12.30164  PMID: 27039665 
  18. Dale KD, Trauer JM, Dodd PJ, Houben RMGJ, Denholm JT. Estimating Long-term Tuberculosis Reactivation Rates in Australian Migrants. Clin Infect Dis. 2020;70(10):2111-8.  https://doi.org/10.1093/cid/ciz569  PMID: 31246254 
  19. van den Boogaard J, Slump E, Schimmel HJ, van der Hoek W, van den Hof S, de Vries G. High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands. Emerg Infect Dis. 2020;26(4):675-81.  https://doi.org/10.3201/eid2604.190123  PMID: 32186488 
  20. Dale KD, Karmakar M, Snow KJ, Menzies D, Trauer JM, Denholm JT. Quantifying the rates of late reactivation tuberculosis: a systematic review. Lancet Infect Dis. 2021;21(10):e303-17.  https://doi.org/10.1016/S1473-3099(20)30728-3  PMID: 33891908 
  21. Swedish Parliament. Lag (2008:344) om hälso- och sjukvård åt asylsökande m.fl. [Act (2008:344) on healthcare for asylum seekers and others]. Stockholm: Swedish Parliament. [Accessed 3 Oct 2023]. Swedish. Available from: https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/lag-2008344-om-halso-och-sjukvard-at_sfs-2008-344/
  22. Wild V, Jaff D, Shah NS, Frick M. Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe. Int J Tuberc Lung Dis. 2017;21(10):1075-85.  https://doi.org/10.5588/ijtld.17.0324  PMID: 28911349 
  23. Walker TM, Merker M, Knoblauch AM, Helbling P, Schoch OD, van der Werf MJ, et al. , MDR-TB Cluster Consortium. A cluster of multidrug-resistant Mycobacterium tuberculosis among patients arriving in Europe from the Horn of Africa: a molecular epidemiological study. Lancet Infect Dis. 2018;18(4):431-40.  https://doi.org/10.1016/S1473-3099(18)30004-5  PMID: 29326013 
  24. Heuvelings CC, de Vries SG, Grobusch MP. Tackling TB in low-incidence countries: improving diagnosis and management in vulnerable populations. Int J Infect Dis. 2017;56:77-80.  https://doi.org/10.1016/j.ijid.2016.12.025  PMID: 28062228 
  25. Arrazola de Oñate W, Weber L, Janssens K, Wanlin M, Forier A, Schol S, et al. Tuberculosis screening yield of asylum seekers in Europe. Eur Respir J. 2016;48(4):1253-4.  https://doi.org/10.1183/13993003.00991-2016  PMID: 27694419 
  26. Bozorgmehr K, Preussler S, Wagner U, Joggerst B, Szecsenyi J, Razum O, et al. Using country of origin to inform targeted tuberculosis screening in asylum seekers: a modelling study of screening data in a German federal state, 2002-2015. BMC Infect Dis. 2019;19(1):304.  https://doi.org/10.1186/s12879-019-3902-x  PMID: 30943917 
  27. Heldal E, Kuyvenhoven JV, Wares F, Migliori GB, Ditiu L, Fernandez de la Hoz K, et al. Diagnosis and treatment of tuberculosis in undocumented migrants in low- or intermediate-incidence countries. Int J Tuberc Lung Dis. 2008;12(8):878-88. PMID: 18647446 

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