Tuberculosis in Adult Migrants in Europe: A TBnet Consensus Statement

Authors

Heinke Kunst
Berit Lange
Olga Hovardovska
Annabelle Bockey
Dominik Zenner
Aase B Andersen
Sally Hargreaves
Manish Pareek
Jon S Friedland
Christian Wejse
Graham Bothamley
Lorenzo Guglielmetti
Dumitru Chesov
Simon Tiberi
Alberto Matteelli
Anna M Mandalakas
Jan Heyckendorf
Johannes Eimer
Akanksha Malhotra
Javier Zamora
Anca Vasiliu
Christoph Lange
TBnet

Publication Date

3-1-2025

Journal

European Respiratory Journal

DOI

10.1183/13993003.01612-2024

PMID

39672603

PMCID

PMC11883149

PubMedCentral® Posted Date

3-6-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Europe, Transients and Migrants, Tuberculosis, Adult, Consensus, Tuberculosis, Multidrug-Resistant, HIV Infections, Prevalence, Coinfection, Incidence, Mass Screening, European Union, Antitubercular Agents

Abstract

INTRODUCTION: Global migration has increased in recent decades owing to war, conflict, persecution and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs depending on migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances in TB care for migrants and new treatment strategies, decisions for managing migrants at risk of TB often rely on expert opinions, rather than clinical evidence.

METHODS: A systematic literature search was conducted, studies were mapped to different recommendation groups and included studies were synthesised by meta-analysis where appropriate. Current evidence on the diagnosis of active TB in migrants entering the European Union/European Economic Area and UK, including clinical presentation and diagnostic delay, treatment outcomes of drug-susceptible TB, prevalence, and treatment outcomes of multidrug-resistant/rifampicin-resistant TB and TB/HIV co-infection, was summarised. A consensus process was used based on the evidence.

RESULTS: We documented that migrants had higher vulnerability for TB, including an increased risk of extrapulmonary TB, multidrug-resistant/rifampicin-resistant TB, TB/HIV co-infection and worse TB treatment outcomes compared to host populations. Consensus recommendations include screening migrants for TB/latent TB infection according to country data, a minimal package for TB care in drug-susceptible and multidrug-resistant/rifampicin-resistant TB, implementation of migrant-sensitive strategies and free healthcare and preventive treatment for migrants with HIV co-infection.

CONCLUSION: Dedicated care for TB prevention and treatment in migrant populations within the European Union/European Economic Area and UK is essential.