ABSTRACT
SETTING: Malta, 2002-2005. OBJECTIVES: To describe the demography and tuberculosis (TB) epidemiology of undocumented immigrants to Malta to tailor TB control strategies to this population. DESIGN: Retrospective population study of undocumented immigrants to Malta using national TB surveillance data. RESULTS: Overall, 85% (4570/5383) of undocumented immigrants were screened on entry using chest X-ray (CXR). Undocumented immigrants were mostly young adults aged 15-34 years (81%) and predominately male (86%), mostly originating from Africa (88%). On screening, 3.5% (160/4570) had CXR suggestive of TB, of whom 12.5% (20/160) had active TB. Using both active and passive surveillance, 33 cases of active TB were diagnosed in these immigrants, 94% of whom were diagnosed during their first 12 months of residence in Malta. Entry screening detected 61% (20/33) of cases (yield 0.44%). Of the total TB cases in Malta, the proportion of undocumented immigrants increased markedly from 33% in 2002 to 60% in 2005. The reported TB incidence among immigrants was 390/100,000 compared to 2.1/100,000 in the Malta-born. CONCLUSION: Tailoring TB control strategies to this migrant population is essential for TB control in Malta. Awareness of increased risk of TB needs to be ongoing, not just at entry but for many years after arrival, even in resettlement countries.
Subject(s)
Emigrants and Immigrants , Health Policy , Mass Screening/methods , Tuberculosis/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Malta/epidemiology , Middle Aged , Retrospective Studies , Tuberculosis/diagnosis , Young AdultABSTRACT
In the European Union (EU) 72,334 tuberculosis (TB) cases were notified in 2011, of which 16,116 (22%) had extrapulmonary tuberculosis (EPTB). The percentage of TB cases with EPTB ranged from 4% to 48% in the reporting countries. This difference might be explained by differences in risk factors for EPTB or challenges in diagnosis. To assess the practices in diagnosis of EPTB we asked European Union/European Economic Area (EU/EEA) countries to participate in a report describing the diagnostic procedures and challenges in diagnosing EPTB. Eleven EU Member States participated and reports showed that in the majority EPTB is diagnosed by a pulmonologist, sometimes in collaboration with the doctor who is specialised in the organ where the symptoms presented. In most countries a medical history and examination is followed by invasive procedures, puncture or biopsy, to collect material for confirmation of the disease (by culture/histology/cytology). Some countries also use the tuberculin skin test or an interferon-gamma-release-assay. A wide variety of radiological tests may be used. Countries that reported challenges in the diagnosis of EPTB reported that EPTB is often not considered because it is a rare disease and most medical professionals will not have experience in diagnosing EPTB. The fact that EPTB can present with a variety of symptoms that may mimic symptoms of other pathologies does pose a further challenge in diagnosis. In addition, obtaining an appropriate sample for confirmation of EPTB was frequently mentioned as a challenge. In summary, diagnosis of EPTB poses challenges due to the diversity of symptoms with which EPTB may present, the low level of suspicion of clinicians, and due to the difficulty in obtaining an adequate sample for confirmation.
