Adult tuberculosis in Israel and migration: trends and challenges between 1999 and 2010.

BACKGROUND: Israel absorbs many migrants from countries with a high prevalence of tuberculosis (TB). OBJECTIVES: To describe the epidemiology of TB among adults in Israel between 1999 and 2010 and identify populations with a high TB burden. DESIGN: Data were retrieved from the National Tuberculosis Registry and the Israeli Bureau of Statistics. RESULTS: A total of 4652 adult TB patients were notified during the study period, with rates decreasing annually from 7.5 per 100,000 population in 1999 to 4.3 in 2010. Most (n = 3745, 80.5%) had pulmonary TB, the average female:male ratio was 1:1.4, and 227 (5.1%) were infected with the human immunodeficiency virus. Of all TB patients, 4079 (87.6%) were born outside Israel; of these, 3338 were citizens and 741 non-citizen migrant workers (MWs). The average annual rates of TB among Israeli-born citizens, foreign-born citizens and MWs were respectively 0.86, 11.9 and 27/100,000. The ratio of MWs to foreign-born citizens fell from 1:11.7 in 1999 to 1:1.5 in 2010. TB was diagnosed 13.9 ± 7.5 years following entry to Israel, mostly during the first year. Of 3551 isolates, 222 (4.5%) were multidrug-resistant; most (95.6%) were from foreign-born patients. The average treatment success rate for smear-positive pulmonary TB was 84.3%. CONCLUSION: TB rates have decreased, while the proportion of foreign-born subjects, particularly MWs, has increased. Adherence to preventive treatment can prevent TB in these cases.