Sotgiu Giovanni, Dara Masoud, Centis Rosella, Matteelli Alberto, Solovic Ivan, Gratziou Christina, Rendon Adrian, Battista Migliori Giovanni
University of Sassari, Department of Biomedical Sciences, Clinical Epidemiology and Medical Statistics Unit, Sassari, Italy.
World Health Organization Regional Office for Europe, Copenhagen, Denmark.
Presse Med. 2017 Mar;46(2 Pt 2):e5-e11. doi: 10.1016/j.lpm.2017.01.013. Epub 2017 Feb 28.
Tuberculosis (TB) can represent an important clinical and public health in developing and developed countries. Low- and middle-income countries are facing an epidemic which is difficult to address because of the drug-resistance spread and the association of TB with HIV/AIDS. High-income countries, whose TB incidence has decreased in the last decades, can be involved in new TB epidemic waves owing to social, healthcare, and economic hurdles and challenges. In particular, migrants coming from high TB incidence countries can represent a new epidemiological issue in the TB care and control in geographical areas where primary care and specialized centres are not equipped to face the clinical and public health issues associated with the TB disease. The healthcare management of individuals with a latent TB infection or the TB disease is heterogeneous and different policies are in place in Europe, and, specifically, in EU countries. Scientific evidence on how to early and efficiently detect TB cases is missing, as well as diagnostic tools to diagnose those who have latent TB infection do not show adequate accuracy. Countries like Greece and Italy have political difficulties in the management of migrants and the poor living conditions in the migration centres can increase the probability of Mycobacterium tuberculosis transmission. A clear advocacy and political commitment are urgently required. The current migration trends represent a threat from a human and a healthcare perspective. New homogeneous and target-oriented policies and strategies are needed to improve the health of the migrant and of the autochthonous populations.
结核病在发展中国家和发达国家都是一个重要的临床和公共卫生问题。低收入和中等收入国家正面临着一场疫情，由于耐药性的传播以及结核病与艾滋病毒/艾滋病的关联，这场疫情难以应对。高收入国家在过去几十年中结核病发病率有所下降，但由于社会、医疗和经济方面的障碍与挑战，可能会卷入新的结核病疫情浪潮。特别是，来自结核病高发病率国家的移民可能会在初级保健和专科医院未配备应对结核病相关临床和公共卫生问题能力的地区，成为结核病防治中的一个新的流行病学问题。欧洲，尤其是欧盟国家，对潜伏性结核感染或结核病患者的医疗管理各不相同，且政策各异。目前缺乏关于如何早期和有效检测结核病病例的科学证据，诊断潜伏性结核感染患者的诊断工具也未显示出足够的准确性。希腊和意大利等国家在移民管理方面存在政治困难，移民中心恶劣的生活条件会增加结核分枝杆菌传播的可能性。迫切需要明确的宣传和政治承诺。当前的移民趋势从人类和医疗保健角度来看都是一种威胁。需要新的统一且有针对性的政策和战略来改善移民和本地居民的健康状况。
