State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
BMC Public Health. 2020 Jun 3;20(1):838. doi: 10.1186/s12889-020-08907-y.
In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent.
Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent.
Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542-2384] and 37% (95% CI = 23-52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information.
Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.
2018 年，全球有 7080 万难民、寻求庇护者和因战争和冲突而流离失所的人。这些人中的许多人在原籍国面临结核病高发的风险，而在旅途中所经历的恶劣条件可能会使这一风险加剧。我们通过系统的文献综述和按原籍国和所在大洲进行的荟萃分析，总结了难民和寻求庇护者中活动性和潜伏性结核病感染的流行率。
从 2000 年 1 月至 2017 年 8 月，我们在 Medline、EMBASE、Web of Science 和 LILACS 上检索了发表的文章，不限制语言。两名独立的作者进行了研究选择、数据提取和质量评估。我们使用随机效应模型来估计活动性和潜伏性结核病流行率的平均指标。根据原籍国和所在大洲进行了亚组荟萃分析。
在 767 篇确定的文章中，有 67 篇被纳入分析，其中 16 篇进入荟萃分析。活动性和潜伏性结核病的平均流行率分别为每 10 万人中有 1331 人（95%置信区间 [CI]：542-2384）和 37%（95%CI：23-52%），两者均存在高度异质性（归因于异质性的估计值差异 [I]：98.2%和 99.8%）。流行率的差异更多地取决于原籍国，而不是所在大洲。91%的研究报告了在所在国对最近抵达的移民进行常规筛查；三分之二的研究证实了结核病的细菌学诊断。许多研究未能提供相关信息。
结核病是难民和寻求庇护者的一个主要健康问题，在任何所在大洲都应给予特别关注。为了保护这一弱势群体，确保获得医疗保健以早期发现、预防和治疗该疾病至关重要。
