Institute for Infection and Immunity, St George's, University of London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Institute for Infection and Immunity, St George's, University of London, London, UK.
Clin Microbiol Infect. 2021 Sep;27(9):1347.e1-1347.e7. doi: 10.1016/j.cmi.2020.12.006. Epub 2020 Dec 19.
The proportion of tuberculosis (TB) cases occurring in migrants in Europe is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin.
We carried out a cross-sectional secondary database analysis, utilizing 23 years of data collected between 1995 and 2017 from the European Surveillance System of the European Centre for Disease Prevention and Control for 32 EU/EFTA countries.
In total, 1 270 896 TB cases were included, comprising 326 987 migrants (25.7%) and 943 909 non-migrants (74.3%). Of TB cases among migrants, 45.2% (n = 147 814) were extrapulmonary compared to 21.7% (n = 204 613) among non-migrants (p < 0.001). Lymphatic, bone/joint and peritoneal/digestive TB were more common among migrant than non-migrant extrapulmonary cases. A lower proportion of extrapulmonary TB was seen in Eastern Europe (17.4%, n = 98 656 of 566 170) and Southern Europe (29.6%, n = 62 481 of 210 828) compared with Western (35.7%, n = 89 498 of 250 517) and Northern Europe (41.8%, n = 101 792 of 243 381). Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary disease, with 62.0% (n = 55 401 of 89 353) and 54.5% (n = 38 327 of 70 378) of cases, respectively, being extrapulmonary.
Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than in non-migrants. There is a need to improve clinical awareness of extrapulmonary TB and to integrate its detection into screening programmes.
在欧洲，结核（TB）病例中移民的比例正在增加。肺外结核在诊断和治疗方面带来挑战，导致严重的发病率和死亡率，但在移民人群中的程度尚不清楚。我们评估了欧盟（EU）/欧洲自由贸易联盟（EFTA）中移民的肺外结核模式。我们调查了移民中肺外结核病例的比例，以及按疾病的具体部位、报告的欧洲区域和移民原籍地区的变化情况。
我们进行了一项横断面二次数据库分析，利用 1995 年至 2017 年期间欧洲疾病预防控制中心欧洲监测系统收集的 32 个欧盟/EFTA 国家 23 年的数据。
共纳入 1270896 例 TB 病例，其中包括 326987 例移民（25.7%）和 943909 例非移民（74.3%）。在移民的 TB 病例中，45.2%（n=147814）为肺外结核，而非移民中为 21.7%（n=204613）（p<0.001）。与非移民的肺外结核病例相比，移民中淋巴、骨骼/关节和腹膜/消化系统结核更为常见。与东欧（17.4%，n=566170 例中的 98656 例）和南欧（29.6%，n=210828 例中的 62481 例）相比，西欧（35.7%，n=250517 例中的 89498 例）和北欧（41.8%，n=243381 例中的 101792 例）的肺外结核比例较低。来自东南亚和撒哈拉以南非洲的移民患肺外疾病的风险最高，分别有 62.0%（n=89353 例中的 55401 例）和 54.5%（n=70378 例中的 38327 例）为肺外疾病。
在欧盟/EFTA 的结核病例中，移民中肺外疾病的比例明显高于非移民。需要提高对肺外结核的临床认识，并将其检测纳入筛查计划。
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