Kunst Heinke, Lange Berit, Hovardovska Olga, Bockey Annabelle, Zenner Dominik, Andersen Aase B, Hargreaves Sally, Pareek Manish, Friedland Jon S, Wejse Christian, Bothamley Graham, Guglielmetti Lorenzo, Chesov Dumitru, Tiberi Simon, Matteelli Alberto, Mandalakas Anna M, Heyckendorf Jan, Eimer Johannes, Malhotra Akanksha, Zamora Javier, Vasiliu Anca, Lange Christoph
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
H. Kunst and B. Lange are joint first authors.
Eur Respir J. 2025 Mar 6;65(3). doi: 10.1183/13993003.01612-2024. Print 2025 Mar.
Global migration has increased in recent decades owing to war, conflict, persecution and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs depending on migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances in TB care for migrants and new treatment strategies, decisions for managing migrants at risk of TB often rely on expert opinions, rather than clinical evidence.
A systematic literature search was conducted, studies were mapped to different recommendation groups and included studies were synthesised by meta-analysis where appropriate. Current evidence on the diagnosis of active TB in migrants entering the European Union/European Economic Area and UK, including clinical presentation and diagnostic delay, treatment outcomes of drug-susceptible TB, prevalence, and treatment outcomes of multidrug-resistant/rifampicin-resistant TB and TB/HIV co-infection, was summarised. A consensus process was used based on the evidence.
We documented that migrants had higher vulnerability for TB, including an increased risk of extrapulmonary TB, multidrug-resistant/rifampicin-resistant TB, TB/HIV co-infection and worse TB treatment outcomes compared to host populations. Consensus recommendations include screening migrants for TB/latent TB infection according to country data, a minimal package for TB care in drug-susceptible and multidrug-resistant/rifampicin-resistant TB, implementation of migrant-sensitive strategies and free healthcare and preventive treatment for migrants with HIV co-infection.
Dedicated care for TB prevention and treatment in migrant populations within the European Union/European Economic Area and UK is essential.
近几十年来，全球移民数量有所增加，这是由于战争、冲突、迫害和自然灾害，但也与工作或学习相关的机会增加有关。移民患结核病（TB）的风险因移民情况、社会经济地位、旅行方式以及途中的结核病风险、原籍国的结核病发病率和医疗保健提供情况而异。尽管在为移民提供结核病护理和新的治疗策略方面取得了进展，但对有结核病风险的移民进行管理的决策往往依赖于专家意见，而非临床证据。
进行了系统的文献检索，将研究映射到不同的推荐组，并在适当情况下通过荟萃分析对纳入的研究进行综合。总结了关于进入欧盟/欧洲经济区和英国的移民中活动性结核病诊断的现有证据，包括临床表现和诊断延迟、药物敏感结核病的治疗结果、患病率、耐多药/利福平耐药结核病以及结核病/艾滋病病毒合并感染的治疗结果。基于这些证据采用了共识程序。
我们记录到，与当地居民相比，移民患结核病的易感性更高，包括肺外结核病、耐多药/利福平耐药结核病、结核病/艾滋病病毒合并感染的风险增加以及结核病治疗结果更差。共识性建议包括根据国家数据对移民进行结核病/潜伏性结核感染筛查、针对药物敏感和耐多药/利福平耐药结核病的基本结核病护理套餐、实施对移民敏感的策略以及为合并感染艾滋病病毒的移民提供免费医疗保健和预防性治疗。
在欧盟/欧洲经济区和英国为移民群体提供专门结核病预防和治疗护理至关重要。
