Tuberculosis incidence in foreign-born people residing in European countries in 2020

doi:10.2807/1560-7917.ES.2023.28.42.2300051

. 2023 Oct;28(42):2300051.

doi: 10.2807/1560-7917.ES.2023.28.42.2300051.

Tuberculosis incidence in foreign-born people residing in European countries in 2020

Anca Vasiliu¹, Niklas Köhler^{2

3

4}, Ekkehardt Altpeter⁵, Tinna Rán Ægisdóttir⁶, Marina Amerali⁷, Wouter Arrazola de Oñate^{8

9}, Ágnes Bakos¹⁰, Stefania D'Amato¹¹, Daniela Maria Cirillo¹², Reinout van Crevel^{13

14}, Edita Davidaviciene¹⁵, Irène Demuth¹⁶, Jose Domínguez¹⁷, Raquel Duarte^{18

19

20}, Gunar Günther^{21

22}, Jean-Paul Guthmann²³, Sophia Hatzianastasiou⁷, Louise Hedevang Holm²⁴, Zaida Herrador²⁵, Urška Hribar²⁶, Conny Huberty¹⁶, Elmira Ibraim²⁷, Sarah Jackson²⁸, Mogens Jensenius²⁹, Kamilla Sigridur Josefsdottir³⁰, Anders Koch^{24

31}, Maria Korzeniewska-Kosela³², Liga Kuksa³³, Heinke Kunst³⁴, Christian Lienhardt^{35

36}, Beatrice Mahler^{27

37}, Mateja Janković Makek^{38

39}, Inge Muylle⁴⁰, Johan Normark^{41

42}, Analita Pace-Asciak⁴³, Goranka Petrović⁴⁴, Despo Pieridou⁴⁵, Giulia Russo¹², Olena Rzhepishevska⁴⁶, Helmut J F Salzer^{47

48}, Marta Sá Marques²⁰, Daniela Schmid⁴⁹, Ivan Solovic^{50

51}, Mariya Sukholytka⁵², Petra Svetina⁵³, Mariya Tyufekchieva⁵⁴, Tuula Vasankari^{55

56}, Piret Viiklepp⁵⁷, Kersti Villand⁵⁷, Jiri Wallenfels⁵⁸, Stefan Wesolowski³², Anna-Maria Mandalakas^{1

2}, Leonardo Martinez⁵⁹, Dominik Zenner^{60

61}, Christoph Lange^{1

2

3

4}; TBnet⁶²

Affiliations

¹ Baylor College of Medicine, Department of Pediatrics, Global and Immigrant Health, Global Tuberculosis Program, Houston, Texas, United States.
² Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
³ German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany.
⁴ Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany.
⁵ Swiss Federal Office of Public Health, Division of Communicable Diseases, Bern, Switzerland.
⁶ The National University Hospital of Iceland, Pharmaceutical Services, Reykjavik, Iceland.
⁷ Tuberculosis Control Office, Department of Respiratory Infections, Directorate for Epidemiological Surveillance & Intervention, National Public Health Organization (NPHO), Athens, Greece.
⁸ Belgian Lung and Tuberculosis Association, Brussels, Belgium.
⁹ Flemish Association of Respiratory Health and TB Control, Leuven, Belgium.
¹⁰ Koranyi National Institute for Pulmonology, Budapest, Hungary.
¹¹ Prevention of Communicable Diseases and International Prophylaxis, General Direction of Health Prevention, Ministry of Health of Italy, Rome, Italy.
¹² Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹³ Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁴ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
¹⁵ Vilnius University hospital Santaros Klinikos, Department of Tuberculosis State information system, Vilnius, Lithuania.
¹⁶ Health Directorate of Luxembourg, Luxembourg.
¹⁷ Institut d'Investigació Germans Trias i Pujol; Universitat Autònoma de Barcelona; CIBER Enfermedades Respiratorias; INNOVA4TB consortium Badalona, Barcelona, Spain.
¹⁸ ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.
¹⁹ ISPUP - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
²⁰ Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal.
²¹ Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
²² Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia.
²³ Division of Infectious Diseases, Santé publique France, Saint-Maurice, France.
²⁴ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
²⁵ Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
²⁶ Tuberculosis Register of the Republic of Slovenia, University Clinic Golnik, Golnik, Slovenia.
²⁷ Marius Nasta Institute of Pulmonology, Bucharest, Romania.
²⁸ Infectious Diseases; Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland.
²⁹ Department of Infectious Diseases, Oslo University Hospital, Ullevaal, Norway.
³⁰ Centre for Health Security and Communicable Disease Control, Directorate of Health, Iceland.
³¹ Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark.
³² Department of Tuberculosis Epidemiology and Surveillance, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
³³ Riga East University Hospital, TB and Lung Disease Clinic, Riga, Latvia.
³⁴ Blizard Institute, The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
³⁵ Unité Unité Mixte Internationale 233 IRD - U1175 INSERM - Université de Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France.
³⁶ Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³⁷ Department Cardio-thoracic, Pneumophtisiology II, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania.
³⁸ University of Zagreb, School of Medicine Zagreb, Croatia.
³⁹ University Hospital Centre Zagreb, Department for Lung diseases, Zagreb, Croatia.
⁴⁰ Division of Pneumology, Onze-Lieve-Vrouw Ziekenhuis (OLV) Aalst, Aalst, Belgium.
⁴¹ Department of Clinical Microbiology, Umeå University, Sweden.
⁴² Wallenberg Centre for Molecular Medicine, Umeå University, Sweden.
⁴³ Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Superintendence of Public Health, Ministry for Health of Malta, La Valetta, Malta.
⁴⁴ Respiratory Diseases and Travel Medicine Department with Vaccination Unit, Infectious Diseases Epidemiology ServiceDepartment, Croatian Institute of Public Health, Zagreb, Croatia.
⁴⁵ Cyprus National Reference Laboratory for Mycobacteria, Microbiology Department, Nicosia General Hospital, Nicosia, Cyprus.
⁴⁶ Department of Chemistry, Department of Clinical Microbiology, Umeå University, Sweden.
⁴⁷ Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4- Pneumology, Kepler University Hospital, Linz, Austria.
⁴⁸ Faculty of Medicine, Johannes-Kepler-University, Linz, Austria and Ignaz Semmelweis Institut, Interuniversity Institute for Infection Resarch, Vienna, Austria.
⁴⁹ Unit for Infectious Diseases Diagnostics and Infectious Diseases Epidemiology, Centre for Pathophysiology, Infectious Diseases and Immunology, Medical University of Vienna, Vienna, Austria.
⁵⁰ National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Slovakia.
⁵¹ Catholic University Ruzomberok, Ruzomberok, Slovakia.
⁵² First Faculty of Medicine and Faculty Thomayer Hospital Prague, Czechia.
⁵³ National TB Program and Tuberculosis Registry of Republic of Slovenia, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
⁵⁴ Health Promotion and Prevention Unit, Directorate Public Health Protection and Health Control, Ministry of Health of Bulgaria, Sofia, Bulgaria.
⁵⁵ University of Turku, Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku, Finland.
⁵⁶ Finnish Lung Health Association (Filha ry), Helsinki, Finland.
⁵⁷ Estonian Tuberculosis Register, Dept. of Registries, National Institute for Health Development, Tallinn, Estonia.
⁵⁸ National TB Surveillance Unit, University Hospital Bulovka, Prague, Czechia.
⁵⁹ Boston University, School of Public Health, Department of Epidemiology, Boston, Massachusetts, United States.
⁶⁰ Global Public Health Unit, Wolfson Institute of Population Health Barts.
⁶¹ The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁶² The Tuberculosis Network European Trials Group (TBNET) (www.tbnet.eu).

PMID: 37855907
PMCID: PMC10588305
DOI: 10.2807/1560-7917.ES.2023.28.42.2300051

Tuberculosis incidence in foreign-born people residing in European countries in 2020

Anca Vasiliu et al. Euro Surveill. 2023 Oct.

. 2023 Oct;28(42):2300051.

doi: 10.2807/1560-7917.ES.2023.28.42.2300051.

Authors

Affiliations

¹ Baylor College of Medicine, Department of Pediatrics, Global and Immigrant Health, Global Tuberculosis Program, Houston, Texas, United States.
² Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
³ German Center for Infection Research (DZIF), TTU-TB, Borstel, Germany.
⁴ Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany.
⁵ Swiss Federal Office of Public Health, Division of Communicable Diseases, Bern, Switzerland.
⁶ The National University Hospital of Iceland, Pharmaceutical Services, Reykjavik, Iceland.
⁷ Tuberculosis Control Office, Department of Respiratory Infections, Directorate for Epidemiological Surveillance & Intervention, National Public Health Organization (NPHO), Athens, Greece.
⁸ Belgian Lung and Tuberculosis Association, Brussels, Belgium.
⁹ Flemish Association of Respiratory Health and TB Control, Leuven, Belgium.
¹⁰ Koranyi National Institute for Pulmonology, Budapest, Hungary.
¹¹ Prevention of Communicable Diseases and International Prophylaxis, General Direction of Health Prevention, Ministry of Health of Italy, Rome, Italy.
¹² Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹³ Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁴ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
¹⁵ Vilnius University hospital Santaros Klinikos, Department of Tuberculosis State information system, Vilnius, Lithuania.
¹⁶ Health Directorate of Luxembourg, Luxembourg.
¹⁷ Institut d'Investigació Germans Trias i Pujol; Universitat Autònoma de Barcelona; CIBER Enfermedades Respiratorias; INNOVA4TB consortium Badalona, Barcelona, Spain.
¹⁸ ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.
¹⁹ ISPUP - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
²⁰ Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal.
²¹ Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
²² Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia.
²³ Division of Infectious Diseases, Santé publique France, Saint-Maurice, France.
²⁴ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
²⁵ Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
²⁶ Tuberculosis Register of the Republic of Slovenia, University Clinic Golnik, Golnik, Slovenia.
²⁷ Marius Nasta Institute of Pulmonology, Bucharest, Romania.
²⁸ Infectious Diseases; Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland.
²⁹ Department of Infectious Diseases, Oslo University Hospital, Ullevaal, Norway.
³⁰ Centre for Health Security and Communicable Disease Control, Directorate of Health, Iceland.
³¹ Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark.
³² Department of Tuberculosis Epidemiology and Surveillance, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
³³ Riga East University Hospital, TB and Lung Disease Clinic, Riga, Latvia.
³⁴ Blizard Institute, The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
³⁵ Unité Unité Mixte Internationale 233 IRD - U1175 INSERM - Université de Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France.
³⁶ Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³⁷ Department Cardio-thoracic, Pneumophtisiology II, University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania.
³⁸ University of Zagreb, School of Medicine Zagreb, Croatia.
³⁹ University Hospital Centre Zagreb, Department for Lung diseases, Zagreb, Croatia.
⁴⁰ Division of Pneumology, Onze-Lieve-Vrouw Ziekenhuis (OLV) Aalst, Aalst, Belgium.
⁴¹ Department of Clinical Microbiology, Umeå University, Sweden.
⁴² Wallenberg Centre for Molecular Medicine, Umeå University, Sweden.
⁴³ Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Superintendence of Public Health, Ministry for Health of Malta, La Valetta, Malta.
⁴⁴ Respiratory Diseases and Travel Medicine Department with Vaccination Unit, Infectious Diseases Epidemiology ServiceDepartment, Croatian Institute of Public Health, Zagreb, Croatia.
⁴⁵ Cyprus National Reference Laboratory for Mycobacteria, Microbiology Department, Nicosia General Hospital, Nicosia, Cyprus.
⁴⁶ Department of Chemistry, Department of Clinical Microbiology, Umeå University, Sweden.
⁴⁷ Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4- Pneumology, Kepler University Hospital, Linz, Austria.
⁴⁸ Faculty of Medicine, Johannes-Kepler-University, Linz, Austria and Ignaz Semmelweis Institut, Interuniversity Institute for Infection Resarch, Vienna, Austria.
⁴⁹ Unit for Infectious Diseases Diagnostics and Infectious Diseases Epidemiology, Centre for Pathophysiology, Infectious Diseases and Immunology, Medical University of Vienna, Vienna, Austria.
⁵⁰ National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Slovakia.
⁵¹ Catholic University Ruzomberok, Ruzomberok, Slovakia.
⁵² First Faculty of Medicine and Faculty Thomayer Hospital Prague, Czechia.
⁵³ National TB Program and Tuberculosis Registry of Republic of Slovenia, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
⁵⁴ Health Promotion and Prevention Unit, Directorate Public Health Protection and Health Control, Ministry of Health of Bulgaria, Sofia, Bulgaria.
⁵⁵ University of Turku, Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku, Finland.
⁵⁶ Finnish Lung Health Association (Filha ry), Helsinki, Finland.
⁵⁷ Estonian Tuberculosis Register, Dept. of Registries, National Institute for Health Development, Tallinn, Estonia.
⁵⁸ National TB Surveillance Unit, University Hospital Bulovka, Prague, Czechia.
⁵⁹ Boston University, School of Public Health, Department of Epidemiology, Boston, Massachusetts, United States.
⁶⁰ Global Public Health Unit, Wolfson Institute of Population Health Barts.
⁶¹ The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁶² The Tuberculosis Network European Trials Group (TBNET) (www.tbnet.eu).

PMID: 37855907
PMCID: PMC10588305
DOI: 10.2807/1560-7917.ES.2023.28.42.2300051

Abstract

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

Keywords: TB; migrants; policy; prevention; refugees.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

**Figure 1**
Countries of origin of foreign-born tuberculosis cases residing in European Union countries and Iceland, Norway, Switzerland and the United Kingdom, 2020

**Figure 2**
Observed incidence rate of tuberculosis per 100,000 foreign-born individuals per country of residence vs incidence in their country of origin as reported by the WHO based on estimated data, European Union countries and Iceland, Norway, Switzerland and the United Kingdom, 2020

**Figure 3**
Incidence rate ratio of tuberculosis in country of residence and incidence rate in country of origin as reported by the WHO based on estimated data, European Union countries and Iceland, Norway, Switzerland and the United Kingdom, 2020

**Figure 4**
Tuberculosis incidence, European Union, Iceland, Norway, Switzerland and United Kingdom, 2020

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[1] Koch R. Die Aetiologie der Tuberkulose. [The etiology of tuberculosis]. Berl Klin Wschr. 1882;15:221-30. German.

[2] Koch R. Die Aetiologie der Tuberkulose. [The etiology of tuberculosis]. Berl Klin Wschr. 1882;15:221-30. German.

[3] McAuliffe M, Triandafyllidou A. World Migration Report 2022. Geneva: International Organization for Migration (IOM); 2021. Available from: https://publications.iom.int/books/world-migration-report-2022

[4] McAuliffe M, Triandafyllidou A. World Migration Report 2022. Geneva: International Organization for Migration (IOM); 2021. Available from: https://publications.iom.int/books/world-migration-report-2022

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[6] Dhavan P, Dias HM, Creswell J, Weil D. An overview of tuberculosis and migration. Int J Tuberc Lung Dis. 2017;21(6):610-23. 10.5588/ijtld.16.0917 - DOI - PubMed

[7] European Centre for Disease Prevention and Control (ECDC), and World Health Organization Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 – 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillanc...

[8] European Centre for Disease Prevention and Control (ECDC), and World Health Organization Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 – 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillanc...

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[10] World Health Organization (WHO). Global Tuberculosis Report. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240037021

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Tuberculosis incidence in foreign-born people residing in European countries in 2020

Affiliations

Tuberculosis incidence in foreign-born people residing in European countries in 2020

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