. 2025 Mar 6;65(3):2401612.

doi: 10.1183/13993003.01612-2024. Print 2025 Mar.

Tuberculosis in adult migrants in Europe: a TBnet consensus statement

Heinke Kunst^{1

2}, Berit Lange^{3

4

2}, Olga Hovardovska^{3

4}, Annabelle Bockey^{3

4

5}, Dominik Zenner^{6

7

8}, Aase B Andersen⁹, Sally Hargreaves¹⁰, Manish Pareek^{11

12}, Jon S Friedland¹⁰, Christian Wejse¹³, Graham Bothamley^{6

14

15}, Lorenzo Guglielmetti¹⁶, Dumitru Chesov^{17

18}, Simon Tiberi⁶, Alberto Matteelli¹⁹, Anna M Mandalakas^{18

20

21}, Jan Heyckendorf²², Johannes Eimer²³, Akanksha Malhotra⁶, Javier Zamora²⁴, Anca Vasiliu^{18

20

21

25}, Christoph Lange^{18

20

21

26

25}; TBnet

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK h.kunst@qmul.ac.uk.
² H. Kunst and B. Lange are joint first authors.
³ Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
⁴ German Center for Infection Research, TI BBD, Braunschweig, Germany.
⁵ PhD Programme Epidemiology Braunschweig-Hannover, Braunschweig, Germany.
⁶ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁷ Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁸ Infection and Population Health Department, Institute for Global Health, University College London, London, UK.
⁹ Dept of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
¹⁰ The Migrant Health Research Group, Institute for Infection and Immunity, City St George's, University of London, and Lancet Migration European Regional Hub, London, UK.
¹¹ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
¹² Development Centre for Population Health, University of Leicester, Leicester, UK.
¹³ Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
¹⁴ Homerton University Hospital, London, UK.
¹⁵ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
¹⁶ Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, APHP Sorbonne Université, Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France.
¹⁷ Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Division of Clinical Infectious Diseases, Chisinau, Moldova.
¹⁸ Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
¹⁹ Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB prevention, Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy.
²⁰ Baylor College of Medicine and Texas Children's Hospital, Global TB Program, Houston, TX, USA.
²¹ Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany.
²² Leibniz Lung Clinic, Department of Internal Medicine I, University Clinic Schleswig-Holstein Campus Kiel, Kiel, Germany.
²³ Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4 - Pneumology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria.
²⁴ Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS, CIBERESP), Madrid, Spain.
²⁵ A. Vasiliu and C. Lange are joint last authors.
²⁶ Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

PMID: 39672603
PMCID: PMC11883149
DOI: 10.1183/13993003.01612-2024

Tuberculosis in adult migrants in Europe: a TBnet consensus statement

Heinke Kunst et al. Eur Respir J. 2025.

. 2025 Mar 6;65(3):2401612.

doi: 10.1183/13993003.01612-2024. Print 2025 Mar.

Authors

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK h.kunst@qmul.ac.uk.
² H. Kunst and B. Lange are joint first authors.
³ Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
⁴ German Center for Infection Research, TI BBD, Braunschweig, Germany.
⁵ PhD Programme Epidemiology Braunschweig-Hannover, Braunschweig, Germany.
⁶ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁷ Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁸ Infection and Population Health Department, Institute for Global Health, University College London, London, UK.
⁹ Dept of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
¹⁰ The Migrant Health Research Group, Institute for Infection and Immunity, City St George's, University of London, and Lancet Migration European Regional Hub, London, UK.
¹¹ Department of Respiratory Sciences, University of Leicester, Leicester, UK.
¹² Development Centre for Population Health, University of Leicester, Leicester, UK.
¹³ Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
¹⁴ Homerton University Hospital, London, UK.
¹⁵ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
¹⁶ Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, APHP Sorbonne Université, Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France.
¹⁷ Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Division of Clinical Infectious Diseases, Chisinau, Moldova.
¹⁸ Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
¹⁹ Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB prevention, Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy.
²⁰ Baylor College of Medicine and Texas Children's Hospital, Global TB Program, Houston, TX, USA.
²¹ Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany.
²² Leibniz Lung Clinic, Department of Internal Medicine I, University Clinic Schleswig-Holstein Campus Kiel, Kiel, Germany.
²³ Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4 - Pneumology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria.
²⁴ Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS, CIBERESP), Madrid, Spain.
²⁵ A. Vasiliu and C. Lange are joint last authors.
²⁶ Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

PMID: 39672603
PMCID: PMC11883149
DOI: 10.1183/13993003.01612-2024

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: Dedicated care for TB prevention and treatment in migrant populations within the European Union/European Economic Area and UK is essential.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: A.B. Andersen reports an unpaid role as chair of a data and safety monitoring board overseeing a phase 1a TB vaccine trial,“nTB-01”, sponsored by the Statens Serum Institute, Copenhagen, conducted by the Aurum Institute, SA. M. Pareek reports grants from Gilead, Sanofi and Moderna, and consulting fees from Qiagen and Pfizer. J.S. Friedland reports a leadership role as a member of the Doctors of the World Expert Consortium on Refugee and Migrant Health. G. Bothamley reports leadership roles with ERS (Long Term Planning Committee 2020–2023) and TBnet (past Chair, current Steering Committee). L. Guglielmetti reports grants from Unitaid. S. Tiberi is an employee of GSK and holds stock or stock options. A. Matteelli reports support for attending meetings from New Diagnostic Working Group. J. Heyckendorf reports payment or honoraria for lectures, presentations, manuscript writing or educational events from Chiesi, Boehringer Ingelheim and GSK; support for attending meetings from Boehringer Ingelheim; and patents TB22 and TB31. C. Lange reports honoraria for lectures at events sponsored by Insmed, Gilead, GSK, medUpdate and medUpdate Europe; he is a member of the data safety board for clinical trials from MSF and a member of the WHO guideline development committee for drug-resistant tuberculosis; he reports leadership roles in the International Union against Tuberculosis and Lung Diseases and TBnet. The remaining authors have no potential conflicts of interest to disclose.

Figures

None — Overview of the study. TB: tuberculosis; MDR: multidrug-resistant; LTBI: latent tuberculosis infection; RR: rifampicin-resistant.

**FIGURE 1**
Diagnosis of active tuberculosis (TB): extrapulmonary TB (EPTB) *versus* pulmonary TB in migrants *versus* non-migrants.

**FIGURE 2**
Unfavourable tuberculosis treatment outcomes in migrants *versus* non-migrants.

**FIGURE 3**
Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) rates in migrants.

**FIGURE 4**
Tuberculosis (TB)/HIV co-infection in a) TB populations and b) people living with HIV.

See this image and copyright information in PMC

References

1. McAuliffe, M, Oucho LA (eds). World Migration Report 2024. International Organization for Migration (IOM). Geneva, International Organization for Migration, 2024.
1. World Health Organization . Global Tuberculosis Report 2024. Geneva, World Health Organization. www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberc... Date last accessed: 1 November 2024.
1. Odone A, Tillmann T, Sandgren A, et al. . Tuberculosis among migrant populations in the European Union and the European Economic Area. Eur J Public Health 2015; 25: 506–512. doi:10.1093/eurpub/cku208 - DOI - PMC - PubMed
1. Essadek HO, Mendioroz J, Guiu IC, et al. . Community strategies to tackle tuberculosis according to the WHO region of origin of immigrant communities. Public Health Action 2018; 8: 135–140. doi:10.5588/pha.18.0011 - DOI - PMC - PubMed
1. Wolters BA, Aartsma Y, Jansen K, et al. . Travel history and challenges of screening for latent TB infection in child asylum seekers. Int J Tuberc Lung Dis 2021; 25: 945–947. doi:10.5588/ijtld.21.0223 - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
- HighWire
- PubMed Central
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Tuberculosis in adult migrants in Europe: a TBnet consensus statement

Affiliations

Tuberculosis in adult migrants in Europe: a TBnet consensus statement

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical