10/12/2018 TB notifications, EU/EEA, 2016 58 994 TB cases notified - - PDF document

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10/12/2018 TB notifications, EU/EEA, 2016 58 994 TB cases notified - - PDF document

10/12/2018 TB notifications, EU/EEA, 2016 58 994 TB cases notified in 30 EU/EEA countries Notification rate of 11.4 per 100 000 population (range 1.868.9) Cases per Screening for Latent TB among Migrants 100 000 population < 5 in the


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Screening for Latent TB among Migrants in the European Union

Marieke J. van der Werf International Conference on Migration Health (ICMH), Rome, Italy, 2 October 2018

TB notifications, EU/EEA, 2016

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58 994 TB cases notified in 30 EU/EEA countries Notification rate of 11.4 per 100 000 population (range 1.8–68.9)

Not reporting 20 to 49 10 to 19 5 to 9 ≥ 50 Cases per 100 000 population < 5 Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data

Notified TB cases, EU/EEA, 2007–2016

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Continuous decline between 2007 and 2016:

  • Number of TB cases decreased by 31%
  • Notification rate decreased by 32%

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

TB cases/100 000 TB cases

Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data

Year of reporting

TB in persons of foreign origin, EU/EEA, 2016

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19 312 TB cases were notified in persons originating from

  • ther countries than the reporting country

32.7% of all TB cases (range 0.2–96.0%)

Not reporting 50 to 74.9% 10 to 49.9% 1 to 9.9% ≥ 75% Proportion of cases < 1% Source: ECDC/WHO (2018). Tuberculosis surveillance and monitoring in Europe 2018–2016 data

TB notification rates by origin and year, 2010-2015

Hollo et al. Eurosurveillance 2017 5

Latent TB infection screening of migrants

Country LTBI screening test WHO-estimated TB incidence in country of

  • rigin

Belgium TST All Finland Only children Germany NA None Greece TST All asylum seekers Italy NA None Netherlands TST or IGRA >50 Norway IGRA >200 Spain TST or IGRA High-incidence countries Sweden TST or IGRA >100 asylum seekers Switzerland NA None United Kingdom IGRA >150

6 Kunst et al. IJTLD 2017

Differences in type of migrants screened for LTBI

  • Children/adults
  • Asylum seekers/other

migrants

  • Incidence in country of origin

Differences in LTBI tests

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Effectiveness of screening for latent TB infection among migrants to the EU/EEA – Analytic framework

Greenaway et al. Eurosurveillance 2018 7

Performance of diagnostic tests for latent tuberculosis infection

Greenaway et al. Eurosurveillance 2018 8

Study Results Pai et al. 2008 TST overall: TST in BCG-vaccinated: TST in non-BCG-vaccinated: IGRA (QFT): IGRA (QFT-3G): IGRA in BCG-vaccinated: IGRA in non-BCG-vaccinated: IGRA (T-SPOT.TB/ ELISpot): IGRA (T-SPOT.TB): Sensitivity, specificity (95% CI) sensitivity: 77% (71–82) specificity: 59% (46–73) specificity: 97% (95–99) sensitivity: 76% (72–80), specificity: 98% (96–99) sensitivity: 70% (63–78) specificity: 96% (94–98) specificity: 99% (98–100) sensitivity: 90% (86–93), specificity: 93% (86–100) specificity: 87% (80–92) Kahwati et al. 2016 (Not BCG vaccinated) TST (10 mm): IGRA (T-SPOT.TB): IGRA (QFT-3G): Sensitivity, specificity (95% CI) sensitivity: 79% (71–87), specificity: 97% (96–99) sensitivity: 90% (87–93), specificity: 95% (92–98) sensitivity: 80% (77–84), specificity: 97% (94–99) Kik et al. 2014 TST: IGRA: Pooled IRR 2.07 (95% CI: 1.38–3.11) 2.40 (95% CI: 1.26–4.60) PPV 1–7% 0–13% NPV 92–100% 88–100%

Efficacy of therapy for latent tuberculosis infection

Zenner et al. Annals of Internal Medicine 2017 9

Latent tuberculosis infection care cascade

Alsdurf et al. Lancet Infectious Diseases 2016 10

Cost effectiveness 16 cost-effectiveness analyses studies Designs and outcomes heterogeneous Cost-effectiveness of screening strategies dependent on

  • LTBI test characteristics
  • which tests were being compared
  • cost of tests
  • BCG vaccination status of population

Greenaway et al. Eurosurveillance 2018 11

Evidence-based statement (Draft) Offer LTBI screening using a TST or an IGRA soon after arrival for all migrant populations from high TB incidence countries and link to care and treatment where indicated. (Certainty of evidence: low)

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Acknowledgements

Christina Greenaway Manish Pareek Claire-Nour Abou Chakra Moneeza Walji Iuliia Makarenko Balqis Alabdulkarim Catherine Hogan Ted McConnell Brittany Scarfo

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Robin Christensen Anh Tran Nick Rowbotham Marieke J van der Werf Teymur Noori Kevin Pottie Alberto Matteelli Dominik Zenner Rachael L. Morton

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