Foreign-born and homeless persons – new epidemiologic and social factors in the control of tuberculosis in Prague
Authors:
M. Kubín; P. Kalina; Z. Jágrová
Authors‘ workplace:
Ředitel: MUDr. Luděk Bajgar
; Hygienická stanice hlavního města Prahy
Published in:
Prakt. Lék. 2010; 90(6): 352-357
Category:
Of different specialties
Overview
Between 1999 and 2008 in Prague, a total of 258 foreign-born citizens were notified to the National Tuberculosis Registry. Their proportion of the total number of cases increased from 7.3 % in 1999 to 26.2 % in 2008. Individuals born in Ukraine, Slovakia and Vietnam accounted for almost two thirds of the notified cases. Males (178 cases, a mean age of 37.9 years) were much more prevalent than females (80 cases, a mean age of 37.4 years).
The most common disease was TB of the respiratory tract (86.8 %) and the remaining cases were non-pulmonary and miliary TB affections. TB detected on symptoms prevailed by 83.7 %, followed by preventive and risk-groups screening (10.1 % and 3.9 % resp.) and autopsy (2.3 %).
Sixteen (6.
2 %) individuals died of TB. In 2003–2008, Mycobacterium tuberculosis was demonstrated in 121 patients; drug resistance was revealed in 25 (20.7 %) cases, in which 7 multi-drug strains were identified. In addition, between 1999 and 2008, a total of 123 cases of TB were reported in homeless persons in Prague. The annual number of cases ranged from 5 to 19 and their proportion of the total number of the notified cases increased from 2.1 % in 1999 to 15.1 % in 2008. Most of them were males – 113 individuals (91.9 %) with a mean age of 50.4 years (range 27–73 years), and 10 were females with a mean age of 48.6 years (range 28–65 years).
TB of the respiratory organs was most prevalent (97.6 %) and the remaining cases were miliary TB and TB meningitis. Twenty-one (17.1 %) individuals died of TB, 11 of them were found dead or in a moribund state and died during the first days of hospitalization. Symptomatic disease was detected in 93 (75.6 %) patients, 14 cases were revealed by screening in risk groups and 10 by autopsy examination. Mycobacterium tuberculosis was demonstrated in 61 cases; 54 (88.6 %) strains were drug-sensitive, 2 were resistant to isoniazid or rifampicin and 5 were multidrug-resistant. Since 1999, TB in foreign and homeless persons has become a novel and serious factor in the control of TB in Prague.
To solve the problem in the near future, a more active approach to the screening for TB must be taken in both of these risk-groups, and strict adherence to controlled therapeutic regimes and to preventive measures must also be maintained around those infected.
Key words:
tuberculosis, homelessness, foreign-born citizens.
Sources
1. Arguin, P.M., Marano, N., Freedman, D.O. Globally mobile populations and the spread of emerging pathogens. Emerg. Infect. Dis. 2009, 15, p. 2-3.
2. Badiaga, S., Raoult, D., Bronqui, P. Preventing and controlling emerging and reemerging transmissible diseases in the homeless. Emerg. Infect. Dis. 2008, 14, p. 1353-1359.
3. CDC. Prevention and control of tuberculosis among homeless persons. Recommendations of the advisory council for the elimination of tuberculosis. MMWR 1992, 41: RR-5. Dostupné na http://www. cdc.gov/ MMWR/preview/MMWRhtml/00019922.htm.
4. CDC. Tuberculosis outbreak among homeless persons – King County, Washington, 2002-2003: recommendations of the advisory council for the elimination of tuberculosis. MMWR 2003; 52: 1209-1210.
5. Český statistický úřad. Cizinci v České republice. Scientia, Praha 2009
6. EuroTB (InVS/KNCV). Surveillance of tuberculosis in Europe. Report on tuberculosis cases notified in 2006. Institut de veille sanitare, Saint-Maurice, France
7. Figueroa-Munoz, J.I., Ramon-Pardo, P. Tuberculosis control in vulnerable groups. Bull WHO 2008, 86, p. 733-735.
8. Gilbert, R.L, Antoine, D., French, C.E. et al. The impact of immigration on tuberculosis rates in the United Kingdom compared with other European countries. Int. J. Tuberc. Lung Dis. 2009,13, p. 645-651.
9. Haddad, M.B., Wilson, T.W., Ijaz K. et al. Tuberculosis and homelessness in the United States, 1994-2003. JAMA 2005, 293, p. 2762-2776.
10. Hargreaves, S., Carballo, M., Friedland, J.S. Screening migrants for tuberculosis: where next? Lancet Infect. Dis. 2009, 9, p. 139-140.
11. Hollo, V., Amato-Gaucim A., Ködmön, C., Manissero, D. Tuberculosis in the EU and EEA/EFTA countries – what is the latest data telling us? Eurosurveillance 2009, 14, p. 1-4.
12. Homolka, J., Krejbich, F. Tuberkulóza u cizinců v České republice v letech 2003-2006. Čas. Lék. čes. 2008, 147, s. 155-158.
13. Hradecký, I. The national report on homelessness. Prague, October 2005.
14. Kong, PoM., Tapy, J., Calixto, P. et al. Skin-test screening and tuberculosis transmission among the homeless. Emerg. Infect. Dis. 2002, 8, p. 1280-1284.
15. Lukács, J., Tubak, V., Mester J. et al. Conventional and molecular epidemiology of tuberculosis in homeless patiens in Budapest, Hungary. J. Clin. Microbiol. 2004, 42, p. 5931-5934.
16. McKenna, M.T., McGray, E., Onorato, I. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1995. NEJM 1995, 332, p. 1071-1076.
17. Nardeli, E., McInnis, B., Thomas, B., Weidhaas, S. Exogenous reinfection with tuberculosis in a shelter for the homeless. NEJM 1986, 315, p. 1570-1575.
18. Story, A., Murad, S., Roberts, W. et al. Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax 2007, 62, p. 667-671.
19. CDC. Trends in Tuberculosis – United States, 2008. MMWR 2009, 58, p. 249-253.
20. Trnka, L., Šnircová, J., Krejbich, F. Vyhledávání tuberkulózy mezi bezdomovci a imigranty v praxi. Zdravotnictví ČR 2006 4, p. 144-148.
21. Ústav zdravotnických informací a statistiky. Tuberkulóza a respirační nemoci 1999-2008. Zdravotnická statistika, Praha.
22. Vries, G., Hest, R.A.H., Richardus, J.H. Impact of mobile radiographic screening on tuberculosis among drug users and homeless persons. Am. J. Respir. Crit. Care Med 2006, 176, p. 201-207.
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