Multidrug-resistant tuberculosis imported into low-incidence countries—a GeoSentinel analysis, 2008–2020

Details

• Alternative Title:
  J Travel Med
• Personal Author:
  Eimer, Johannes ; Patimeteeporn, Calvin ; Jensenius, Mogens ; Gkrania-Klotsas, Effrossyni ; Duvignaud, Alexandre ; Barnett, Elizabeth D. ; Hochberg, Natasha S. ; Chen, Lin H. ; Trigo-Esteban, Elena ; Gertler, Maximilian ; Greenaway, Christina ; Grobusch, Martin P. ; Angelo, Kristina M. ; Hamer, Davidson H. ; Caumes, Eric ; Asgeirsson, Hilmir
• Description:
  Background:
  
  Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travellers and migrants with MDR-TB.
  
  Methods:
  
  Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin.
  
  Results:
  
  Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10–751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8–522] vs. 369 days [IQR: 84–827]), while patients from Georgia presented very early, irrespective of the level of resistance (8 days [IQR: 2–18] vs. 2 days [IQR: 1–17]).
  
  Conclusions:
  
  MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.
  
  
• Subjects:
  Antitubercular Agents Extensively Drug-Resistant Tuberculosis Humans Incidence Mycobacterium Tuberculosis Travel Tuberculosis, Multidrug-Resistant
• Keywords:
  Epidemiology Extensively Drug-resistant Tuberculosis Immigration MDR-TB Medical Migration Migrant
• Source:
  J Travel Med. 28(6)
• Pubmed ID:
  33987682
• Pubmed Central ID:
  PMC9638878
• Document Type:
  Journal Article
• Funding:
  G0701652/MRC_/Medical Research CouncilUnited Kingdom/ ; U50CK00189/Cooperative Agreement/ ; U50 CK000189/CK/NCEZID CDC HHSUnited States/ ; Public Health Agency of Canada/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; International Society of Travel Medicine/ ; CC/CDC HHSUnited States/
• Volume:
  28
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:1bca94588f01f4753fdcea3deb378e70e3822fd1a478f795c5b6f25a19114b03964e3f06503b22e22e57a1fdf9fd2d30b9b7ad46dacce0be603ea75b0b4f0fa9
• Download URL:
  https://stacks.cdc.gov/view/cdc/122068/cdc_122068_DS1.pdf
• File Type:
  [PDF - 201.37 KB ]