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![Number of international migrants in 2015. Source: Adapted from United Nations (UN, [13])](publication/315208247/figure/fig2/AS:472942988533761@1489769803585/Number-of-international-migrants-in-2015-Source-Adapted-from-United-Nations-UN-13.png)
Source publication
Background
International migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a matter of concern in high-income countries and targeted screening of migrants for active and latent TB infection is a main strategy t...
Citations
... Multiple risk factors for TB are clustered in different subpopulations. (3)(4)(5) Epidemiological data have shown that long-term opioid users are more susceptible to TB than the rest. (6) As per a comprehensive community-based case-control study, higher TB risk was independently associated with tobacco smoking, drug use (especially injectable drugs OR = 5.67; 95%CI: 2.68, 11.98), homelessness and area-level deprivation. ...
Epidemiological studies have shown high tuberculosis (TB) prevalence among chronic opioid users. Opioid receptors are found on multiple immune cells and immunomodulatory properties of opioids could be a contributory factor for ensuing immunosuppression and development or reactivation of TB. Toll-like receptors (TLR) mediate an immune response against microbial pathogens, including Mycobacterium tuberculosis. Mycobacterial antigens and opioids co-stimulate TLRs 2/4/9 in immune cells, with resulting receptor cross-talk via multiple cytosolic secondary messengers, leading to significant immunomodulatory downstream effects. Blockade of specific immune pathways involved in the host defence against TB by morphine may play a critical role in causing tuberculosis among chronic morphine users despite multiple confounding factors such as socioeconomic deprivation, Human immunodeficiency virus co-infection and malnutrition. In this review, we map out immune pathways involved when immune cells are co-stimulated with mycobacterial antigens and morphine to explore a potential immunopathological basis for TB amongst long-term opioid users.
... The outbreak of war has significantly reduced the socio-economic level in the region, increased the level of malnutrition, and limited access to basic health care. Therefore, people migrating from these areas are at a higher risk of contracting tuberculosis [9,[25][26][27]. It also constitutes a serious challenge to the progress of European countries in the fight against tuberculosis, especially in Poland, which, at the beginning of the war, received a huge number of refugees from that region at the very beginning of the war [16,17,21,28]. ...
Ukraine is at the forefront of one of the largest outbreaks of tuberculosis (TB) in Europe, including multidrug-resistant tuberculosis. Due to the ongoing armed conflict in this area, there is a significant number of refugees from Ukraine to other European countries. The aim of the study is to emphasize the essence of the problem of the increased incidence of tuberculosis, taking into account the impact of the armed conflict in Ukraine, resulting in the intensification of migration movements. A descriptive epidemiological method was used as the research method. The material was collected by analyzing source statistical data from WHO and statistical yearbooks of selected European countries. Particularly, Ukrainian refugees in Poland, Germany, the Czech Republic, and Slovakia are at higher risk of contracting tuberculosis due to factors like migration stress, poor nutrition, and comorbidities. Epidemiological data from these countries show a rise in tuberculosis cases among foreigners, emphasizing the need for European specialists to be more vigilant in this unique situation, focusing on refugees and other vulnerable populations. More research and collaborative efforts are essential to closely monitor and prevent the severe outcomes of tuberculosis transmission.
... Compared to their counterparts in HICs, migrants living in LMICs are frequently subjected to higher levels of social deprivation and lower access to health services, and specific policies to recognise migrants as potentially vulnerable groups within LMICs remain rare. 7 To improve understanding of health disparities in mortality between locally-born and migrant populations in an LMIC setting, we (i) investigated the differences in demographic and socio-economic characteristics of internal and international migrants and non-migrants in a cohort of low-income individuals living in Brazil; (ii) provided the first estimates of sex-specific age-standardised mortality rates for each group; and (iii) investigated the disparities in death risk, considering overall mortality as well as specific causes of death, between internal migrants and Brazilian-born non-migrants and between international migrants and Brazilian-born individuals. ...
Background:
To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course.
Methods:
We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.
Findings:
The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05).
Interpretation:
Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants.
Funding:
The Wellcome Trust.
... Experimental provision of food baskets was associated with increased completion of TB treatment and cure rates in Brazil. There is also evidence showing a cure rate 7% higher among beneficiaries of the "Bolsa Família" program, in Brazil (Pescarini et al., 2017). ...
Objective:
to map scientific evidence on the extent of tuberculosis in migrants from the international borders between Brazil and the countries of South America.
Design:
Scoping review of quantitative, qualitative and mixed studies. The research was conducted between February and April 2021. The terms "migrants", "tuberculosis", "Brazil", "Uruguay", "Paraguay", "Bolivia", "Peru", "British Guiana" "English Guiana", "French Guiana", "Suriname", "Venezuela", "Argentina", "Colombia" combined with Boolean operators "AND" and "OR" to identified relevant documents. Studies addressing tuberculosis on migrants from international borders of Brazil were included. Pubmed Central (PMC), LILACS (Scientific and technical literature of Latin America and the Caribbean/BVS), Scopus (Elsevier), Scielo (Scientific Electronic Library Online) and gray literature CAPES thesis database were searched. The study was carried out in three stages where the data was selected and extracted by two independent reviewers for full reading.
Results:
A total of 705 articles were extracted from the databases chosen for the search, 04 master's dissertations and 01 doctoral thesis. Of these 456 were excluded because they did not meet at least one of the eligibility criteria for this SR and 4 were further excluded because they were duplicates who had not been previously identified. A total of 58 documents were, thus, selected for assessment of the full text. Of these, 40 were further excluded for not meeting at least one of the eligibility criteria. A total of 18 studies were included for data collection: 15 articles, 2 master's dissertations and 1 doctoral thesis, produced between 2002 and 2021.
Conclusion:
This scoping review mapped the existing evidence on tuberculosis at the international borders of Brazil and on access of immigrants with tuberculosis to health services in Brazil.
Descriptors:
tuberculosis; immigrants; public health surveillance; epidemiological surveillance; sanitary control of borders; health services accessibility.
... In countries with low TB incidence, the groups of immigrants coming from other countries have higher disease incidence coefficients than the autochthonous population ( Schneeberger et al., 2010 ;Heldal et al., 2008 ;Kik et al., 2011 ). However, this relationship has been poorly addressed in countries with high TB incidence ( Pescarini et al., 2017 ). ...
... As a result of the universalization of the Health Unified System (SUS) in Brazil, every immigrant whether being legal or not has the right to receive proper healthcare ( Pescarini et al., 2017 ;Aguiar and Mota, 2014 ), which is extended to TB prevention and treatment. ...
... Most studies in this search reported a predominance of Bolivians with TB ( Aguiar and Mota, 2014 ;Martinez et al., 2012 ;Goldberg, 2013 ), in addition to analyzing the vulnerability of immigrants who face barriers against access to health services ( Aguiar and Mota, 2014 ;Martinez et al., 2012 ;Steffens and Martins, 2016 ;Silveira et al., 2016 ) and precarious life and work conditions in their establishment in the country ( Pescarini et al., 2017 ;Goldberg, 2013 ;Steffens and Martins, 2016 ) which has led them to develop the most active form of TB. All of the studies ( Pescarini et al., 2017 ;Aguiar and Mota, 2014 ;Martinez et al., 2012 ;Goldberg, 2013 ;Steffens and Martins, 2016 ;Silveira et al., 2016 ;Pinto et al., 2018 ) were carried out in the MSP and three manuscripts ( Pescarini et al., 2017 ;Goldberg, 2013 ;Pinto et al., 2018 ) addressed TB epidemiological aspects in immigrants. ...
Objective
To analyze the profile of immigrants with tuberculosis (TB) and to identify the associated vulnerability characteristics.
Methods
A cross-sectional study which used TB-WEB data from cases residing in São Paulo in 2016 (203 immigrants and 6,069 non-immigrants). The variables were analyzed using prevalence ratio and confidence intervals.
Results
Among the immigrant cases, 67% were Bolivians. When compared to non-immigrants, immigrants were younger and frequently indigenous or presenting yellow ethnicity. They were also associated with a higher education level. We observed less immigrants having extrapulmonary TB and comorbidities, such as HIV/AIDS, diabetes mellitus, or drug use. Compared to cured cases, immigrants were not associated with treatment default and death, but they were associated with transfer to another state/country.
Conclusions
Younger individuals and higher education levels were identified among immigrants, as well as a lower occurrence of comorbidities and drug use. It is believed that these results have led immigrants to more favorable outcomes of TB treatment.
... According to the report of the Russian Ministry of Health, the number of TB cases in Russia decreased between 2009 and 2019 by >50% (from 133,229 people in 2000 to 60,531 people in 2019) [25]. Still, the TB rates in Russia remain very high, especially among vulnerable groups in the large cities [26], and WLWH represent such vulnerable group. According to our study of 377 patients done in tuberculosis clinics in Moscow between 2015-2016, 56.8% of HIV-positive individuals had TB [27]. ...
... Russia is highly endemic for both HIV-1 and TB. Russia is classified today as a middle-income country according to WHO criteria of the health care spending (5% of GDP) [26,45]. The TB-related epidemiological situation in Russia is improving, and currently is reported at 41.2 cases per 100,000 population [46]. ...
Women living with HIV-1 are at high risk of infection with human papillomavirus of high carcinogenic risk (HR HPVs). M. tuberculosis (TB) promotes HPV infection and increases the risk to develop HPV-associated cancer. Our knowledge of persisting HR HPVs genotypes, and of the factors promoting HR HPV infection in people living with HIV-1 with clinical TB manifestations is sparse. Here, we analyzed 58 women living with HIV-1 with clinical TB manifestations (WLWH with TB) followed up in specialized centers in Russia, a middle income country endemic for HIV-1 and TB, for the presence in cervical smears of DNA of twelve HR HPV genotypes. DNA encoding HPV16 E5, E6/E7 was sequenced. Sociodemographic data of patients was collected by questionnaire. All women were at C2-C3 stages of HIV-infection (by CDC). The majority were over 30 years old, had secondary education, were unemployed, had sexual partners, experienced 2–3 pregnancies and at least one abortion, and were smokers. The most prevalent was HPV16 detected in the cervical smears of 38% of study participants. Altogether 34.5% of study participants were positive for HR HPV types other than HPV16; however, but none of these types was seen in more than 7% of tested samples. Altogether, 20.7% of study participants were positive for several HR HPV types. Infections with HPVs other than HPV16 were common among WLWH with generalized TB receiving combined ART/TB-therapy, and associated with their ability to work, indirectly reflecting both their health and lifestyle. The overall prevalence of HR HPVs was associated with sexual activity of women reflected by the number of pregnancies, and of HPV 16, with young age; none was associated to CD4+-counts, route of HIV-infection, duration of life with HIV, forms of TB-infection, or duration of ART, characterizing the immune status. Thus, WLWH with TB—especially young—were predisposed to infection with HPV16, advancing it as a basis for a therapeutic HPV vaccine. Phylogenetic analysis of HPV16 E5, E6/E7 DNA revealed no common ancestry; sequences were similar to those of the European and American HPV16 strains, indicating that HPV vaccine for WLWH could be the same as HPV16 vaccines developed for the general population. Sociodemographic and health correlates of HR HPV prevalence in WLWH deserve further analysis to develop criteria/recommendations for prophylactic catch-up and therapeutic HPV vaccination of this highly susceptible and vulnerable population group.
... Studies have shown that violence, labor exploitation, and sexual harassment are frequently reported during migration and in the country of destination [31,32]. Stressful, stigmatizing, and vulnerable conditions thus contribute to the development of non-infectious and infectious diseases in this population, including TB infection or reactivation of latent TB infection (LTBI) [33][34][35]. ...
... Most migrants are from low and middle-income countries and are generally headed for large cities in the new country [35,36]. These migrants are more likely to settle in low-income neighborhoods in the city center and tend to have higher TB burden. ...
... These migrants are more likely to settle in low-income neighborhoods in the city center and tend to have higher TB burden. As a result, this population often experiences more poverty, vulnerability, and social exclusion than in their home communities [35,37]. There has been a major increase in migrants to (and within) South America in the last 15 years, and although this growing number can contribute to greater social integration, it can also increase the social vulnerability of these individuals and TB cross-contamination, as already evidenced in studies [38]. ...
Background
Tuberculosis (TB) in migrants is of concern to health authorities worldwide and is even more critical in Brazil, considering the country´s size and long land borders. The aim of the study was to identify critical areas in Brazil for migrants diagnosed with TB and to describe the temporal trend in this phenomenon in recent years.
Methods
This is an ecological study that used spatial analysis and time series analysis. As the study population, all cases of migrants diagnosed with TB from 2014 to 2019 were included, and Brazilian municipalities were considered as the unit of ecological analysis. The Getis-Ord Gi* technique was applied to identify critical areas, and based on the identified clusters, seasonal-trend decomposition based on loess (STL) and Prais-Winsten autoregression were used, respectively, to trace and classify temporal trend in the analyzed series. In addition, several municipal socioeconomic indicators were selected to verify the association between the identified clusters and social vulnerability.
Results
2,471 TB cases were reported in migrants. Gi* analysis showed that areas with spatial association with TB in immigrants coincide with critical areas for TB in the general population (coast of the Southeast and North regions). Four TB clusters were identified in immigrants in the states of Amazonas, Roraima, São Paulo, and Rio de Janeiro, with an upward trend in most of these clusters. The temporal trend in TB in immigrants was classified as increasing in Brazil (+ 60.66% per year [95% CI: 27.21–91.85]) and in the clusters in the states of Amazonas, Roraima, and Rio de Janeiro (+1.01, +2.15, and + 2.90% per year, respectively). The cluster in the state of São Paulo was the only one classified as stationary. The descriptive data on the municipalities belonging to the clusters showed evidence of the association between TB incidence and conditions of social vulnerability.
Conclusions
The study revealed the critical situation of TB among migrants in the country. Based on the findings, health authorities might focus on actions in regions identified, stablishing an intensive monitoring and following up, ensuring that these cases concluded their treatment and avoiding that they could spread the disease to the other regions or scenarios. The population of migrants are very dynamic, therefore strategies for following up them across Brazil are really urgent to manage the tuberculosis among international migrants in an efficient and proper way.
... The unknown number of Venezuelans that reside illegally in Colombia might be the most vulnerable population to cases of labor exploitation, extortion, violence, illegal trafficking, sexual abuse, forced recruitment, discrimination, and xenophobia 17,18 . Assuring health services, education, and other basic services to the migrant population is likely a cumbersome issue in the border departments (i.e., Santander, Norte de Santander, and La Guajira) that requires extra resources, strategies, or immigration policies 19,20 . ...
Historically, human migrations have determined the spread of many infectious diseases by promoting the emergence of temporal outbreaks between populations. We aimed to analyze health indicators, expenditure, and disability caused by tuberculosis (TB) and HIV/AIDS burden under the Colombian-Venezuelan migration flow focusing on the Northeastern border. A retrospective study was conducted using TB and HIV/AIDS data since 2009. We consolidated a database using official reports from the Colombian Surveillance System, World Health Organization, Indexmundi, the Global Health Observatory, IHME HIV atlas, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Disability metrics regarding DALYs (disability adjusted life years) and YLDs (years lived with disability), were compared between countries. Mapping was performed on ArcGIS using official migration data of Venezuelan citizens. Our results indicate that TB profiles from Colombia and Venezuela are identical in terms of disease burden, except for an increase in TB incidence in the Colombian-Venezuelan border departments in recent years, concomitantly with the massive Venezuelan immigration since 2005. We identified a four-fold underfunding for the TB program in Venezuela, which might explain the low-testing rates for cases of multidrug-resistant TB (67%) and HIV/AIDS (60%), as well as extended hospital stays (150 days). We found a significant increase in DALYs of HIV/AIDS patients in Venezuela, specifically, 362.35 compared to 265.37 observed in Colombia during 2017. This study suggests that the Venezuelan massive migration and program underfunding might exacerbate the dual burden of TB and HIV in Colombia, especially towards the Colombian‐Venezuelan border.
... An estimated 10.0 million people developed TB in 2018, of which approximately 1.5 million people lost their lives [3]. TB disproportionally affects low to middle-income countries [4]. For example, in 2017, 44% of TB cases occurred in south Asia and 25% in Africa, as compared to 2.7% cases in Europe, and 2.8% in the Americas [3]. ...
The cell wall of Mycobacterium tuberculosis (Mtb) has a unique structural organisation, comprising a high lipid content mixed with polysaccharides. This makes cell wall a formidable barrier impermeable to hydrophilic agents. In addition, during host infection, Mtb resides in macrophages within avascular necrotic granulomas and cavities, which shield the bacterium from the action of most antibiotics. To overcome these protective barriers, a new class of anti-TB agents exhibiting lipophilic character have been recommended by various reports in literature. Herein, a series of lipophilic heterocyclic quinolone compounds was synthesised and evaluated in vitro against pMSp12::GFP strain of Mtb, two protozoan parasites (Plasmodium falciparum and Trypanosoma brucei brucei) and against ESKAPE pathogens. The resultant compounds exhibited varied anti-Mtb activity with MIC90 values in the range of 0.24-31 µ M. Cross-screening against P. falciparum and T.b. brucei, identified several compounds with antiprotozoal activities in the range of 0.4-20 µ M. Compounds were generally inactive against ESKAPE pathogens, with only compounds 8c, 8g and 13 exhibiting moderate to poor activity against S. aureus and A. baumannii.
... [9] An increase of immigration may have a significant impact on the pattern of TB transmission in countries. [10] TB immigrants are normally people who move from countries where TB is indigenous to the affluent countries from the view point of facilities. Thus, migratory flows from developing countries with a high prevalence of TB are a source of concern for TB control, [11] as some immigrants due to having a hidden infection [12] on the one hand, and TB patients travelling to other countries such as Iran who called "health tourism" [13] on the other hand, are effective in the transmission of TB; therefore, international travel and migrations will change the epidemiology of this disease. ...
Background:
Today, because of increasing immigration and the prevalence of drug-resistant tuberculosis in Iran, identifying intra-community cases is necessary in the country. It will be possible through the use of molecular epidemiologic methods. In this inquiry, in order to determine the role of immigrants in the transmission of specific strains to Iran, the studies have been examined which had been conducted based on molecular epidemiologic methods among Iranians and non-Iranians people.
Methods:
All studies from 1997 to the end of March 2017 were examined in three databases of PubMed, Scopus, and Google Scholar and finally, 16 studies were selected.
Results:
The common clustering rate between Iranians and non-Iranians was determined to be 19.8, and the intra-community recent transmission rate was from 0% to 49% with average of 18.1%. The rate of multidrug-resistant tuberculosis (MDR-TB) was 12.5%, which was higher among immigrants, especially Afghans, and a significant number of the strains were Beijing.
Conclusions:
The studies have shown that migrants, especially Afghans, are more effective in transmitting specific strains of tuberculosis to migratory areas. To control tuberculosis, it is necessary to register of immigrant's health information, while enter to the country, so that, by doing appropriate diagnostic tests, the curing the patients, the transmission of tuberculosis to the country would be prevented.
