Post-migration follow-up of migrants identified to be at increased risk of developing tuberculosis at pre-migration screening: a systematic review and meta-analysis

Isaac H.Y. Chan, Nishta Kaushik, Claudia C. Dobler*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

17 Citations (Scopus)

Abstract

Background Post-migration follow-up of migrants considered at increased risk of developing tuberculosis based on pre-migration screening abnormalities (high-risk migrants) is implemented in several low-incidence countries. We aimed to determine the rate of tuberculosis in this population to inform cross-border tuberculosis control policies. Methods We searched MEDLINE and Embase (since inception to Jan 12, 2017) for studies evaluating post-migration follow-up of high-risk migrants. Outcomes evaluated were the number of tuberculosis cases occurring post-migration, expressed as the tuberculosis incidence per 100 000 person-years of follow-up, as cumulative incidence of tuberculosis per 100 000 persons, and the cumulative incidence of tuberculosis at the first post-migration follow-up visit. Random-effects models were used to summarise outcomes across studies. Findings We identified 20 publications (describing 23 study cohorts) reporting the pre-migration screening outcomes of 8 355 030 migrants processed between Jan 1, 1981, and May 1, 2014, with 222 375 high-risk migrants identified. The pooled cumulative incidence of tuberculosis post-migration in our study population from 22 cohorts was 2794 per 100 000 persons (95% CI 2179–3409; I2=99%). The pooled cumulative incidence of tuberculosis at the first follow-up visit from ten cohorts was 3284 per 100 000 persons (95% CI 2173–4395; I2=99%). The pooled tuberculosis incidence from 15 cohorts was 1249 per 100 000 person-years of follow-up (95% CI 924-1574; I2=98%). Interpretation The high rate of tuberculosis in high-risk migrants suggests that tuberculosis control measures in this population, including more sensitive pre-migration screening, preventive treatment of latent tuberculosis infection, or post-migration follow-up, are potentially effective cross-border tuberculosis control strategies in low-incidence countries. Funding Australian National Health and Medical Research Council.

Original languageEnglish
Pages (from-to)770-779
Number of pages10
JournalThe Lancet Infectious Diseases
Volume17
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017
Externally publishedYes

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