Tuberculosis among asylum seekers in Milan, Italy: epidemiological analysis and evaluation of interventions.

In countries of the European Union, tuberculosis (TB) mainly affects marginalised people, including asylum seekers. Migratory flows from high-incidence countries to Italy have increased up to 2017, posing challenges to the national health system. This study sought to assess TB and latent TB infection (LTBI) prevalence among asylum seekers in Milan during the biennium 2016-2017 and to evaluate interventions in place.A two-level active surveillance and screening system was developed for both TB and LTBI. Asylum seekers underwent an initial screening with a tuberculin skin test (TST) and a questionnaire at the receiving sites. At the Regional TB Reference Centre, those with a positive result underwent chest radiography. People aged <35 years with negative chest radiography results underwent further testing by interferon-γ release assay. If results of the assay were positive, LTBI treatment was offered. TB and LTBI prevalence were compared with literature data.A total of 5324 asylum seekers, mostly young (10-39 years; 98%), male (84%) and from sub-Saharan Africa (69%), were enrolled in the study. 69 active TB cases were diagnosed and 863 LTBI-positive individuals were detected. TB prevalence was high (1236 per 100 000 population) and LTBI prevalence was 28%. Despite losses (41%) during the transition from initial screening sites and the diagnostic centre, a good TB cure rate (84%) and optimal LTBI treatment completion (94%) were achieved.Our study shows that TB incidence is high among asylum seekers in Milan and that well-coordinated screening measures are critical for early diagnosis and treatment. It also proves that rolling out successful at-scale interventions for both prophylaxis and disease management is feasible.
Competing Interests: Conflict of interest: S. Villa has nothing to disclose. Conflict of interest: L.R. Codecasa has nothing to disclose. Conflict of interest: M. Faccini has nothing to disclose. Conflict of interest: M.M. Pontello has nothing to disclose. Conflict of interest: M. Ferrarese has nothing to disclose. Conflict of interest: P.F. Castellotti has nothing to disclose. Conflict of interest: S. Senatore has nothing to disclose. Conflict of interest: A. Lamberti has nothing to disclose. Conflict of interest: E. Mazzola has nothing to disclose. Conflict of interest: C.F. Perno has nothing to disclose. Conflict of interest: D. Campisi has nothing to disclose. Conflict of interest: M. Saporiti has nothing to disclose. Conflict of interest: M.C. Raviglione has nothing to disclose.
(Copyright ©ERS 2019.)