Open Access Highly Accessed Research article

Migrant tuberculosis: the extent of transmission in a low burden country

Zaza Kamper-Jørgensen17*, Aase Bengaard Andersen2, Axel Kok-Jensen1, Mads Kamper-Jørgensen3, Ib Christian Bygbjerg46, Peter Henrik Andersen5, Vibeke Østergaard Thomsen1 and Troels Lillebaek16

Author Affiliations

1 International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark

2 Department of Infectious Diseases, Odense University Hospital, Odense, Denmark

3 Department of Public Health, University of Copenhagen, Copenhagen, Denmark

4 International Health Unit, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark

5 Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark

6 Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

7 International Reference Laboratory of Mycobacteriology, Statens Serum Institut, 5 Orestads Boulevard, DK-2300 Copenhagen, Denmark

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BMC Infectious Diseases 2012, 12:60  doi:10.1186/1471-2334-12-60

Published: 18 March 2012

Abstract

Background

Human migration caused by political unrest, wars and poverty is a major topic in international health. Infectious diseases like tuberculosis follow their host, with potential impact on both the migrants and the population in the recipient countries. In this study, we evaluate Mycobacterium tuberculosis transmission between the national population and migrants in Denmark.

Methods

Register study based on IS6110-RFLP results from nationwide genotyping of tuberculosis cases during 1992 through 2004. Cases with 100% identical genotypes were defined as clustered and part of a transmission chain. Origin of clusters involving both Danes and migrants was defined as Danish/migrant/uncertain. Subsequently, the proportion of cases likely infected by the "opposite" ethnic group was estimated.

Results

4,631 cases were included, representing 99% of culture confirmed cases during 1992 through 2004. Migrants contributed 61.6% of cases. Up to 7.9% (95% CI 7.0-8.9) of migrants were infected by Danes. The corresponding figure was 5.8% (95% CI 4.8-7.0) for Danes. Thus, transmission from Danes to migrants occurred up to 2.5 (95% CI 1.8-3.5) times more frequent than vice versa (OR = 1). A dominant strain, Cluster-2, was almost exclusively found in Danes, particular younger-middle-aged males.

Conclusions

Transmission between Danes and migrants is limited, and risk of being infected by the "opposite" ethnic group is highest for migrants. TB-control efforts should focus on continues micro-epidemics, e.g. with Cluster-2 in Danes, prevention of reactivation TB in high-risk migrants, and outbreaks in socially marginalized migrants, such as Somalis and Greenlanders. Fears that TB in migrants poses a threat for resident Danes seem exaggerated and unjustified. We believe this to be true for other low incidence countries as well.

Keywords:
Denmark; Genotyping; IS6110-RFLP; Molecular epidemiology