First Published: 2017-03-22

Migrants in Europe at risk of drug-resistant tuberculosis
Migrants, refugees who are often in densely-populated, unsanitary conditions most at risk from new form of TB which cannot easily be cured with existing drugs.
Middle East Online

European countries do not have a standardised approach to screening TB

VIENNA - In the late 19th century, an estimated one in seven Europeans was dying of tuberculosis, then known as "consumption" for its slow, remorseless wasting of the human body.

Now, after decades of low TB rates thanks to antibiotics and strong public health systems, the continent is threatened by a new and different form of the lung disease -- one which cannot easily be cured with existing drugs.

And the people most at risk, experts say, are migrants and refugees who often find themselves in densely-populated, unsanitary, disease-favourable conditions similar to those blamed for Europe's Victorian era "Great White Plague".

"Although rare in European countries, the risks posed by the current migrant crisis makes MDR-TB (multi- drug-resistant tuberculosis) an important and urgent health priority," the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) said in a recent statement.

And it warned there was a "human rights obligation" to improve the diagnosis, treatment and prevention of drug-resistant tuburculosis in migrants.

Infections on European soil were mainly among migrants themselves, and public health experts stress they should be viewed as a vulnerable group in need of help -- not disease spreaders.

A hundred percent of MDR-TB cases in Austria, the Netherlands and Norway were diagnosed in migrants and refugees, said the ESCMID, and around 90 percent in Britain, France, Italy and Germany.

This represented just over 1,400 cases in 12 countries in 2014.

- Access denied -

Some migrants may arrive already sick with MDR-TB, others with a latent, unobserved infection.

Some may catch these dangerous germs on overcrowded refugee boats or in work or migrant camps.

"Migrants are among the most susceptible groups to tuberculosis," Michel Kazatchkine, the UN secretary-general's special envoy on HIV/AIDS in Eastern Europe and Central Asia, said.

"Most of them acquire a disease in the host country," he said.

Drug-resistant TB strains are more difficult and expensive to treat.

Symptoms are not immediately visible, and the disease can spread easily from one person to another via coughing, sneezing, or simply talking.

But many cases may never be spotted, as European countries do not have a standardised approach to screening.

Migrants may be refused access to treatment or may not know how to, and others might want to avoid a positive diagnosis for fear of being deported.

"The situation in Europe is such that governments are now tightening up in terms of who is able to access free statutory health services," Sally Hargreaves of the International Health Unit at Imperial College London, said.

In 2015 alone, Europe received a million migrants from war-torn countries in Africa and the Middle East.

"There's very little evidence to suggest that migrants pose a major threat to the general population of a country they go to in health terms," Nicholas Beeching of the ESCMID's Study Group on Infections in Travellers and Migrants said.

"Nevertheless, of course it presents a challenge because we want to identify people with MDR-TB and make sure that they get appropriate treatment and also make sure it doesn't spread within their own community... and the general community."

- Pre-antibiotic era -

In 2015, about half-a-million people worldwide developed MDR-TB and the even more resistant strain XDR-TB, according to the World Health Organization.

One in five were in the WHO's European region, which comprises 53 countries including from hard-hit eastern Europe and Russia.

Treatment was successful in under half of MDR-TB patients and less than a third for XDR-TB -- a rate which "approximates that... seen in the pre-antimicrobial era," the journal Clinical Microbiology and Infection warned in its March edition.

"If drug resistance increases substantially, TB elimination will become more difficult if not impossible, to achieve."

TB, an infection of the lungs that can be deadly if untreated, killed some 1.8 million people worldwide in 2015 and infected 10.4 million.

It remains the top infectious killer worldwide -- particularly in Asia, Africa and Eastern Europe, which also has the most MDR-TB cases.

MDR-TB does not respond to the two most potent TB drugs -- isoniazid and rifampin, and XDR-TB to an even longer list.

"While anyone can contract TB, the disease thrives among people living in poverty, communities and groups that are marginalised and other vulnerable populations," the WHO says in a message for World TB Day on Friday -- migrants and refugees among them.

"Addressing the health needs of the disadvantaged, the marginalised, those out of reach of the health system, will mean improving access to health services for everyone."


More strikes hit E. Ghouta as UN delays truce vote

Russia pours cold water on UN bid to condemn Iran over missiles to Yemen

Egypt presidential race starts with Sisi likely to win

Saudi Arabia to boost entertainment in next decade

Blatter supports Morocco bid for 2026 World Cup

Turkey says US embassy Jerusalem opening in May 'extremely worrying'

Lebanon says both suspects in Kuwait murder of Filipina maid held

38 dead in Mogadishu car bombings

Morocco police arrests prominent newspaper publisher

Syria regime continues to pound Ghouta as world stutters

UN rights commission wants S.Sudan war crimes charges

Iran grounds airline's ATR planes after crash

Turkey summons Dutch diplomat over Armenian 'genocide' vote

Turkey navy threatens to engage Italian drillship near Cyprus

Iran police shoving headscarf protester sparks social media storm

UN Security Council to vote Friday on Syria ceasefire

Dubai says Djibouti illegally seized African port

Dutch parliament recognises 1915 Armenian massacre as genocide

Heavily bombarded Eastern Ghouta awaits UN resolution

Russia says Syria rebels rejected offer to evacuate E. Ghouta

UN diplomats press for Syria ceasefire without Russia veto

Iranian minister’s presence at UN rights meeting angers critics

Iran warns it will leave nuke deal if banks cannot do business

Qatar to plant thousands of trees to ‘beautify’ World Cup venues

Pro-Kurdish party says Turkey lying about 'no civilian deaths' in Afrin

African migrants protest Israeli detention policy

Egypt sentences 21 to death for planning attacks

Israeli handball teams in Qatar spark furious outcry from locals

UN report highlights S.Sudan journalist treatment

Palestinian dies after being shot by Israeli soldiers

Gulf states urge Syria to end Ghouta violence

Wanted Bahraini militants die at sea en route to Iran

Iran's Ahmadinejad calls for immediate free elections

Merkel calls for end to 'massacre' in Syria

Iraq urges FIFA to lift ban on hosting internationals

Carnage of Ghouta's bombs breaking families

Blockaded Gaza Strip forced to pump sewage into sea

African migrants start hunger strike over Israel expulsion

UN chief 'deeply alarmed' by Eastern Ghouta violence

Three militiamen killed in Libya car bomb attack

Russia denies ‘groundless’ accusations of role in Ghouta killings

Turkey says whoever helps YPG is 'legitimate target'

Morocco dismantles IS-linked terrorist cell

Turkey urged to end gas standoff with Cyprus

PKK attack near Iraq kills 2 Turkish soldiers