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Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany

INTRODUCTION: In 2015, 4062 unaccompanied minor refugees were registered in Berlin, Germany. According to national policies, basic clinical examination and tuberculosis (TB) screening is a prerequisite to admission to permanent accommodation and schooling for every refugee. This article evaluates th...

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Autores principales: Thee, Stephanie, Krüger, Renate, von Bernuth, Horst, Meisel, Christian, Kölsch, Uwe, Kirchberger, Valerie, Feiterna-Sperling, Cornelia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528979/
https://www.ncbi.nlm.nih.gov/pubmed/31112542
http://dx.doi.org/10.1371/journal.pone.0216234
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author Thee, Stephanie
Krüger, Renate
von Bernuth, Horst
Meisel, Christian
Kölsch, Uwe
Kirchberger, Valerie
Feiterna-Sperling, Cornelia
author_facet Thee, Stephanie
Krüger, Renate
von Bernuth, Horst
Meisel, Christian
Kölsch, Uwe
Kirchberger, Valerie
Feiterna-Sperling, Cornelia
author_sort Thee, Stephanie
collection PubMed
description INTRODUCTION: In 2015, 4062 unaccompanied minor refugees were registered in Berlin, Germany. According to national policies, basic clinical examination and tuberculosis (TB) screening is a prerequisite to admission to permanent accommodation and schooling for every refugee. This article evaluates the use of an interferon-γ-release-assay (IGRA) during the initial examination and TB screening of 970 unaccompanied minor refugees. RESULTS: IGRA test were obtained during TB screening for 301 (31.0%) of 970 adolescents not previously screened for TB. Positive IGRA results were obtained in 13.9% (42/301). Most of the 42 IGRA-positive refugees originated from Afghanistan or Syria (n?20 and 10 respectively). Two IGRA-positive adolescents were lost to follow-up, 2 were diagnosed with TB and the remaining 38 diagnosed with latent TB infection (LTBI). Demographic features of the 40 patients with positive IGRA result were as follows: 39 male, median age 16.8 years (IQR 16.0–17.2y), none meeting underweight criteria (median BMI 21.3kg/m(2)). On initial chest X-ray 2/40 participants had signs of active TB, while in 38 active disease was excluded and the diagnosis of latent TB infection (LTBI) made. Active hepatitis B-co-infection was diagnosed in 3/38 patients. All patients with LTBI received Isoniazid and Rifampicin for 3 months without occurrence of severe adverse events. The most frequently observed side effect was transient upper abdominal pain (n = 5). Asymptomatic elevation of liver transaminases was seen in 2 patients. 29 patients completed treatment with no signs of TB disease at the end of chemoprevention and 9 were lost to follow up. CONCLUSION: Screening for TB infection in minor refugees was feasible in our setting with a relatively high rate of TB infection detected. Chemopreventive treatment was tolerated well regardless of underlying hepatitis-B-status. Minor refugees migrating to Germany should be screened for TB infection, instead of TB disease only, regardless of the background TB incidence.
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spelling pubmed-65289792019-05-31 Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany Thee, Stephanie Krüger, Renate von Bernuth, Horst Meisel, Christian Kölsch, Uwe Kirchberger, Valerie Feiterna-Sperling, Cornelia PLoS One Research Article INTRODUCTION: In 2015, 4062 unaccompanied minor refugees were registered in Berlin, Germany. According to national policies, basic clinical examination and tuberculosis (TB) screening is a prerequisite to admission to permanent accommodation and schooling for every refugee. This article evaluates the use of an interferon-γ-release-assay (IGRA) during the initial examination and TB screening of 970 unaccompanied minor refugees. RESULTS: IGRA test were obtained during TB screening for 301 (31.0%) of 970 adolescents not previously screened for TB. Positive IGRA results were obtained in 13.9% (42/301). Most of the 42 IGRA-positive refugees originated from Afghanistan or Syria (n?20 and 10 respectively). Two IGRA-positive adolescents were lost to follow-up, 2 were diagnosed with TB and the remaining 38 diagnosed with latent TB infection (LTBI). Demographic features of the 40 patients with positive IGRA result were as follows: 39 male, median age 16.8 years (IQR 16.0–17.2y), none meeting underweight criteria (median BMI 21.3kg/m(2)). On initial chest X-ray 2/40 participants had signs of active TB, while in 38 active disease was excluded and the diagnosis of latent TB infection (LTBI) made. Active hepatitis B-co-infection was diagnosed in 3/38 patients. All patients with LTBI received Isoniazid and Rifampicin for 3 months without occurrence of severe adverse events. The most frequently observed side effect was transient upper abdominal pain (n = 5). Asymptomatic elevation of liver transaminases was seen in 2 patients. 29 patients completed treatment with no signs of TB disease at the end of chemoprevention and 9 were lost to follow up. CONCLUSION: Screening for TB infection in minor refugees was feasible in our setting with a relatively high rate of TB infection detected. Chemopreventive treatment was tolerated well regardless of underlying hepatitis-B-status. Minor refugees migrating to Germany should be screened for TB infection, instead of TB disease only, regardless of the background TB incidence. Public Library of Science 2019-05-21 /pmc/articles/PMC6528979/ /pubmed/31112542 http://dx.doi.org/10.1371/journal.pone.0216234 Text en © 2019 Thee et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Thee, Stephanie
Krüger, Renate
von Bernuth, Horst
Meisel, Christian
Kölsch, Uwe
Kirchberger, Valerie
Feiterna-Sperling, Cornelia
Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title_full Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title_fullStr Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title_full_unstemmed Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title_short Screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in Berlin, Germany
title_sort screening and treatment for tuberculosis in a cohort of unaccompanied minor refugees in berlin, germany
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528979/
https://www.ncbi.nlm.nih.gov/pubmed/31112542
http://dx.doi.org/10.1371/journal.pone.0216234
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