Multidrug-resistant tuberculosis in migrants, multi-country cluster, Third update, 13 April 2017
Conclusions and options for response
A multi-country cluster of multidrug-resistant tuberculosis (MDR TB) involving 28 migrants has been delineated by whole genome sequencing (WGS).
In December 2016, Switzerland initially reported a cluster of seven MDR TB cases to the European Commission in newly-arrived migrants from Somalia (5 cases), Eritrea (1 case) and Ethiopia (1 case). The Commission then informed the Member States through an Early Warning and Response System (EWRS) message. Following the EWRS notification, Germany, Austria, Finland, France and Sweden reported cases that were linked to this cluster on the basis of WGS. Switzerland later reported an eighth case. As of 4 April 2017, isolates from 28 cases that are part of the WGS cluster had been reported from Germany (14), Switzerland (8), Austria (2), France (2),
Finland (1) and Sweden (1). All cases have a recent history of migration from Somalia (23), Eritrea (3), Sudan (1) and Ethiopia (1).
The six countries involved in the multi-country cluster have implemented migrant screening.
Early case identification of active TB and drug susceptibility testing, especially in migrants arriving from the Horn of Africa, is important in order to identify and treat active cases and provide preventive treatment or monitoring for those diagnosed with latent tuberculosis infection .
It is therefore important to rapidly investigate exposure risk factors, including the travel history and itineraries of patients and their contacts, and share this information to determine whether transmission may have taken place in the EU/EEA, during migration, or in the country of origin. Depending on the results of the investigation, appropriate prevention and control measures should be taken.
Although the number of cases detected so far suggests that there is only a limited risk of this cluster becoming a widespread event in Europe, more cases associated with this cluster may yet be identified.