Multidrug-resistant tuberculosis in migrants, multi-country cluster, second update, 27 March 2017
Conclusions and options for response
A multi-country cluster of multidrug-resistant tuberculosis (MDR TB) involving 25 migrants has been delineated by whole genome sequencing (WGS). All cases have a recent history of migration from Somalia (22 cases),
Eritrea (2 cases) and Ethiopia (1 case). Cases have been reported by Germany (13 cases), Switzerland (8 cases), Austria (2 cases), Finland and Sweden (1 case each). A WGS analysis of the 25 cluster isolates supports the hypothesis that the cases are part of a chain of recent transmission likely to have taken place either in the country of origin or in a place along the migration route to the country of destination. Based on the currently available information, it is not possible as of yet to rule out that transmission occurred in an EU/EFTA country.
It therefore remains 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/EFTA, 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 may yet be identified in association with this cluster.
Early case finding of active TB and drug susceptibility testing, especially in newly arriving migrants from the Horn of Africa, is important in order to identify and treat active cases and to provide preventive treatment or monitoring for those diagnosed with latent tuberculosis infection.