The proportion of tuberculosis (TB) cases in Europe occurring in migrants is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin.
We carried out a cross-sectional secondary database analysis, utilising 23 years of data from the European Centre for Disease Prevention and Control’s European Surveillance System for 32 EU/EFTA countries collected 1995-2017.
1,270,896 TB cases were included, comprising 326,987 (25.7%) migrants and 943,909 (74.3%) non-migrants. 45.2% (n=147,814) of TB cases among migrants were extrapulmonary, compared to 21.7% (n=204,613) among non-migrants (p<0.001). Lymphatic, bone/joint and peritoneal/digestive TB were more common among migrant than non-migrant extrapulmonary cases. A lower proportion of extrapulmonary TB was seen in Eastern (17.4%, n=98,656 of 566,170) and Southern (29.6%, n=62,481 of 210,828) compared with Western (35.7%, n=89,498 of 250,517) and Northern (41.8%, n=101,792 of 243,381) Europe. Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary disease, with 62.0% (n=55,401 of 89,353) and 54.5% (n=38,327 of 70,378) of cases respectively being extrapulmonary.
Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than non-migrants. There is a need to improve clinical awareness of extrapulmonary TB and integrate its detection into screening programmes.

Copyright © 2020. Published by Elsevier Ltd.