Foreign-born and homeless persons – new epidemiologic and social factors in the control of tuberculosis in Prague

Česká verzia

Authors: M. Kubín; P. Kalina; Z. Jágrová
Authors place of work: Ředitel: MUDr. Luděk Bajgar ; Hygienická stanice hlavního města Prahy
Published in the journal: Prakt. Lék. 2010; 90(6): 352-357
Category: Of different specialties

Summary

Between 1999 and 2008 in Prague, a total of 258 foreign-born citizens were notified to the National Tuberculosis Registry. Their proportion of the total number of cases increased from 7.3 % in 1999 to 26.2 % in 2008. Individuals born in Ukraine, Slovakia and Vietnam accounted for almost two thirds of the notified cases. Males (178 cases, a mean age of 37.9 years) were much more prevalent than females (80 cases, a mean age of 37.4 years).

The most common disease was TB of the respiratory tract (86.8 %) and the remaining cases were non-pulmonary and miliary TB affections. TB detected on symptoms prevailed by 83.7 %, followed by preventive and risk-groups screening (10.1 % and 3.9 % resp.) and autopsy (2.3 %).

Sixteen (6.
2 %) individuals died of TB. In 2003–2008, Mycobacterium tuberculosis was demonstrated in 121 patients; drug resistance was revealed in 25 (20.7 %) cases, in which 7 multi-drug strains were identified. In addition, between 1999 and 2008, a total of 123 cases of TB were reported in homeless persons in Prague. The annual number of cases ranged from 5 to 19 and their proportion of the total number of the notified cases increased from 2.1 % in 1999 to 15.1 % in 2008. Most of them were males – 113 individuals (91.9 %) with a mean age of 50.4 years (range 27–73 years), and 10 were females with a mean age of 48.6 years (range 28–65 years).

TB of the respiratory organs was most prevalent (97.6 %) and the remaining cases were miliary TB and TB meningitis. Twenty-one (17.1 %) individuals died of TB, 11 of them were found dead or in a moribund state and died during the first days of hospitalization. Symptomatic disease was detected in 93 (75.6 %) patients, 14 cases were revealed by screening in risk groups and 10 by autopsy examination. Mycobacterium tuberculosis was demonstrated in 61 cases; 54 (88.6 %) strains were drug-sensitive, 2 were resistant to isoniazid or rifampicin and 5 were multidrug-resistant. Since 1999, TB in foreign and homeless persons has become a novel and serious factor in the control of TB in Prague.

To solve the problem in the near future, a more active approach to the screening for TB must be taken in both of these risk-groups, and strict adherence to controlled therapeutic regimes and to preventive measures must also be maintained around those infected.

Key words:
tuberculosis, homelessness, foreign-born citizens.

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