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Background Progress towards the World Health Organization’s End TB Strategy is monitored by assessing tuberculosis (TB) incidence, often derived from TB notification, assuming complete case detection and reporting. This assumption is unlikely to hold in many settings, including European Union (EU) countries. Aim We aimed to assess observed and estimated completeness of TB notification through inventory studies and capture–recapture (CRC) methodology in six EU countries: Croatia, Denmark, Finland, the Netherlands, Portugal Slovenia. Methods We performed record linkage, case ascertainment and CRC analyses of data collected retrospectively from at least three national TB-related registers in each country between 2014 and 2016. Results Observed completeness of TB notification by inventory studies was 73.9% in Croatia, 98.7% in Denmark, 83.6% in Finland, 81.6% in the Netherlands, 85.8% in Portugal and 100% in Slovenia. Subsequent CRC analysis estimated completeness of TB notification to be 98.4% in Denmark, 76.5% in Finland and 77.0% in Portugal. In Croatia, CRC analyses produced implausible results while in the Netherlands and Slovenia, it was methodologically considered not meaningful. Conclusion Inventory studies and CRC methodology suggest a TB notification completeness between 73.9% and 100% in the six EU countries. Mandatory reporting by clinicians and laboratories, and cross-checking of registers, strongly contributes to accurate notification rates, but hospital episode registers likely contain a considerable proportion of false-positive TB records and are thus less useful. Further strengthening routine surveillance to count TB cases, i.e. incidence, accurately by employing record-linkage of high-quality TB registers should make CRC studies obsolete in EU countries.

Efficiency and yield of an active TB case-finding programme during and after an outbreak can guide scaling downhttp://ow.ly/ZT1Me

In low tuberculosis (TB) incidence countries foreign-born patients constitute a high percentage of the TB burden, up to 90% in Scandinavian countries [1] and 73% in the Netherlands in 2014 [2]. Several European Union (EU) countries have developed screening strategies to identify TB in migrants at an early stage and prevent transmission, but there is no uniform EU policy [3–5]. In the Netherlands, TB screening of migrants has been stipulated in the Alien's Act since 1966. At that time, screening was mainly carried out for migrant workers from Southern European countries, Morocco and Turkey. Since the 1990s, TB screening has increasingly included immigrants and asylum seekers from other countries in the world. For the screening of asylum seekers a mobile radiography screening programme has been in place since 1992 with national coverage [6]. The annual overall yield of TB screening has been well above 200 cases per 100 000 persons screened until a few years ago [6, 7]. It declined to 85 cases per 100 000 persons screened in 2014, due to the high number of asylum seekers from countries with traditionally low TB incidence rates such as Iran, Iraq and, predominantly, Syria [2]. Screening asylum seekers from areas with a TB incidence of

Europe is facing a refugee crisis in which hundreds of thousands of displaced persons, often originating from tuberculosis (TB) high-endemic countries, risked their lives for a safer and better future in the European Union (EU) [1]. Among these asylum seekers a considerable proportion were accompanied or unaccompanied minors [2, 3]. Screening practices for TB and latent TB infection (LTBI) among refugees are highly variable in the EU [4, 5]. Details of practices, including mandatory radiographic screening for intrathoracic TB among children of all ages, and aggregate yield of TB entry screening among asylum seekers in the Netherlands from 2012 to September 2015 have been described [1, 6]. Entry screening for LTBI was not routine. We present the results of radiographic TB screening among >34 000 asylum seeker children in the Netherlands 2013–2017 (age groups suggested by the authors) and discuss options for policy changes. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Wolters has nothing to disclose. Conflict of interest: Dr. Akkerman has nothing to disclose. Conflict of interest: Dr. Aartsma has nothing to disclose. Conflict of interest: Dr. de Lange has nothing to disclose. Conflict of interest: Dr. Scholvinck has nothing to disclose. Conflict of interest: Dr. van der Werf has nothing to disclose. Conflict of interest: Dr. Van Hest has nothing to disclose.

Latent tuberculosis infection (LTBI) screening and preventive treatment is one of the components of the World Health Organization (WHO) End TB strategy, and particularly relevant for low tuberculosis (TB) incidence countries, i.e. less than 100TB cases per million population. The Netherlands is such a low-incidence country with traditionally a strong emphasis on programmatic management of LTBI, e.g. examining contacts of infectious TB patients by the public health services. Increasingly, curative services are involved in LTBI management of clinical risk groups. The country recently adopted a five-year strategic national plan recommending LTBI screening of high-risk migrants populations. A monitoring and evaluation system is already in place to measure programme performance and guide policy. Research on LTBI screening of migrants is on-going and results should inform future decisions in scaling-up this intervention. Several challenges remain for programmatic LTBI management, such as securing financial resources and the right professional cadre for implementation; availability of screening tests and drugs; collecting additional data for monitoring and evaluation, in line with the WHO indicators for LTBI programmatic management; developing cultural-sensitive and client-centred education for migrants; reducing patient costs for LTBI screening and preventive treatment; and assessing cost-effectiveness and impact on TB epidemiology. Keywords: Elimination, Latent tuberculosis infection, Prevention, Screening, Tuberculosis, Municipal Public Health Service

There is need to collect, analyse and compare TB screening data from migrants in EU countries more systematically http://ow.ly/x2eQ303k2CK

For 3 years, Europe has faced an increasing refugee crisis in which hundreds of thousands of displaced persons are risking their lives to seek a safer and better future in the European Union (EU). Many of these migrants originate from highly tuberculosis (TB)-endemic countries. Furthermore, their travel conditions are often poor, allowing potential transmission of infectious diseases, including TB. The Netherlands have observed an increased influx of asylum seekers since 2012 too, with fluctuating numbers every month, and a sharp increase in the summer of 2015, putting constraints on the process of registration, identification, application and accommodation, including mandatory radiographic screening for intrathoracic TB. We describe the impact of such migration on the Public Health TB Clinic of Groningen (responsible for nearly all TB entry screening for asylum seekers in the Netherlands), and our flexible and efficient practice model for daily radiographic TB screening. We report the yield of this intervention over the last 4 years, and reflect on issues concerning entry screening. The Dutch practice model for radiographic TB screening of asylum seekers has proved feasible

IntroductionThe current refugee crisis emphasizes the need for information on infectious diseases and resistant microorganisms in asylum seekers with possible consequences for public health and infection control.MethodsWe collected data from asylum seekers admitted to our university hospital or who presented at the Emergency Department (n = 273). We collected general and demographic characteristics including country of origin, the reason of presentation, and the screening results of multi-drug resistant organisms.Results67% of the patients were male with a median age of the study group of 24 years (IQR 15-33); 48% of the patients had an infectious disease-predominantly malaria with P. vivax or tuberculosis. Patients also reported with diseases which are less common-e. g. leishmaniasis, or even conditions rarely diagnosed in Europe-e. g. louse borne relapsing fever. A carriage rate of 31% for multi-drug resistant microorganisms (MDRO) was observed, with ESBL-expressing E. coli (n = 20) being the most common MDRO. No carriage of Carbapenemase Producing Enterobacteriaceae was found.ConclusionThe current refugee crisis in Europe challenges hospitals to quickly identify and respond to communicable diseases and the carriage of MDRO. A rapid response is necessary to optimize the treatment of infectious diseases amongst asylum seekers to maximize infection control.

Statins are members of a class of pharmaceutical widely used to reduce high levels of serum cholesterol. In addition, statins have so-called "pleiotropic effects," which include inflammation reduction, immunomodulation, and antimicrobial effects. An increasing number of studies are emerging which detail the attenuation of bacterial growth and in vitro and in vivo virulence by statin treatment. In this review, we describe the current information available concerning the effects of statins on bacterial infections and provide insight regarding the potential use of these compounds as antimicrobial therapeutic agents.