Risk of Mycobacterium tuberculosis Transmission in a Low-Incidence Country Due to Immigration from High-Incidence Areas

doi:10.1128/JCM.39.3.855-861.2001

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Journal of Clinical Microbiology, March 2001, p. 855-861, Vol. 39, No. 3
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.3.855-861.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Risk of Mycobacterium tuberculosis Transmission in a Low-Incidence Country Due to Immigration from High-Incidence Areas

Troels Lillebaek,¹^,^* Åse B. Andersen,² Jeanett Bauer,¹ Asger Dirksen,³ Steffen Glismann,⁴ Petra de Haas,⁵ and Axel Kok-Jensen³

International Reference Laboratory for Mycobacteriology¹ and Department of Epidemiology,⁴ Statens Serum Institut, National Institute for Prevention and Control of Infectious Diseases and Congenital Disorders, 2300 Copenhagen, and Clinics of Infectious Diseases² and Pulmonary Medicine,³ Rigshospitalet University Hospital, 2200 Copenhagen, Denmark, and Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands⁵

Received 28 August 2000/Returned for modification 18 November 2000/Accepted 11 December 2000

Does immigration from a high-prevalence area contribute to an increased risk of tuberculosis in a low-incidence country? Thetuberculosis incidence in Somalia is among the highest ever registered.Due to civil war and starvation, nearly half of all Somalis havebeen forced from their homes, causing significant migration tolow-incidence countries. In Denmark, two-thirds of all tuberculosispatients are immigrants, half from Somalia. To determine the magnitudeof Mycobacterium tuberculosis transmission between Somalis andDanes, we analyzed DNA fingerprint patterns of isolates collectedin Denmark from 1992 to 1999, comprising >97% of all culture-positivepatients (n = 3,320). Of these, 763 were Somalian immigrants,55.2% of whom shared identical DNA fingerprint patterns; 74.9%of these were most likely infected before their arrival in Denmark,23.3% were most likely infected in Denmark by other Somalis, and1.8% were most likely infected by Danes. In the same period, only0.9% of all Danish tuberculosis patients were most likely infectedby Somalis. The Somalian immigrants in Denmark could be distributedinto 35 different clusters with possible active transmission,of which 18 were retrieved among Somalis in the Netherlands. Thisindicated the existence of some internationally predominant Somalianstrains causing clustering less likely to represent recent transmission.In conclusion, M. tuberculosis transmission among Somalis in Denmarkis limited, and transmission between Somalis and Danes is nearlynonexistent. The higher transmission rates between nationalitiesfound in the Netherlands do not apply to the situation in Denmarkand not necessarily elsewhere, since many different factors mayinfluence the magnitude of activetransmission.

^* Corresponding author. Mailing address: Statens Serum Institut, International Reference Laboratory for Mycobacteriology, 5Artillerivej, 2300 Copenhagen S, Denmark. Phone: 4532683705. Fax:4532683871. E-mail: Lillebaek{at}dadlnet.dk.

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