Open AccessCan Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low‐transmission setting
Author(s) -
Denholm Justin T.,
McBryde Emma S.
Publication year - 2014
Publication title -
australian and new zealand journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.946
H-Index - 76
eISSN - 1753-6405
pISSN - 1326-0200
DOI - 10.1111/1753-6405.12161
Subject(s) - tuberculosis , medicine , immigration , transmission (telecommunications) , incidence (geometry) , latent tuberculosis , disease , public health , limiting , environmental health , mycobacterium tuberculosis , geography , computer science , pathology , optics , telecommunications , mechanical engineering , physics , archaeology , engineering
Background: The 2050 Millennium Development Goals (MDG) for tuberculosis (TB) aim for elimination of TB as a public health issue. We used a mathematical modelling approach to evaluate the feasibility of this target in a low‐prevalence setting with immigration‐related strategies directed at latent tuberculosis. Methods: We used a stochastic individual‐based model to simulate tuberculosis disease among immigrants to Victoria, Australia; a representative low‐transmission setting. A variety of screening and treatment approaches aimed at preventing reactivation of latent infection were applied to evaluate overall tuberculosis incidence reduction and rates of multidrug resistant disease. Results: Without additional intervention, tuberculosis incidence was predicted to reach 34.5 cases/million by 2050. Strategies involving the introduction of an available screening/treatment combination reduced TB incidence to between 16.9–23.8 cases/million, and required screening of 136–427 new arrivals for each case of TB prevented. Limiting screening to higher incidence regions of origin was less effective but more efficient. Conclusions: Public health strategies targeting latent tuberculosis infection in immigrants may substantially reduce tuberculosis incidence in a low prevalence region. However, immigration‐focused strategies cannot achieve the 2050 MDG and alternative or complementary approaches are required.