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2015 Aug 15 - Immigrants and tuberculosis in Hong Kong

CC Leung, MB, BS, FHKAM (Medicine); CK Chan, MB, BS, FHKAM (Medicine); KC Chang, MB, BS, FHKAM (Medicine); WS Law, MB, ChB, FHKAM (Medicine); SN Lee, MB, ChB, FHKAM (Medicine); LB Tai, MB, ChB, FHKAM (Medicine); Eric CC Leung, MB, BS, FHKAM (Medicine); CM Tam, MB, BS, FHKAM (Medicine)
Tuberculosis and Chest Service, Department of Health, Wanchai Chest Clinic, 1/F, 99 Kennedy Road, Wanchai, Hong Kong

Objective: To examine the impact of immigrant populations on the epidemiology of tuberculosis in Hong Kong.
Design: Longitudinal cohort study.
Setting: Hong Kong.
Participants: Socio-demographic and disease characteristics of all tuberculosis notifications in 2006 were captured from the statutory tuberculosis registry and central tuberculosis reference laboratory. Using 2006 By-census population data, indirect sex- and age-standardised incidence ratios by place of birth were calculated. Treatment outcome at 12 months was ascertained from government tuberculosis programme record forms, and tuberculosis relapse was tracked through the notification registry and death registry up to 30 June 2013.

Results: Moderately higher sex- and age-standardised incidence ratios were observed among various immigrant groups: 1.06 (Mainland China), 2.02 (India, Pakistan, Bangladesh), 1.59 (Philippines, Thailand, Indonesia, Nepal), and 3.11 (Vietnam). Recent Mainland migrants had a lower sex- and age-standardised incidence ratio (0.51 vs 1.09) than those who immigrated 7 years ago or earlier. Age younger than 65 years, birth in the Mainland or the above Asian countries, and previous treatment were independently associated with resistance to isoniazid and/or rifampicin. Older age, birth in the above Asian countries, non-permanent residents, previous history of treatment, and resistance to isoniazid and/or rifampicin were independently associated with poor treatment outcome (other than cure/treatment completion) at 1 year. Birth outside Hong Kong was an independent predictor of relapse following successful completion of treatment (adjusted hazard ratio=1.76; 95% confidence interval, 1.07-2.89; P=0.025).
Conclusion: Immigrants carry with them a higher tuberculosis incidence and/or drug resistance rate from their place of origin. The higher drug resistance rate, poorer treatment outcome, and excess relapse risk raise concern over secondary transmission of drug-resistant tuberculosis within the local community.

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