BMJ  2005;331:237 (23 July), doi:10.1136/bmj.331.7510.237-b

Letter

TB in immigrants is not public health risk, but uncontrolled epidemics are

EDITOR—Before the second world war no medicines existed to cure tuberculosis (TB). Only 50 years later, strains of tuberculosis that are resistant to all major drugs have emerged.¹ Many areas of the former Soviet Union have been found to harbour high incidences of multidrug resistant tuberculosis.¹ In many Western countries, an increasing number of cases of tuberculosis in foreign born residents has resulted in a change from the expected downward trend.²

Over the past years, increasing numbers of people have left the new states of the former Soviet Union. In neighbouring Scandinavian countries there is public concern that increased immigration may result in increased transmission of infectious diseases, such as multidrug resistant tuberculosis. More than 30 000 former Soviet citizens have arrived in Norway since 2001.³ Only four of these were diagnosed with multidrug resistant tuberculosis on arrival, and their infections were not transmitted to other people in Norway.^{4 5}

Little evidence exists that increased immigration and imported tuberculosis threaten public health in the neighbouring countries of the former Soviet Union. Tuberculosis is rarely transmitted from immigrants,^{2 4 5} and, from a global point of view, it is far more threatening to the public health if epidemics are uncontrolled than it is to take part in controlling them. So long as tuberculosis remains a major health problem in some parts of the world, no country can expect to eliminate this disease.

Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway ulf.dahle{at}fhi.no

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Competing interests: None declared.

References

1. Toungoussova OS, Mariandyshev AO, Bjune G, Caugant DA, Sandven P. Resistance of multidrug-resistant strains of Mycobacterium tuberculosis from the Archangel oblast, Russia, to second-line anti-tuberculosis drugs. Eur J Clin Microbiol Infect Dis 2005;24: 202-6.[CrossRef][Web of Science][Medline]
2. Dahle UR, Sandven P, Heldal E, Caugant D. Continued low rates of transmission of Mycobacterium tuberculosis in Norway. J Clin Microbiol 2003;41: 2968-73.[Abstract/Free Full Text]
3. Statistics Norway. Immigrant population, by sex and country background. http://statbank.ssb.no//statistikkbanken/default_fr.asp?PLanguage=1 (accessed 6 Jul 2005).
4. Winje BA, Mannsaaker T, Heldal E, Blystad H, Dahle UR. Tuberculosis in Norway 2004. MSIS report 2005;33:26 (www.fhi.no/dav/DF14FB5348.PDF). [In Norwegian.]
5. Winje BA, Mannsaaker T, Blystad H, Dahle UR. Tuberculosis in Norway 2003. MSIS report 2004;32:32. (www.fhi.no/dav/A5FE92684F.PDF). [In Norwegian.]

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