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*In ten years the TB situation in Europe
will be much worse than it is today.
http://www.hs.fi/english/article/Mi...osis+back+to+the+western+world+/1135260140729
Helsingin Sanomat International Edition
Migrants from developing countries bring tuberculosis back to the western world
September 14, 2010
By Antti Ôžmmälä
As recently as a couple of decades ago, tuberculosis was considered a done deal - an illness that was completely disappearing from the western world.
Immigration and the new strands of pathogens resistant to drugs, however, have once again turned it into a significant health threat.
The spreading of the illness is aided by the fact that the developing countries have not succeeded in restraining their tuberculosis epidemics.
One of the oldest and most persistent infectious diseases in the world, TB has always kept spreading with migration movements.
Tuberculosis developed Into a world-wide epidemic when Great Britain became a superpower in the 19th century.
The movement of soldiers, traders, and government officials helped to spread infectious diseases into every corner of the British Empire from Asia to Africa.
Now the growing migration into the western countries brings back from the developing world the same diseases that were exported there during the colonial era.
“It is good to know the history and to remember the correct sequence of events when talking about the threats of immigration”��, says senior medical officer MD Rauni Ruohonen of the Finnish Lung Health Association (Filha).
In the globalised world, illnesses no longer recognise national borders, but some nations are still more afflicted by them than others.
Tuberculosis is first and foremost an illness of the poor.
Immigrants suffer from it more often than native populations. In Western Europe the majority of both the regular and the drug-resistant tuberculosis cases are found among those from abroad.
In the spring, a special issue of the prestigious medical journal The Lancet wrote that most of the immigrants fall outside the normal TB screenings, which increases the disease’s risk of spreading and complicates the patients’ recovery.
“A comprehensive screening of all the people who come from countries with high TB incidence would be a very good idea. In addition to the medical examination upon arrival, doctors should be vigilant with the risk groups in order to recognise also the latent varieties”��, says Research Professor Petri Ruutu at the National Institute for Health and Welfare (THL).
Besides TB, the inadequacy with screening tests and treatment also applies to other infectious diseases, such as HIV and malaria.
Health care is part of the ongoing heated debate surrounding immigration.
In many countries it boils down to the question of who is entitled to treatment.
Those in the weakest position are the illegal immigrants. In Europe alone, their number is estimated to be between five and eight million.
In most cases these individuals are not entitled to services of any kind. The lack of food and basic hygiene is likely to predispose people to illnesses and to help the diseases to spread among the population.
Many experts share the view that not receiving treatment for example for tuberculosis is a violation against basic human rights.
“People should understand that all the immigrants are patients, who are to be treated well. Furthermore, the problem with TB cannot be solved in any other way. It would make more sense to provide treatment for all those with the illness, so that its spread inside a country or from one country to the next could be prevented”��, Rauni Ruohonen says.
According to the International Tuberculosis and Lung Diseases Organisation, immigrants should not be turned away from a country and sent to another before their TB treatment has been completed successfully.
Even though few European countries have so far agreed to widen their tuberculosis screening and treatment practices, Ruohonen believes that the situation will change.
“For example in Norway all the illegal immigrants with TB receive treatment until they have received a clean bill of health.”��
The most important reason for this is that the health hazards and treatment costs of tuberculosis grow continuously.
Ruohonen believes that in ten years’ time the TB situation in Europe will be much worse than today after the drug-resistant strains of the illness have become more prevalent in Africa, and after they have spread into the Old World via immigration.
Tuberculosis is a lung disease which, if left untreated, kills more than 50% of its victims. The mycobacteria spreads through the air in droplet form, through coughing, sneezing or spitting.
According to the WHO, a third of the world’s population carries Mycobacterium tuberculosis, which causes TB in humans.
A tenth of them will contract the active illness in their lifetime. The carriers of the HI-virus are the largest risk group because of their lowered ability to resist infections.
Most of the world’s TB cases are discovered in the developing countries.
In Europe the TB situation is complicated by the increasing immigration combined with the spreading of new drug-resistant strains of the illness as well as growing numbers of HIV patients in Eastern Europe.
Although Finland is a close neighbour of Russia, which has a growing HIV and TB problem, cases of tuberculosis in finland are today relatively rare.
according to THL, last year there were something over 400 cases recorded, with approximately one on three of these involving people who had been born abroad.
One obvious reason for the relatively insignificant spread of TB to Finland from abroad is that the country's immigration numbers are modest when compared with many other European countries, and infections have also usually been recognised and treated quickly.
Refugees and asylum-seekers arriving from high-risk countries are examined for infectious disieases shortly after their arrival.
Nevertheless, the screening does not cover foreign students, people coming here to work, or other immigrant groups.
Petri Ruutu from THL recognises the gap in the system and acknowledges that screening ought to be extended to anyone coming here for months or years.
Skara Brae,
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