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Aust N Z J Public Health. 2014 Feb;38(1):78-82. doi: 10.1111/1753-6405.12161.

Can Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low-transmission setting.

Author information

1
Victorian Infectious Diseases Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria; Department of Microbiology and Immunology, University of Melbourne, Victoria;

Abstract

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.

KEYWORDS:

immigration; latent tuberculosis infection; mathematical model; public health; screening

PMID:
24494951
DOI:
10.1111/1753-6405.12161
[Indexed for MEDLINE]

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