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19 Dec 2016

#MDR #tuberculosis in #migrants, multi-country #cluster, November 2016 (@ECDC_EU, summary)


Title: #MDR #tuberculosis in #migrants, multi-country #cluster, November 2016.

Subject: Multi-drug resistant tuberculosis in migrants, rapid risk assessment.

Source: European Centre for Disease Prevention and Control (ECDC), full PDF file: (LINK). Summary.

Code: [     ]



MDR tuberculosis in migrants, multi-country cluster, November 2016


Suggested citation: European Centre for Disease Prevention and Control. Multidrug-resistant tuberculosis in migrants, multicountry cluster – 19 December 2016. Stockholm: ECDC; 2016. 

© European Centre for Disease Prevention and Control, Stockholm, 2016


Conclusions and options for response

  • An international whole genome sequencing cluster involving 16 cases of multidrug-resistant tuberculosis (MDR TB) in asylum seekers has been detected.
  • The first seven cases were identified in Switzerland between February and August 2016.
  • Their countries of origin are Somalia (5 cases), Eritrea (1) and Ethiopia (1).
  • Whole genome sequencing (WGS) showed no difference among isolates in four cases and differences of one allele in the three others.
  • Based on the WGS results, the strains belong to a single molecular cluster.
  • The same genetic clone with the same and so far unknown drug resistance profile was detected in nine additional cases from Somalia, six of them diagnosed in Germany, two in Austria, and one in Sweden
  • Further multi-country outbreak investigation is focussing on identifying exposure risk factors, including the travel itinerary and the history of possible contacts among patients in this single-strain outbreak of MDR TB.
  • Although the limited number of cases detected so far suggests that there is only a limited risk of this outbreak becoming a widespread event, more cases may occur in association with this cluster.
  • Sharing WGS-based typing information between affected countries on outbreak-related cases is important to the further delineation of the extent of the outbreak. 
  • Improving understanding of this outbreak – including identifying any other potential cases and contacts – will allow targeted prevention and control measures.
  • It will be important to perform epidemiological investigations, which would comprise contact tracing, source case investigation, and investigation of possible epidemiological links, as well as to ensure early case finding of active TB and drug susceptibility testing, especially in newly arriving migrants from the Horn of Africa, in order to identify and treat active cases and to provide preventive treatment or monitoring for those diagnosed with latent tuberculosis infection.


Keywords: ECDC; European Region; Updates; Drugs Resistance; Antibiotics; Tuberculosis; MDR-TB.