• Open Access

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

Authors

  • Justin T. Denholm,

    Corresponding author
    1. Victorian Infectious Diseases Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria
    2. Department of Microbiology and Immunology, University of Melbourne, Victoria;
    • Correspondence to: Dr Justin T. Denholm, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria 3050; e-mail: justin.denholm@mh.org.au

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  • Emma S. McBryde

    1. Victorian Infectious Diseases Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria
    2. Burnet Institute, Victoria
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  • The authors have stated they have no conflict of interest.

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.

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