BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

1st Faculty of Medicine and Faculty Thomayer Hospital Prague Czechia

Baylor College of Medicine Department of Pediatrics Global and Immigrant Health Global Tuberculosis Program Houston Texas United States

Belgian Lung and Tuberculosis Association Brussels Belgium

Blizard Institute The London School of Medicine and Dentistry Queen Mary University of London London United Kingdom

Boston University School of Public Health Department of Epidemiology Boston Massachusetts United States

Catholic University Ruzomberok Ruzomberok Slovakia

Centre for Health Security and Communicable Disease Control Directorate of Health Iceland

Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford Oxford United Kingdom

Centro Hospitalar de Vila Nova de Gaia Espinho Porto Portugal

Centro Nacional de Epidemiología Instituto de Salud Carlos 3 Madrid Spain

Cyprus National Reference Laboratory for Mycobacteria Microbiology Department Nicosia General Hospital Nicosia Cyprus

Department Cardio thoracic Pneumophtisiology 2 University of Medicine and Pharmacy Carol Davila Bucharest Romania

Department of Chemistry Department of Clinical Microbiology Umeå University Sweden

Department of Clinical Microbiology Umeå University Sweden

Department of Infectious Disease Epidemiology and Prevention Statens Serum Institut Copenhagen Denmark

Department of Infectious Diseases Oslo University Hospital Ullevaal Norway

Department of Infectious Diseases Rigshospitalet University Hospital Copenhagen Denmark

Department of Internal Medicine and Radboud Center for Infectious Diseases Radboud University Medical Center Nijmegen the Netherlands

Department of Medical Sciences School of Medicine University of Namibia Windhoek Namibia

Department of Pulmonary Medicine and Allergology Inselspital Bern University Hospital University of Bern Switzerland

Department of Tuberculosis Epidemiology and Surveillance National Tuberculosis and Lung Diseases Research Institute Warsaw Poland

Division of Clinical Infectious Diseases Research Center Borstel Borstel Germany

Division of Infectious Diseases and Tropical Medicine Department of Internal Medicine 4 Pneumology Kepler University Hospital Linz Austria

Division of Infectious Diseases Santé publique France Saint Maurice France

Division of Pneumology Onze Lieve Vrouw Ziekenhuis Aalst Aalst Belgium

Emerging Bacterial Pathogens Unit IRCCS San Raffaele Scientific Institute Milan Italy

Epidemiology and Population Health Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine London United Kingdom

Estonian Tuberculosis Register Dept of Registries National Institute for Health Development Tallinn Estonia

Faculty of Medicine Johannes Kepler University Linz Austria and Ignaz Semmelweis Institut Interuniversity Institute for Infection Resarch Vienna Austria

Finnish Lung Health Association Helsinki Finland

Flemish Association of Respiratory Health and TB Control Leuven Belgium

German Center for Infection Research TTU TB Borstel Germany

Global Public Health Unit Wolfson Institute of Population Health Barts

Health Directorate of Luxembourg Luxembourg

Health Promotion and Prevention Unit Directorate Public Health Protection and Health Control Ministry of Health of Bulgaria Sofia Bulgaria

ICBAS Instituto de Ciências Biomédicas Abel Salazar Universidade do Porto

Infectious Disease Prevention and Control Unit Health Promotion and Disease Prevention Directorate Superintendence of Public Health Ministry for Health of Malta La Valetta Malta

Infectious Diseases; Health Service Executive Health Protection Surveillance Centre Dublin Ireland

Institut d'Investigació Germans Trias i Pujol; Universitat Autònoma de Barcelona; CIBER Enfermedades Respiratorias; INNOVA4TB consortium Badalona Barcelona Spain

ISPUP Instituto de Saúde Pública da Universidade do Porto Porto Portugal

Koranyi National Institute for Pulmonology Budapest Hungary

Marius Nasta Institute of Pulmonology Bucharest Romania

National Institute for TB Lung Diseases and Thoracic Surgery Vysne Hagy Slovakia

National TB Program and Tuberculosis Registry of Republic of Slovenia University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia

National TB Surveillance Unit University Hospital Bulovka Prague Czechia

Prevention of Communicable Diseases and International Prophylaxis General Direction of Health Prevention Ministry of Health of Italy Rome Italy

Respiratory Diseases and Travel Medicine Department with Vaccination Unit Infectious Diseases Epidemiology ServiceDepartment Croatian Institute of Public Health Zagreb Croatia

Respiratory Medicine and International Health University of Lübeck Lübeck Germany

Riga East University Hospital TB and Lung Disease Clinic Riga Latvia

Swiss Federal Office of Public Health Division of Communicable Diseases Bern Switzerland

The London School of Medicine and Dentistry Queen Mary University of London London United Kingdom

The National University Hospital of Iceland Pharmaceutical Services Reykjavik Iceland

Tuberculosis Control Office Department of Respiratory Infections Directorate for Epidemiological Surveillance and Intervention National Public Health Organization Athens Greece

Tuberculosis Register of the Republic of Slovenia University Clinic Golnik Golnik Slovenia

Unit for Infectious Diseases Diagnostics and Infectious Diseases Epidemiology Centre for Pathophysiology Infectious Diseases and Immunology Medical University of Vienna Vienna Austria

Unité Unité Mixte Internationale 233 IRD U1175 INSERM Université de Montpellier Institut de Recherche pour le Développement Montpellier France

University Hospital Centre Zagreb Department for Lung diseases Zagreb Croatia

University of Turku Division of Medicine Department of Pulmonary Diseases and Clinical Allergology Turku Finland

University of Zagreb School of Medicine Zagreb Croatia

Vilnius University hospital Santaros Klinikos Department of Tuberculosis State information system Vilnius Lithuania

Wallenberg Centre for Molecular Medicine Umeå University Sweden

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