Biosecurity

THE EFFECT OF MIGRATION WITHIN THE EUROPEAN UNION/EUROPEAN ECONOMIC AREA ON THE DISTRIBUTION OF TUBERCULOSIS, 2007 TO 2013

The epidemiology of communicable diseases can be affected by migration; between 2007 and 2011, around 40% of HIV cases in the European Union (EU) and European Economic Area (EEA) were reported among migrants [1] [2] [3]. Migration from high-incidence countries (defined as incidence as ≥20 tuberculosis (TB) cases/100,000 inhabitants/year) is known to contribute notably to TB burden in low-incidence countries (<20 TB cases/100,000 inhabitants/year) using the thresholds previously proposed by the Wolfheze working group [4] and adopted in the EU monitoring framework [5] [6-14]. Persons with latent TB infection as well as patients with active TB and multidrug-resistant (MDR) TB can easily move from one country to another in the EU.

The free movement of persons within the EU is a fundamental right guaranteed to EU citizens by the Treaties [15]. Before 2010, the migration flows within the EU/EEA were mainly from eastern European Member States to Member States in the south and west [16] [17]. Driven by the economic crisis, from 2007 onwards, an increase was seen in numbers of people migrating from the countries most heavily affected by the depression (Greece, Spain, Italy, Ireland and Portugal) to western and northern EU countries [16]. In 2013, 17.7 million EU citizens were living in an EU country other than their country of birth, corresponding to 3.5% of the total population [18]. The highest number of migrants from other EU countries resided in Germany (3,635,265; 4.4% of the total population) and the lowest in Estonia (13,238; 1.0% of the total population). Possible cross-border transmission of communicable diseases as a consequence of free movement of persons across the borders has raised concerns in some countries [19,20].