Tuberculosis in Undocumented Migrants, Geneva

To the Editor: In today's globalized world, a growing number of people are migrating in search of a better life. Simultaneously, industrialized countries are strengthening border controls and administrative barriers to contain this influx of newcomers, resulting in a significant increase in illegal migration and human trafficking. The U.S. Department of State estimates the annual flow of irregular migrants worldwide to be 700,000–2 million (1). Many of the migrants are from countries where tuberculosis is endemic, and they contribute to the increasing proportion of foreign-born persons with tuberculosis in North America and Europe. These persons may be highly contagious in the local population, as they have limited access to healthcare and often go untreated (2,3). Of 450,000 residents in Geneva, Switzerland, 10,000–20,000 are undocumented and come from developing countries or Eastern Europe. All patients treated for tuberculosis in Geneva are systematically registered by the Antituberculosis Center, a facility at Geneva University Hospital. An outpatient clinic provides free consultations for patients with tuberculosis who have no health insurance, and patients are not required to disclose their immigration status to physicians. Patients with sufficient funds pay for their medication. All cases of tuberculosis in undocumented migrants (foreign residents with no resident permits) reported from 1994 to 1998 were reviewed by the same investigator. Their sociode-mographic and clinical characteristics were compared with those of 7 South American legal residents with tuberculosis (representing the whole sample of South American tuberculosis patients) during the same period and with those of a group of 50 tuberculosis patients from the general population in a previous study. From 1994 to 1998, a total of 397 persons in Geneva were notified that they were infected with tuberculosis. Twenty-two (6%) case-patients were found among undocumented migrants. The mean age was 31 years (19–48 years), and 20 (91%) were women; 15 (68%) came from South America, 5 (22%) came from Africa, and 2 (9%) came from Europe. Nineteen (95%) of 20 persons had symptoms for >1 month preceding their first medical encounter. Approximately 27.2% had pulmonary manifestations only, 36.4% had extra-pulmonary manifestations only, and the remaining 36.4% had both pulmonary and extrapulmonary manifestations. Mycobacterium tuberculosis was found in 11 of 14 with pulmonary involvement, and chest radiograph was normal in 5 (22%). When compared with patients from the general population, women were more numerous (91% vs. 30%), and extrapul-monary tuberculosis was more frequent among undocumented residents (72% vs. 34%). The time …