Public health: fear of tuberculosis among refugees from Ukraine

The disease is more common in Ukraine than in Switzerland. But there is no screening. However, the risk remains low.

Tuberculosis is caused by bacteria that affect the lungs. Pathogens spread when the infected person coughs or sneezes. Contamination requires a stay of nearly 20 hours in the same room.

AFP

More than 45,000 refugees are now in Switzerland due to the Russian invasion of Ukraine. However, in these two countries tuberculosis is almost 15 times more common than in Switzerland, namely 70 cases/100,000 inhabitants/year. They are also considered to be countries with a high risk of multidrug-resistant tuberculosis (and cannot be treated or treated poorly) with more than 30% of new cases being diagnosed. That is why the Swiss Longliga recently sounded the alarm. “We have to stay alert, because there is a risk,” explains Jesica Mazza-Stalder, head of the tuberculosis pharmacy at the CHUV and medical adviser to the Vaud Lung League.

No medical examinations

Especially because the refugees who come with us do not undergo any medical tests, nor for tuberculosis, Covid or other contagious diseases. “Border health measures in the area of ​​asylum were abolished in 2018, with the revision of the epidemic law and its regulation. Since then, no systematic screening has taken place,” confirms Anne Césard, spokesperson for the Secretariat of State for Migration (SEM). When refugees enroll for S status, they are only offered an optional health questionnaire, she explains. But they are informed about screening, treatment and prevention of communicable diseases and have access to care.

This questionnaire has been available since the beginning of the week, says Daniel Dauwalder, spokesperson for the OFSP. It was prepared by a working group of the Confederation and the cantons. The aim is precisely to reduce the risk of disease transmission by raising awareness of refugees and facilitating the first contact with a health professional. Because the FOPH admits it: in Ukraine the vaccination rate of the population is lower than in Switzerland and there are therefore gaps among the refugees. But at home they have access to vaccines, he recalls.

400 cases of tuberculosis in Switzerland

With regard to tuberculosis, the FOPH recalls that it already exists in Switzerland with 400 cases diagnosed per year. And based on WHO calculations, Bern estimates that there are “45 cases per 100,000 refugees from Ukraine.” So if we extrapolate these figures to the current situation, there could possibly be about twenty cases of the 45,000 Ukrainians who arrived in our country.

Isn’t this infectious disease at risk of developing in Switzerland? Jesica Mazza-Stalder wants to be reassuring. “In the canton of Vaud, we have not yet observed any cases among Ukrainian refugees,” she says. “It’s too early to see a possible uptrend,” the FOPH said for its part.

Much less contagious than Covid

According to them, tuberculosis is much less contagious than Covid, or flu, for example, because the bacteria multiply much less quickly than a virus. “Only people who live under the same roof as the patient are at risk of infection and are monitored for prompt treatment if necessary,” explains the Vaud practitioner. For her, the form in 33 languages ​​that has been drawn up for refugees and asylum seekers is therefore more than enough to refer the doctor for additional examinations or even treatment.

According to the WHO, 10 million people contract tuberculosis each year and 1.5 million die from it, making it the second deadliest infectious disease in the world after Covid-19. Ukraine is high on the global list of multidrug-resistant tuberculosis cases, so there is no treatment for it. This country was one of the pioneer countries in the fight against this disease in Europe. But the war reversed the progress made. In addition, it has caused delays in diagnosis and thus in preventive treatment. Medicines are also running out.

The WHO has therefore sounded the alarm, insisting on the need to ensure the treatment of the 3.5 million refugees who have fled the war. The catch: Most countries in Europe have few cases of TB and are unprepared to treat more patients. But in Switzerland there is no risk, emphasizes Jesica Mazza-Stalder, medical adviser to the Vaud Lung League. Our country is ready and has enough medicines.

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