The burden of Tuberculosis in a province of a low incidence country: epidemiological differences between Italy-born, regular foreigner and irregular foreigner TB cases.

Introduction: Tuberculosis (TB) represent a serious public health issue even in most developed countries, where TB cases are mostly concentrated in some risk groups, like immigrants from high-incidence TB countries. Aim of the study was to describe the occurrence of TB in Siracusa Local Health Authority (Italy) and to explore its determinants in three different populations: Italy-born, regular foreigner and irregular foreigner. Methods: Cases were classified per patient origin and legal ground: Italy-born (IB); regular foreigners (REF); irregular foreigners (IRF). All the notifications were evaluated and uploaded to the Notification System of Infectious Diseases (PREMAL) by the Epidemiology Unit of the Prevention Department of Siracusa LHA. Results: During the study period, 183 TB cases were detected: 72 (39.3%) were Italy-born, 26 (14.2%) were regular foreigners and 85 (46.5%) were irregular foreigners. Overall, foreign-born cases (regularly and irregularly residents) accounted for 60.7% of all cases. We demonstrated significative differences in epidemiological, demographic and clinical features among the three different groups.Furthermore, we registered a decrease in TB notifications of 59.5% among Italy-born patients, 46.0% among regular foreigners and 95.5% among irregular foreigners, who, however, remain the population group with the highest incidence of tuberculosis in Siracusa LHA. Conclusions: TB control in migrants is considered key to achieving TB elimination in low TB incidence countries, in accordance with the World Health Organization (WHO)'s End TB Strategy, that set ambitious targets for 2020-2035, including 90% reduction in TB incidence and 95% reduction in TB deaths by 2035, compared with 2015.