As per the new study, researchers have found multidrug-resistant Mycobacterium tuberculosis in eight refugees from the Institute of Medical Microbiology at the University of Zurich arriving in Europe from the Horn of Africa.
The examinations gave an impulse for launching a transnational investigation and developing a pan-European alerting system. At the Swiss National Center for Mycobacteria (NZM) at the University of Zurich, resistant tuberculosis pathogens are a regular part of the day-to-day business.
But then, the Mycobacterium tuberculosis found in a Somali asylum seeker in the refugee center in Chiasso in February 2016 was extraordinary.
Peter Keller, Head of Diagnostics at NZM, who identified the germ said, “These bacteria exhibited a new combination of resistance mutations against four different antibiotics that had at no other time been described”.
The multidrug resistance makes it necessary for individuals carrying these bacteria to be isolated and undergo intravenous drug treatment at a hospital for several months. In the months following the discovery, the same resistant germ was also seen in further patients, all of whom had migrated to Europe from countries on the Horn of Africa.
Altogether, the NZM identified the pathogen in eight refugees from Somalia, Eritrea, and Djibouti between February and November 2016. Because of the rapid detection and the isolation measures, no further individuals were infected with Switzerland.
Alarm issued and preventive measures
This remarkable rise prompted the management of NZM and of the Federal Office of Public Health (FOPH) to alert their colleagues across Europe. In the meantime, the German reference laboratory in Borstel near Hamburg also registered a case with the same pathogen.
The NZM at that point made their molecular-biological information available to the European Center for Disease Prevention and Control (ECDC) to enable their group to identify further possible cases in the EU. Throughout these analyses, the European tuberculosis reference laboratories identified a total of 21 cases in cross-border collaboration.
Similarly, as with the cases in Switzerland, these patients had also come from the Horn of Africa or Sudan. On account of the alert, the pathogen was prevented from spreading further, and the specialists also took preventive measures.
Peter Keller, who initiated the European analyses says, “The extraordinary case prompted the development of a European alerting organization for dangerous tuberculosis pathogens”.
He is the corresponding author of the wide-reaching study, in which multiple European centers are included and which was published in the prestigious journal Lancet Infectious Diseases.
Chain of infection reconstructed
Molecular-genetic analyses and interviews with patients made it possible for the researchers to partially reconstruct the chain of infection. The information demonstrates that the tuberculosis pathogen spread among migrants in a refugee camp near Bani Walid in Libya.
The overcrowded camp, somewhere in the range of 180 kilometers southeast of Tripoli, is notorious for its poor hygiene and inhumane conditions. When the patients are diagnosed their results showed particular resistant Mycobacterium tuberculosis had come through this camp.
Rapid test created
It is longer possible to identify to any degree of certainty the first carrier or who introduced the bacteria to the camp. In northern Somalia, scientists believe that because of mutations the pathogen originated where it is probably going to have developed the dangerous new combination of resistances.
Genetic analyses have allowed scientists to develop a rapid PCR test. The test can be used in suspected cases with this Mycobacterium tuberculosis and the outcomes are obtained in a matter of hours.