Can Australia eliminate TB? Modelling immigration strategies for reaching MDG targets in a low-transmission setting

Aust N Z J Public Health. 2014 Feb;38(1):78-82. doi: 10.1111/1753-6405.12161.


Background: The 2050 Millennium Development Goals (MDG) for tuberculosis (TB) aim for elimination of TB as a public health issue. We used a mathematical modelling approach to evaluate the feasibility of this target in a low-prevalence setting with immigration-related strategies directed at latent tuberculosis.

Methods: We used a stochastic individual-based model to simulate tuberculosis disease among immigrants to Victoria, Australia; a representative low-transmission setting. A variety of screening and treatment approaches aimed at preventing reactivation of latent infection were applied to evaluate overall tuberculosis incidence reduction and rates of multidrug resistant disease.

Results: Without additional intervention, tuberculosis incidence was predicted to reach 34.5 cases/million by 2050. Strategies involving the introduction of an available screening/treatment combination reduced TB incidence to between 16.9-23.8 cases/million, and required screening of 136-427 new arrivals for each case of TB prevented. Limiting screening to higher incidence regions of origin was less effective but more efficient.

Conclusions: Public health strategies targeting latent tuberculosis infection in immigrants may substantially reduce tuberculosis incidence in a low prevalence region. However, immigration-focused strategies cannot achieve the 2050 MDG and alternative or complementary approaches are required.

Keywords: immigration; latent tuberculosis infection; mathematical model; public health; screening.

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Australia
  • Communicable Disease Control / methods
  • Computer Simulation
  • Emigrants and Immigrants*
  • Emigration and Immigration*
  • Humans
  • Incidence
  • Latent Tuberculosis / diagnosis
  • Latent Tuberculosis / ethnology
  • Latent Tuberculosis / microbiology
  • Latent Tuberculosis / prevention & control*
  • Latent Tuberculosis / transmission
  • Mass Screening / methods*
  • Models, Theoretical*
  • Predictive Value of Tests
  • Prevalence
  • Public Health
  • Residence Characteristics*
  • Risk Factors
  • Victoria / epidemiology


  • Antitubercular Agents