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Abstract
Rationale: Approximately two-thirds of new cases of tuberculosis (TB) in the United States are among non-U.S.-born persons. Culture-based overseas TB screening in U.S.-bound immigrants and refugees has substantially reduced the importation of TB into the United States, but it is unclear to what extent this program prevents the importation of multidrug-resistant TB (MDR-TB). Objectives: To study the epidemiology of MDR-TB in U.S.-bound immigrants and refugees and to evaluate the effect of culture-based overseas TB screening in U.S.-bound immigrants and refugees on reducing the importation of MDR-TB into the United States. Methods: We analyzed data of immigrants and refugees who completed overseas treatment for culture-positive TB during 2015-2019. We also compared mean annual number of MDR-TB cases in non-U.S.-born persons within 1 year of arrival in the United States between 1996-2006 (when overseas screening followed a smear-based algorithm) and 2014-2019 (after full implementation of a culture-based algorithm). Results: Of 3,300 culture-positive TB cases identified by culture-based overseas TB screening in immigrants and refugees during 2015-2019, 122 (3.7%; 95% confidence interval [CI], 3.1-4.1) had MDR-TB, 20 (0.6%; 95% CI, 0.3-0.9) had rifampicin-resistant TB, 382 (11.6%; 95% CI, 10.5-12.7) had isoniazid-resistant TB, and 2,776 (84.1%; 95% CI, 82.9-85.4) had rifampicin- and isoniazid-susceptible TB. None were diagnosed with extensively drug-resistant TB. All 3,300 persons with culture-positive TB completed treatment overseas; of 70 and 11 persons who were treated overseas for MDR-TB and rifampicin-resistant TB, respectively, none were diagnosed with TB disease at postarrival evaluation in the United States. Culture-based overseas TB screening in U.S.-bound immigrants and refugees prevented 24.4 MDR-TB cases per year from arriving in the United States, 18.2 cases more than smear-based overseas TB screening. The mean annual number of MDR-TB cases among non-U.S.-born persons within 1 year of arrival in the United States decreased from 34.6 cases in 1996-2006 to 19.5 cases in 2014-2019 (difference of 15.1; P < 0.001). Conclusions: Culture-based overseas TB screening in U.S.-bound immigrants and refugees substantially reduced the importation of MDR-TB into the United States.
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Phares CR, Liu Y, Wang Z, Posey DL, Lee D, Jentes ES, Weinberg M, Mitchell T, Stauffer W, Self JL, Marano N. Disease Surveillance Among U.S.-Bound Immigrants and Refugees — Electronic Disease Notification System, United States, 2014–2019. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-21. [PMID: 35051136 PMCID: PMC8791661 DOI: 10.15585/mmwr.ss7102a1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Problem/Condition Period Covered Description of System Results Interpretation Public Health Action
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3
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Abstract
Although considerable progress has been made in reducing US tuberculosis incidence, the goal of eliminating the disease from the United States remains elusive. A continued focus on preventing new tuberculosis infections while also identifying and treating persons with existing tuberculosis infection is needed. Continued vigilance to ensure ongoing control of tuberculosis transmission remains key.
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Affiliation(s)
- Adam J Langer
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop US12-4, Atlanta, GA 30329, USA.
| | - Thomas R Navin
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop US12-4, Atlanta, GA 30329, USA
| | - Carla A Winston
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop US12-4, Atlanta, GA 30329, USA
| | - Philip LoBue
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Mailstop US12-4, Atlanta, GA 30329, USA
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Immigrant and Refugee Health: A Centers for Disease Control and Prevention Perspective on Protecting the Health and Health Security of Individuals and Communities During Planned Migrations. Pediatr Clin North Am 2019; 66:549-560. [PMID: 31036234 PMCID: PMC6625646 DOI: 10.1016/j.pcl.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Migration and forced displacement are at record levels in today's geopolitical environment; ensuring the health of migrating populations and the health security of asylum and receiving countries is critically important. Overseas screening, treatment, and vaccination during planned migration to the United States represents one successful model. These strategies have improved tuberculosis detection and treatment, reducing rates in the United States; decreased transmission and importation of vaccine-preventable diseases; prevented morbidity and mortality from parasitic diseases among refugees; and saved health costs. We describe the work of CDC's Division of Global Migration and Quarantine and partners in developing and implementing these strategies.
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Lee S, Ryu JY, Kim DH. Pre-immigration Screening for Tuberculosis in South Korea: A Comparison of Smear- and Culture-Based Protocols. Tuberc Respir Dis (Seoul) 2018; 82:151-157. [PMID: 30302957 PMCID: PMC6435930 DOI: 10.4046/trd.2018.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the most important disease screened for upon patient history review during preimmigration medical examinations as performed in South Korea in prospective immigrants to certain Western countries. In 2007, the U.S. Centers for Disease Control and Prevention (CDC) changed the TB screening protocol from a smear-based test to the complete Culture and Directly Observed Therapy Tuberculosis Technical Instructions (CDOT TB TI) for reducing the incidence of TB in foreign-born immigrants. METHODS This study evaluated the effect of the revised (as compared with the old) protocol in South Korea. RESULTS Of the 40,558 visa applicants, 365 exhibited chest radiographic results suggestive of active or inactive TB, and 351 underwent sputum tests (acid-fast bacilli smear and Mycobacterium tuberculosis culture). To this end, using the CDOT TB TI, 36 subjects (88.8 per 10⁵ of the population) were found to have TB, compared with only seven using the older U.S. CDC technical instruction (TI) (p<0.001). In addition, there were six drug-resistant cases which were identified (16.7 per 10⁵ of the population), two of whom had multidrug-resistance (5.6 per 10⁵ of the population). CONCLUSION The culture-based 2007 TI identified a great deal of TB cases current to the individuals tested, as compared to older U.S. CDC TI.
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Affiliation(s)
- Sangyoon Lee
- Department of Occupational and Environmental Medicine, Inha University Hospital, Incheon, Korea
| | - Ji Young Ryu
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Dae Hwan Kim
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
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Dobler CC, Fox GJ, Douglas P, Viney KA, Ahmad Khan F, Temesgen Z, Marais BJ. Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives. Eur Respir J 2018; 52:13993003.00591-2018. [PMID: 29794133 DOI: 10.1183/13993003.00591-2018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.
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Affiliation(s)
- Claudia C Dobler
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Mayo Clinic Center for Tuberculosis, Rochester, MN, USA
| | - Greg J Fox
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Paul Douglas
- International Organization for Migration (IOM), Geneva, Switzerland
| | - Kerri A Viney
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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7
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Cookson ST, Maloney SA. Keeping Up With a World in Motion: Screening Strategies for Migrating Populations. Clin Infect Dis 2017; 65:1410-1411. [DOI: 10.1093/cid/cix508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/09/2017] [Indexed: 11/14/2022] Open
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8
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Role of the Health Department in Tuberculosis Prevention and Control-Legal and Public Health Considerations. Microbiol Spectr 2017; 5. [PMID: 28256190 DOI: 10.1128/microbiolspec.tnmi7-0034-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Because tuberculosis is caused by an infectious organism that is spread from person to person through the air, public health measures are essential to control the disease. There are three priority strategies for tuberculosis prevention and control in the United States: (i) identifying and treating persons who have tuberculosis disease; (ii) finding persons exposed to infectious tuberculosis patients, evaluating them for Mycobacterium tuberculosis infection and disease, and providing subsequent treatment, if appropriate; and (iii) testing populations at high risk for latent tuberculosis infection (LTBI) and treating those persons who are infected to prevent progression to disease. These strategies for prevention and control of tuberculosis are discussed in a framework containing the following important topics: historical and epidemiological context of tuberculosis control, organization of public health tuberculosis control programs, legal basis for public health authority, conducting overall planning and development of policy, identifying persons who have clinically active tuberculosis, evaluation of immigrants, managing persons who have or who are suspected of having disease, medical consultation, interjurisdictional referrals, identifying and managing persons infected with Mycobacterium tuberculosis, providing laboratory and diagnostic services, collecting and analyzing data, and providing training and education. This chapter describes the role of the health department in the context of these components. This discussion is primarily applicable to tuberculosis prevention and control programs in the United States.
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Aldridge RW, Zenner D, White PJ, Muzyamba MC, Loutet M, Dhavan P, Mosca D, Hayward AC, Abubakar I. Prevalence of and risk factors for active tuberculosis in migrants screened before entry to the UK: a population-based cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2016; 16:962-70. [PMID: 27013215 DOI: 10.1016/s1473-3099(16)00072-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND An increasing number of countries with low incidence of tuberculosis have pre-entry screening programmes for migrants. We present the first estimates of the prevalence of and risk factors for tuberculosis in migrants from 15 high-incidence countries screened before entry to the UK. METHODS We did a population-based cross-sectional study of applicants for long-term visas who were screened for tuberculosis before entry to the UK in a pilot programme between Oct 1, 2005, and Dec 31, 2013. The primary outcome was prevalence of bacteriologically confirmed tuberculosis. We used Poisson regression to estimate crude prevalence and created a multivariable logistic regression model to identify risk factors for the primary outcome. FINDINGS 476 455 visa applicants were screened, and the crude prevalence of bacteriologically confirmed tuberculosis was 92 (95% CI 84-101) per 100 000 individuals. After adjustment for age and sex, factors that were strongly associated with an increased risk of bacteriologically confirmed disease at pre-entry screening were self-report of close or household contact with an individual with tuberculosis (odds ratio 11·6, 95% CI 7·0-19·3; p<0·0001) and being an applicant for settlement and dependant visas (1·3, 1·0-1·6; p=0·0203). INTERPRETATION Migrants reporting contact with an individual with tuberculosis had the highest risk of tuberculosis at pre-entry screening. To tackle this disease burden in migrants, a comprehensive and collaborative approach is needed between countries with pre-entry screening programmes, health services in the countries of origin and migration, national tuberculosis control programmes, and international public health bodies. FUNDING Wellcome Trust, Medical Research Council, and UK National Institute for Health Research.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Informatics, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
| | - Dominik Zenner
- Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Peter J White
- Modelling and Economics Unit, Public Health England, London, UK; MRC Centre for Outbreak Analysis and Modelling, and National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Imperial College London, London, UK
| | - Morris C Muzyamba
- Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Miranda Loutet
- Centre for Infectious Disease Epidemiology, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Poonam Dhavan
- Migration Health Division, International Organization for Migration, Geneva, Switzerland
| | - Davide Mosca
- Migration Health Division, International Organization for Migration, Geneva, Switzerland
| | - Andrew C Hayward
- Centre for Public Health Informatics, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Ibrahim Abubakar
- Centre for Infectious Disease Epidemiology, University College London, London, UK; Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK; Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Baker BJ, Winston CA, Liu Y, France AM, Cain KP. Abrupt Decline in Tuberculosis among Foreign-Born Persons in the United States. PLoS One 2016; 11:e0147353. [PMID: 26863004 PMCID: PMC4749239 DOI: 10.1371/journal.pone.0147353] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/01/2016] [Indexed: 11/23/2022] Open
Abstract
While the number of reported tuberculosis (TB) cases in the United States has declined over the past two decades, TB morbidity among foreign-born persons has remained persistently elevated. A recent unexpected decline in reported TB cases among foreign-born persons beginning in 2007 provided an opportunity to examine contributing factors and inform future TB control strategies. We investigated the relative influence of three factors on the decline: 1) changes in the size of the foreign-born population through immigration and emigration, 2) changes in distribution of country of origin among foreign-born persons, and 3) changes in the TB case rates among foreign-born subpopulations. Using data from the U.S. National Tuberculosis Surveillance System and the American Community Survey, we examined TB case counts, TB case rates, and population estimates, stratified by years since U.S. entry and country of origin. Regression modeling was used to assess statistically significant changes in trend. Among foreign-born recent entrants (<3 years since U.S. entry), we found a 39.5% decline (-1,013 cases) beginning in 2007 (P<0.05 compared to 2000–2007) and ending in 2011 (P<0.05 compared to 2011–2014). Among recent entrants from Mexico, 80.7% of the decline was attributable to a decrease in population, while the declines among recent entrants from the Philippines, India, Vietnam, and China were almost exclusively (95.5%–100%) the result of decreases in TB case rates. Among foreign-born non-recent entrants (≥3 years since U.S. entry), we found an 8.9% decline (-443 cases) that resulted entirely (100%) from a decrease in the TB case rate. Both recent and non-recent entrants contributed to the decline in TB cases; factors contributing to the decline among recent entrants varied by country of origin. Strategies that impact both recent and non-recent entrants (e.g., investment in overseas TB control) as well as those that focus on non-recent entrants (e.g., expanded targeted testing of high-risk subgroups among non-recent entrants) will be necessary to achieve further declines in TB morbidity among foreign-born persons.
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Affiliation(s)
- Brian J. Baker
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Carla A. Winston
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yecai Liu
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anne Marie France
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin P. Cain
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
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Liu Y, Posey DL, Cetron MS, Painter JA. Effect of a culture-based screening algorithm on tuberculosis incidence in immigrants and refugees bound for the United States: a population-based cross-sectional study. Ann Intern Med 2015; 162:420-8. [PMID: 25775314 PMCID: PMC4646057 DOI: 10.7326/m14-2082] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Before 2007, immigrants and refugees bound for the United States were screened for tuberculosis (TB) by a smear-based algorithm that could not diagnose smear-negative/culture-positive TB. In 2007, the Centers for Disease Control and Prevention implemented a culture-based algorithm. OBJECTIVE To evaluate the effect of the culture-based algorithm on preventing the importation of TB to the United States by immigrants and refugees from foreign countries. DESIGN Population-based, cross-sectional study. SETTING Panel physician sites for overseas medical examination. PATIENTS Immigrants and refugees with TB. MEASUREMENTS Comparison of the increase of smear-negative/culture-positive TB cases diagnosed overseas among immigrants and refugees by the culture-based algorithm with the decline of reported cases among foreign-born persons within 1 year after arrival in the United States from 2007 to 2012. RESULTS Of the 3 212 421 arrivals of immigrants and refugees from 2007 to 2012, a total of 1 650 961 (51.4%) were screened by the smear-based algorithm and 1 561 460 (48.6%) were screened by the culture-based algorithm. Among the 4032 TB cases diagnosed by the culture-based algorithm, 2195 (54.4%) were smear-negative/culture-positive. Before implementation (2002 to 2006), the annual number of reported cases among foreign-born persons within 1 year after arrival was relatively constant (range, 1424 to 1626 cases; mean, 1504 cases) but decreased from 1511 to 940 cases during implementation (2007 to 2012). During the same period, the annual number of smear-negative/culture-positive TB cases diagnosed overseas among immigrants and refugees bound for the United States by the culture-based algorithm increased from 4 to 629. LIMITATION This analysis did not control for the decline in new arrivals of nonimmigrant visitors to the United States and the decrease of incidence of TB in their countries of origin. CONCLUSION Implementation of the culture-based algorithm may have substantially reduced the incidence of TB among newly arrived, foreign-born persons in the United States. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Yecai Liu
- From Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Drew L. Posey
- From Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin S. Cetron
- From Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A. Painter
- From Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Liang S, Zhang J, Hu L, Chen J, Wu J, Huang Y, Zeng Y, Zhu Y, Li Z, Wen Y, Liang W, Zhuo J, He H. USA's expanded overseas tuberculosis screening program: a retrospective study in China. BMC Public Health 2015; 15:231. [PMID: 25886508 PMCID: PMC4364631 DOI: 10.1186/s12889-015-1558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To address increasing tuberculosis (TB) incidence in foreign-born populations, immigrant TB screening programs have been implemented in the USA. These programs are modified periodically, the effectiveness of which have been disputed. The aim of this retrospective study was to assess the value of the 2009 Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (CDOT TB TI) in a cohort of the USA permanent-resident applicants from China. METHODS Standardized forms were used to collect demographic, clinical, and laboratory data of Chinese individuals screened at the Guangdong International Travel Healthcare Center for permanent residence in the USA between October 08, 2009 and December 31, 2012. Applicants' data were further retrospectively evaluated by three experienced panel physicians and radiologists according to the 1991 Technical Instructions for Tuberculosis Screening and Treatment (TI). TB cases and characteristics identified by the 1991 and expanded 2009 programs were compared. RESULTS The CDOT TB TI identified more than twice as many TB cases that required treatment completion before clearance for travel than the 1991 TI (270 vs. 131). In addition, the expanded screening program identified more cases of negative sputum smear but positive culture (181 vs. 44), and more cases of radiography suggestive of inactive (22 vs. 3) and active (248 vs. 128) TB. Specifically, the 1991 TI screening program failed to identify 25/38 (65.79%) cases carrying drug-resistant isolates, and 13/131 (9.92%) would have been inappropriately treated. Moreover, 220/270 (81.48%) of the cases were asymptomatic, which were identified by screening and subsequently treated. Improved chest radiograph and sputum negative conversion occurred in all treated cases. CONCLUSION CDOT TB TI, a screening program that includes sputum culture and drug susceptibility tests, identifies a greater number of TB cases, likely contributing to the overall decrease in TB prevalence in host (USA) and origin (China) countries.
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Affiliation(s)
- Shaojun Liang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jianming Zhang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Longfei Hu
- Shenzhen Entery-exit Inspection and Quarantine Bureau, 1101 Fuqiang Road, Futian District, Shenzhen, Guangdong, 518045, PR China.
| | - Jiandong Chen
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jian Wu
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yongxin Huang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yan Zeng
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Yufeng Zhu
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Zhaohui Li
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Ying Wen
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Wuyi Liang
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Jinxue Zhuo
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
| | - Hongtao He
- Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China.
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Aldridge RW, Yates TA, Zenner D, White PJ, Abubakar I, Hayward AC. Pre-entry screening programmes for tuberculosis in migrants to low-incidence countries: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2014; 14:1240-9. [DOI: 10.1016/s1473-3099(14)70966-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Can migration health assessments become a mechanism for global public health good? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9954-63. [PMID: 25342234 PMCID: PMC4210960 DOI: 10.3390/ijerph111009954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/09/2014] [Accepted: 09/18/2014] [Indexed: 12/05/2022]
Abstract
Migrant health assessments (HAs) consist of a medical examination to assess a migrant’s health status and to provide medical clearance for work or residency based on conditions defined by the destination country and/or employer. We argue that better linkages between health systems and migrant HA processors at the country level are needed to shift these from being limited as an instrument of determining non-admissibility for purposes of visa issuance, to a process that may enhance public health. The importance of providing appropriate care and follow-up of migrants who “fail” their HA and the need for global efforts to enable data-collection and research on HAs are also highlighted.
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15
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Chuke SO, Yen NTN, Laserson KF, Phuoc NH, Trinh NA, Nhung DTC, Mai VTC, Qui AD, Hai HH, Loan LTH, Jones WG, Whitworth WC, Shah JJ, Painter JA, Mazurek GH, Maloney SA. Tuberculin Skin Tests versus Interferon-Gamma Release Assays in Tuberculosis Screening among Immigrant Visa Applicants. Tuberc Res Treat 2014; 2014:217969. [PMID: 24738031 PMCID: PMC3967820 DOI: 10.1155/2014/217969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/15/2014] [Indexed: 12/02/2022] Open
Abstract
Objective. Use of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs) as part of tuberculosis (TB) screening among immigrants from high TB-burden countries has not been fully evaluated. Methods. Prevalence of Mycobacterium tuberculosis infection (MTBI) based on TST, or the QuantiFERON-TB Gold test (QFT-G), was determined among immigrant applicants in Vietnam bound for the United States (US); factors associated with test results and discordance were assessed; predictive values of TST and QFT-G for identifying chest radiographs (CXRs) consistent with TB were calculated. Results. Of 1,246 immigrant visa applicants studied, 57.9% were TST positive, 28.3% were QFT-G positive, and test agreement was 59.4%. Increasing age was associated with positive TST results, positive QFT-G results, TST-positive but QFT-G-negative discordance, and abnormal CXRs consistent with TB. Positive predictive values of TST and QFT-G for an abnormal CXR were 25.9% and 25.6%, respectively. Conclusion. The estimated prevalence of MTBI among US-bound visa applicants in Vietnam based on TST was twice that based on QFT-G, and 14 times higher than a TST-based estimate of MTBI prevalence reported for the general US population in 2000. QFT-G was not better than TST at predicting abnormal CXRs consistent with TB.
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Affiliation(s)
- Stella O. Chuke
- Northrop Grumman Information Systems Sector, 2800 Century Parkway NE, Atlanta, GA 30345, USA
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Nguyen Thi Ngoc Yen
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Kayla F. Laserson
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA
- Center for Global Health, CDC, Mail Stop D-68, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Nguyen Huu Phuoc
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen An Trinh
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Duong Thi Cam Nhung
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Vo Thi Chi Mai
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - An Dang Qui
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Hoang Hoa Hai
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Le Thien Huong Loan
- Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam
| | - Warren G. Jones
- International Organization for Migration (IOM), 1B Pham Ngoc Thach District 1, Ho Chi Minh City, Vietnam
- International Organization for Migration (IOM), P.O. Box 55040, Westlands, Nairobi 00200, Kenya
| | - William C. Whitworth
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - J. Jina Shah
- Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA
- Department of Family & Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU 3E, San Francisco, CA 94143, USA
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - John A. Painter
- Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Gerald H. Mazurek
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Susan A. Maloney
- Center for Global Health, CDC, Mail Stop D-68, 1600 Clifton Road NE, Atlanta, GA 30333, USA
- Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA
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Walter ND, Painter J, Parker M, Lowenthal P, Flood J, Fu Y, Asis R, Reves R. Persistent latent tuberculosis reactivation risk in United States immigrants. Am J Respir Crit Care Med 2014; 189:88-95. [PMID: 24308495 DOI: 10.1164/rccm.201308-1480oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Current guidelines limit latent tuberculosis infection (LTBI) evaluation to persons in the United States less than or equal to 5 years based on the assumption that high TB rates among recent entrants are attributable to high LTBI reactivation risk, which declines over time. We hypothesized that high postarrival TB rates may instead be caused by imported active TB. OBJECTIVES Estimate reactivation and imported TB in an immigrant cohort. METHODS We linked preimmigration records from a cohort of California-bound Filipino immigrants during 2001-2010 with subsequent TB reports. TB was likely LTBI reactivation if the immigrant had no evidence of active TB at preimmigration examination, likely imported if preimmigration radiograph was abnormal and TB was reported less than or equal to 6 months after arrival, and likely reactivation of inactive TB if radiograph was abnormal but TB was reported more than 6 months after arrival. MEASUREMENTS AND MAIN RESULTS Among 123,114 immigrants, 793 TB cases were reported. Within 1 year of preimmigration examination, 85% of TB was imported; 6 and 9% were reactivation of LTBI and inactive TB, respectively. Conversely, during Years 2-9 after U.S. entry, 76 and 24% were reactivation of LTBI and inactive TB, respectively. The rate of LTBI reactivation (32 per 100,000) did not decline during Years 1-9. CONCLUSIONS High postarrival TB rates were caused by detection of imported TB through active postarrival surveillance. Among immigrants without active TB at baseline, reported TB did not decline over 9 years, indicating sustained high risk of LTBI reactivation. Revised guidelines should support LTBI screening and treatment more than 5 years after U.S. arrival.
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Affiliation(s)
- Nicholas D Walter
- 1 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, Colorado
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17
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Painter JA, Graviss EA, Hai HH, Nhung DTC, Nga TTT, Ha NP, Wall K, Loan LTH, Parker M, Manangan L, O’Brien R, Maloney SA, Hoekstra RM, Reves R. Tuberculosis screening by tuberculosis skin test or QuantiFERON-TB Gold In-Tube Assay among an immigrant population with a high prevalence of tuberculosis and BCG vaccination. PLoS One 2013; 8:e82727. [PMID: 24367546 PMCID: PMC3868593 DOI: 10.1371/journal.pone.0082727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Each year 1 million persons acquire permanent U.S. residency visas after tuberculosis (TB) screening. Most applicants undergo a 2-stage screening with tuberculin skin test (TST) followed by CXR only if TST-positive at > 5 mm. Due to cross reaction with bacillus Calmette-Guérin (BCG), TST may yield false positive results in BCG-vaccinated persons. Interferon gamma release assays exclude antigens found in BCG. In Vietnam, like most high TB-prevalence countries, there is universal BCG vaccination at birth. OBJECTIVES 1. Compare the sensitivity of QuantiFERON-TB Gold In-Tube Assay (QFT) and TST for culture-positive pulmonary TB. 2. Compare the age-specific and overall prevalence of positive TST and QFT among applicants with normal and abnormal CXR. METHODS We obtained TST and QFT results on 996 applicants with abnormal CXR, of whom 132 had TB, and 479 with normal CXR. RESULTS The sensitivity for tuberculosis was 86.4% for QFT; 89.4%, 81.1%, and 52.3% for TST at 5, 10, and 15 mm. The estimated prevalence of positive results at age 15-19 years was 22% and 42% for QFT and TST at 10 mm, respectively. The prevalence increased thereafter by 0.7% year of age for TST and 2.1% for QFT, the latter being more consistent with the increase in TB among applicants. CONCLUSIONS During 2-stage screening, QFT is as sensitive as TST in detecting TB with fewer requiring CXR and being diagnosed with LTBI. These data support the use of QFT over TST in this population.
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Affiliation(s)
- John A. Painter
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward A. Graviss
- The Methodist Hospital Research Institute, Houston, Texas, United States of America
| | - Hoang Hoa Hai
- Cho Ray Hospital, Visa Medical Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ngan P. Ha
- The Methodist Hospital Research Institute, Houston, Texas, United States of America
| | - Kirsten Wall
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
| | | | - Matt Parker
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
| | - Lilia Manangan
- National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rick O’Brien
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Susan A. Maloney
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - R. M. Hoekstra
- Biostatistics and Information Management Office, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Randall Reves
- Denver Health and Hospital Authority, Denver, Colorado, United States of America
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18
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Dara M, Gushulak BD, Posey DL, Zellweger JP, Migliori GB. The history and evolution of immigration medical screening for tuberculosis. Expert Rev Anti Infect Ther 2013; 11:137-46. [PMID: 23409820 DOI: 10.1586/eri.12.168] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying and managing TB in immigrating populations has been an important aspect of immigration health for over a century, with the primary aim being protecting the host population by preventing the import of communicable diseases carried by the arriving migrants. This review describes the history and development of screening for TB and latent TB infection in the immigration context (describing both screening strategies and diagnostic tests used over the last century), outlining current practices and considering the future impact of new advances in screening. The recent focus of the WHO, regarding their elimination strategy, is further increasing the importance of diagnosing and treating latent TB infection. The last section of this review discusses the latest public health developments in the context of TB screening in immigrant populations.
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Affiliation(s)
- Masoud Dara
- WHO Regional Office for Europe, Copenhagen, Denmark
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19
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Barnett ED, Weld LH, McCarthy AE, So H, Walker PF, Stauffer W, Cetron M. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 1: US-bound migrants evaluated by comprehensive protocol-based health assessment. Clin Infect Dis 2012; 56:913-24. [PMID: 23223584 DOI: 10.1093/cid/cis1015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many nations are struggling to develop structured systems and guidelines to optimize the health of new arrivals, but there is currently no international consensus about the best approach. METHODS Data on 7792 migrants who crossed international borders for the purpose of resettlement and underwent a protocol-based health assessment were collected from the GeoSentinel Surveillance network. Demographic and health characteristics of a subgroup of these migrants seen at 2 US-based GeoSentinel clinics for protocol-based health assessments are described. RESULTS There was significant variation over time in screened migrant populations and in their demographic characteristics. Significant diagnoses identified in all migrant groups included latent tuberculosis, found in 43% of migrants, eosinophilia in 15%, and hepatitis B infection in 6%. Variation by region occurred for select diagnoses such as parasitic infections. Notably absent were infectious tuberculosis, soil-transmitted helminths, and malaria. Although some conditions would be unfamiliar to clinicians in receiving countries, universal health problems such as dental caries, anemia, ophthalmologic conditions, and hypertension were found in 32%, 11%, 10%, and 5%, respectively, of screened migrants. CONCLUSIONS Data from postarrival health assessments can inform clinicians about screening tests to perform in new immigrants and help communities prepare for health problems expected in specific migrant populations. These data support recommendations developed in some countries to screen all newly arriving migrants for some specific diseases (such as tuberculosis) and can be used to help in the process of developing additional screening recommendations that might be applied broadly or focused on specific at-risk populations.
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20
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McCarthy AE, Weld LH, Barnett ED, So H, Coyle C, Greenaway C, Stauffer W, Leder K, Lopez-Velez R, Gautret P, Castelli F, Jenks N, Walker PF, Loutan L, Cetron M. Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 2: migrants resettled internationally and evaluated for specific health concerns. Clin Infect Dis 2012; 56:925-33. [PMID: 23223602 DOI: 10.1093/cid/cis1016] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants. METHODS Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared. RESULTS A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19-39 years; 11% were children. Most (58%) were seen >1 year after arrival; 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%); 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas). CONCLUSIONS Eliciting a migration history is important at every encounter; migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants.
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Affiliation(s)
- Anne E McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada
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21
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Lambert LA, Pratt RH, Armstrong LR, Haddad MB. Tuberculosis among healthcare workers, United States, 1995-2007. Infect Control Hosp Epidemiol 2012; 33:1126-32. [PMID: 23041811 PMCID: PMC5025871 DOI: 10.1086/668016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We examined surveillance data to describe the epidemiology of tuberculosis (TB) among healthcare workers (HCWs) in the United States during the period 1995-2007. DESIGN Cross-sectional descriptive analysis of existing surveillance data. SETTING AND PARTICIPANTS TB cases reported to the Centers for Disease Control and Prevention from the 50 states and the District of Columbia from 1995 through 2007. RESULTS Of the 200,744 reported TB cases in persons 18 years of age or older, 6,049 (3%) occurred in individuals who were classified as HCWs. HCWs with TB were more likely than other adults with TB to be women (unadjusted odds ratio [95% confidence interval], 4.1 [3.8-4.3]), be foreign born (1.3 [1.3-1.4]), have extrapulmonary TB (1.6 [1.5-1.7]), and complete TB treatment (2.5 [2.3-2.8]). CONCLUSIONS Healthcare institutions may benefit from intensifying TB screening of HCWs upon hire, especially persons from countries with a high incidence of TB, and encouraging treatment for latent TB infection among HCWs to prevent progression to TB disease.
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Affiliation(s)
- Lauren A Lambert
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia 30333, USA.
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22
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Alvarez GG, Gushulak B, Abu Rumman K, Altpeter E, Chemtob D, Douglas P, Erkens C, Helbling P, Hamilton I, Jones J, Matteelli A, Paty MC, Posey DL, Sagebiel D, Slump E, Tegnell A, Valín ER, Winje BA, Ellis E. A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Infect Dis 2011; 11:3. [PMID: 21205318 PMCID: PMC3022715 DOI: 10.1186/1471-2334-11-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. METHODS Descriptive study of immigration TB screening programs. RESULTS 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. CONCLUSIONS In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved screening programs.
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Affiliation(s)
- Gonzalo G Alvarez
- Divisions of Respirology and Infectious Diseases, University of Ottawa at The Ottawa Hospital, The Ottawa Health Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.
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Manangan LP, Salibay CJA, Wallace RM, Kammerer S, Pratt R, McAllister L, Robison V. Tuberculosis among persons born in the Philippines and living in the United States, 2000-2007. Am J Public Health 2011; 101:101-11. [PMID: 20299652 PMCID: PMC3000726 DOI: 10.2105/ajph.2009.175331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined demographic, clinical, and treatment outcome characteristics of Filipinos with tuberculosis (TB) in the United States. METHODS We calculated TB case rates from US Census Bureau population estimates and National Tuberculosis Surveillance System data for US-born non-Hispanic Whites and for US residents born in the Philippines, India, China, Cambodia, Vietnam, Pakistan, and Korea--countries that are major contributors to the TB burden in the United States. We compared Filipinos with the other groups through univariate and multivariate analyses. RESULTS Of 45,504 TB patients, 15.5% were Filipinos; 43.0% were other Asian/Pacific Islander groups; and 41.6% were Whites. Per 100 000 persons in 2007, the TB rate was 73.5 among Cambodians, 54.0 among Vietnamese, 52.1 among Filipinos, and 0.9 among Whites. Filipinos were more likely than other groups to be employed as health care workers and to have used private health care providers but less likely to be HIV positive and to be offered HIV testing. CONCLUSIONS The relatively high TB rate among Filipinos indicates that TB control strategies should target this population. Providers should be encouraged to offer HIV testing to all TB patients.
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Affiliation(s)
- Lilia Ponce Manangan
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
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25
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Horsburgh CR, Goldberg S, Bethel J, Chen S, Colson PW, Hirsch-Moverman Y, Hughes S, Shrestha-Kuwahara R, Sterling TR, Wall K, Weinfurter P. Latent TB Infection Treatment Acceptance and Completion in the United States and Canada. Chest 2010; 137:401-9. [PMID: 19793865 DOI: 10.1378/chest.09-0394] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Liu Y, Weinberg MS, Ortega LS, Painter JA, Maloney SA. Overseas screening for tuberculosis in U.S.-bound immigrants and refugees. N Engl J Med 2009; 360:2406-15. [PMID: 19494216 DOI: 10.1056/nejmoa0809497] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2007, a total of 57.8% of the 13,293 new cases of tuberculosis in the United States were diagnosed in foreign-born persons, and the tuberculosis rate among foreign-born persons was 9.8 times as high as that among U.S.-born persons (20.6 vs. 2.1 cases per 100,000 population). Annual arrivals of approximately 400,000 immigrants and 50,000 to 70,000 refugees from overseas are likely to contribute substantially to the tuberculosis burden among foreign-born persons in the United States. METHODS The Centers for Disease Control and Prevention (CDC) collects information on overseas screening for tuberculosis among U.S.-bound immigrants and refugees, along with follow-up evaluation after their arrival in the United States. We analyzed screening and follow-up data from the CDC to study the epidemiology of tuberculosis in these populations. RESULTS From 1999 through 2005, a total of 26,075 smear-negative cases of tuberculosis (i.e., cases in which a chest radiograph was suggestive of active tuberculosis but sputum smears were negative for acid-fast bacilli on 3 consecutive days) and 22,716 cases of inactive tuberculosis (i.e., cases in which a chest radiograph was suggestive of tuberculosis that was no longer clinically active) were diagnosed by overseas medical screening of 2,714,223 U.S.-bound immigrants, representing prevalences of 961 cases per 100,000 persons (95% confidence interval [CI], 949 to 973) and 837 cases per 100,000 persons (95% CI, 826 to 848), respectively. Among 378,506 U.S.-bound refugees, smear-negative tuberculosis was diagnosed in 3923 and inactive tuberculosis in 10,743, representing prevalences of 1036 cases per 100,000 persons (95% CI, 1004 to 1068) and 2838 cases per 100,000 persons (95% CI, 2785 to 2891), respectively. Active pulmonary tuberculosis was diagnosed in the United States in 7.0% of immigrants and refugees with an overseas diagnosis of smear-negative tuberculosis and in 1.6% of those with an overseas diagnosis of inactive tuberculosis. CONCLUSIONS Overseas screening for tuberculosis with follow-up evaluation after arrival in the United States is a high-yield intervention for identifying tuberculosis in U.S.-bound immigrants and refugees and could reduce the number of tuberculosis cases among foreign-born persons in the United States.
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Affiliation(s)
- Yecai Liu
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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27
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Oeltmann JE, Varma JK, Ortega L, Liu Y, O'Rourke T, Cano M, Harrington T, Toney S, Jones W, Karuchit S, Diem L, Rienthong D, Tappero JW, Ijaz K, Maloney SA. Multidrug-resistant tuberculosis outbreak among US-bound Hmong refugees, Thailand, 2005. Emerg Infect Dis 2009; 14:1715-21. [PMID: 18976554 PMCID: PMC2630728 DOI: 10.3201/eid1411.071629] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In January 2005, tuberculosis (TB), including multidrug-resistant TB (MDR TB), was reported among Hmong refugees who were living in or had recently immigrated to the United States from a camp in Thailand. We investigated TB and drug resistance, enhanced TB screenings, and expanded treatment capacity in the camp. In February 2005, 272 patients with TB (24 MDR TB) remained in the camp. Among 17 MDR TB patients interviewed, 13 were found to be linked socially. Of 23 MDR TB isolates genotyped, 20 were similar according to 3 molecular typing methods. Before enhanced screening was implemented, 46 TB cases (6 MDR TB) were diagnosed in the United States among 9,455 resettled refugees. After enhanced screening had begun, only 4 TB cases (1 MDR TB), were found among 5,705 resettled refugees. An MDR TB outbreak among US-bound refugees led to importation of disease; enhanced pre-immigration TB screening and treatment decreased subsequent importation.
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Affiliation(s)
- John E Oeltmann
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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28
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Jia ZW, Tang GY, Jin Z, Dye C, Vlas SJ, Li XW, Feng D, Fang LQ, Zhao WJ, Cao WC. Modeling the impact of immigration on the epidemiology of tuberculosis. Theor Popul Biol 2007; 73:437-48. [PMID: 18255113 DOI: 10.1016/j.tpb.2007.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 11/11/2007] [Accepted: 12/04/2007] [Indexed: 11/16/2022]
Abstract
This paper presents two new theoretical frameworks to investigate the impact of immigration on the transmission dynamics of tuberculosis. For the basic model, we present new analysis on the existence and stability of equilibria. Then, we use numerical simulations of the model to illustrate the behavior of the system. We apply the model to Canadian reported data on tuberculosis and observe a good agreement between the model prediction and the data. For the extended model, which incorporated the recruitment of the latent and infectious in immigrants to the basic model, we find that the usual threshold condition does not apply and a unique equilibrium exists for all parameter values. This indicates that the disease does not disappear and becomes endemic in host areas. This finding is also supported by numerical simulations with the extended model. Our study suggests that immigrants have a considerable influence on the overall transmission dynamics behavior of tuberculosis.
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Affiliation(s)
- Zhong-Wei Jia
- School of Information Engineering, Beijing University of Posts and Telecommunications, 10 Xitucheng Road, Beijing 100876, PR China
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Joshi R, Patil S, Kalantri S, Schwartzman K, Menzies D, Pai M. Prevalence of abnormal radiological findings in health care workers with latent tuberculosis infection and correlations with T cell immune response. PLoS One 2007; 2:e805. [PMID: 17726535 PMCID: PMC1950085 DOI: 10.1371/journal.pone.0000805] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 08/02/2007] [Indexed: 11/25/2022] Open
Abstract
Background More than half of all health care workers (HCWs) in high TB-incidence, low and middle income countries are latently infected with tuberculosis (TB). We determined radiological lesions in a cohort of HCWs with latent TB infection (LTBI) in India, and determined their association with demographic, occupational and T-cell immune response variables. Methodology We obtained chest radiographs of HCWs who had undergone tuberculin skin test (TST) and QuantiFERON-TB Gold In Tube (QFT), an interferon-γ release assay, in a previous cross-sectional study, and were diagnosed to have LTBI because they were positive by either TST or QFT, but had no evidence of clinical disease. Two observers independently interpreted these radiographs using a standardized data form and any discordance between them resolved by a third observer. The radiological diagnostic categories (normal, suggestive of inactive TB, and suggestive of active TB) were compared with results of TST, QFT assay, demographic, and occupational covariates. Results A total of 330 HCWs with positive TST or QFT underwent standard chest radiography. Of these 330, 113 radiographs (34.2%) were finally classified as normal, 206 (62.4%) had lesions suggestive of inactive TB, and 11 (3.4%) had features suggestive of active TB. The mean TST indurations and interferon-γ levels in the HCWs in these three categories were not significantly different. None of the demographic or occupational covariates was associated with prevalence of inactive TB lesions on chest radiography. Conclusion/Significance In a high TB incidence setting, nearly two-thirds of HCWs with latent TB infection had abnormal radiographic findings, and these findings had no clear correlation with T cell immune responses. Further studies are needed to verify these findings and to identify the causes and prognosis of radiologic abnormalities in health care workers.
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Affiliation(s)
- Rajnish Joshi
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California, United States of America
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Samir Patil
- Parmanand D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Shriprakash Kalantri
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Kevin Schwartzman
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Madhukar Pai
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- * To whom correspondence should be addressed. E-mail:
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Nortier JL, del Marmol V. Nephrogenic systemic fibrosis the need for a multidisciplinary approach. Nephrol Dial Transplant 2007; 22:3097-101. [PMID: 17617650 DOI: 10.1093/ndt/gfm430] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Patel S, Parsyan AE, Gunn J, Barry MA, Reed C, Sharnprapai S, Horsburgh CR. Risk of Progression to Active Tuberculosis Among Foreign-Born Persons With Latent Tuberculosis. Chest 2007; 131:1811-6. [PMID: 17413054 DOI: 10.1378/chest.06-2601] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Increased risk for tuberculosis (TB) disease has been identified in foreign-born persons in the United States, particularly during the first 5 years after their arrival in the United States. This could be explained by undetected TB disease at entry, increased prevalence of latent TB infection (LTBI), increased progression from LTBI to TB, or a combination of these factors. METHODS We performed a cluster analysis of TB cases in Boston and a case-control study of risk factors for TB with an unclustered isolate among Boston residents with LTBI to determine whether such persons have an increased risk for reactivation of disease. RESULTS Of 321 case patients with TB seen between 1996 and 2000, 133 isolates were clustered and 188 were not. In multivariate analysis, foreign birth was associated with an unclustered isolate (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2 to 3.8; p < 0.01), while being a close contact of a TB case was negatively associated (OR, 0.22; 95% CI, 0.07 to 0.73; p = 0.02). When 188 TB patients with unclustered isolates were compared to 188 age-matched control subjects with LTBI, there was no association between the occurrence of TB and foreign birth (OR, 0.71; 95% CI, 0.42 to 1.3); among foreign-born persons, there was no association between the occurrence of TB and being in the United States <or= 5 years (OR, 0.90; 95% CI, 0.56 to 1.44). CONCLUSIONS We conclude that the increased risk for TB among foreign-born persons in the United States may be attributable to the increased prevalence of LTBI among foreign-born persons or the increased prevalence of active disease at arrival in the United States, but not to an increased rate of reactivation among persons with LTBI.
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Affiliation(s)
- Shalini Patel
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Boston University, Boston, USA
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Laifer G, Widmer AF, Simcock M, Bassetti S, Trampuz A, Frei R, Tamm M, Battegay M, Fluckiger U. TB in a low-incidence country: differences between new immigrants, foreign-born residents and native residents. Am J Med 2007; 120:350-6. [PMID: 17398230 DOI: 10.1016/j.amjmed.2006.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 09/06/2006] [Accepted: 10/31/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND New immigrants and foreign-born residents add to the burden of pulmonary tuberculosis (TB) in low-incidence countries. The highest TB rates have been found among recent immigrants. Active screening programs are likely to change the clinical presentation of TB, but the extent of the difference between immigrant and resident populations has not been studied prospectively. METHODS Adult new immigrants were screened upon entry to 1 of 5 immigration centers in Switzerland. Immigrants with abnormal chest radiographs were enrolled and compared in a cohort study to consecutive admitted foreign-born residents from moderate-to-high incidence countries and native residents presenting with suspected TB. RESULTS Of 42,601 new immigrants screened, 112 had chest radiographs suspicious for TB. They were compared with foreign-born residents (n=118) and native residents (n=155) with suspected TB (n=385 patients included). Active TB was confirmed in 40.5% of all patients (immigrants 38.4%, foreign-born residents 50%, native residents 34.8%). Clinical signs and symptoms of TB and laboratory markers of inflammation were significantly less common in immigrants than in the other groups with normal results in >70%. The proportion of positive results on rapid testing to detect M. tuberculosis (MTB) in 3 respiratory specimens was significantly lower in immigrants (34.9% for acid-fast staining; 55.8% for polymerase chain reaction) compared with foreign-born residents (76.2% and 89.1%, respectively) and native residents (83.3% and 90.9%, respectively). Isoniazid resistance and multi-drug resistance were more prevalent in immigrants. CONCLUSION New immigrants with TB detected in a screening program are often asymptomatic and have a low yield of rapid diagnostic tests but are at higher risk for resistant MTB strains. Postmigration follow-up of pulmonary infiltrates is essential in order to control TB among immigrants, even in the absence of clinical and laboratory signs of infection.
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Affiliation(s)
- Gerd Laifer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland.
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Cain KP, Haley CA, Armstrong LR, Garman KN, Wells CD, Iademarco MF, Castro KG, Laserson KF. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med 2006; 175:75-9. [PMID: 17038659 DOI: 10.1164/rccm.200608-1178oc] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE In the United States, the number of annual reported cases of tuberculosis (TB) among U.S.-born persons declined by 62% from 1993 to 2004, but increased by 5% among foreign-born persons. Over half of all reported cases of TB in the United States occur among foreign-born persons, most of these due to activation of latent TB infection (LTBI). Current guidelines recommend targeting only foreign-born persons who entered the United States within the previous 5 yr for LTBI testing. OBJECTIVE We sought to assess the epidemiologic basis for this guideline. METHODS We calculated TB case rates among foreign-born persons, stratified by duration of United States residence and world region of origin. We determined the number of cases using 2004 U.S. TB surveillance data, and calculated case rates using population data from the 2004 American Community Survey. MEASUREMENTS AND MAIN RESULTS In 2004, a total of 14,517 cases of TB were reported; 3,444 (24%) of these were among foreign-born persons who had entered the United States more than 5 yr previously. The rate of TB disease among foreign-born persons was 21.5/100,000, compared with 2.7/100,000 for U.S.-born persons, and varied by duration of residence and world region of origin. CONCLUSIONS Almost one-quarter of all TB cases in the United States occur among foreign-born persons who have resided in the United States for longer than 5 yr; case rates for such persons from selected regions of origin remain substantially elevated. To eliminate TB, we must address the burden of LTBI in this high-risk group.
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Affiliation(s)
- Kevin P Cain
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-10, Atlanta, GA 30333, USA.
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