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Stockbridge EL, Miller TL, Carlson EK, Ho C. Private sector tuberculosis prevention in the US: Characteristics associated with interferon-gamma release assay or tuberculin skin testing. PLoS One 2018; 13:e0193432. [PMID: 29590130 PMCID: PMC5873986 DOI: 10.1371/journal.pone.0193432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether latent tuberculosis infection risk factors are associated with an increased likelihood of latent tuberculosis infection testing in the US private healthcare sector. DATA SOURCE A national sample of medical and pharmacy claims representing services rendered January 2011 through December 2013 for 3,997,986 commercially insured individuals in the US who were 0 to 64 years of age. STUDY DESIGN We used multivariable logistic regression models to determine whether TB/LTBI risk factors were associated with an increased likelihood of Interferon-Gamma Release Assay (IGRA) or Tuberculin Skin Test (TST) testing in the private sector. PRINCIPAL FINDINGS 4.31% (4.27-4.34%) received at least one TST/IGRA test between 2011 and 2013 while 1.69% (1.67-1.72%) received a TST/IGRA test in 2013. Clinical risk factors associated with a significantly increased likelihood of testing included HIV, immunosuppressive therapy, exposure to tuberculosis, a history of tuberculosis, diabetes, tobacco use, end stage renal disease, and alcohol use disorder. Other significant variables included gender, age, asthma, the state tuberculosis rate, population density, and percent of foreign-born persons in a county. CONCLUSIONS Private sector TST/IGRA testing is not uncommon and testing varies with clinical risk indicators. Thus, the private sector can be a powerful resource in the fight against tuberculosis. Analyses of administrative data can inform how best to leverage private sector healthcare toward tuberculosis prevention activities.
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Affiliation(s)
- Erica L. Stockbridge
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States of America
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, AZ, United States of America
- * E-mail:
| | - Thaddeus L. Miller
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States of America
| | - Erin K. Carlson
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States of America
| | - Christine Ho
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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High Rates of Tuberculosis and Opportunities for Prevention among International Students in the United States. Ann Am Thorac Soc 2017; 13:522-8. [PMID: 26730745 DOI: 10.1513/annalsats.201508-547oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years. OBJECTIVES To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population. METHODS Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions. MEASUREMENTS AND MAIN RESULTS Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection. CONCLUSIONS The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis.
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Jewett A, Bell T, Cohen NJ, Buckley K, Leino V, Even S, Beavers S, Brown C, Marano N. US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:409-15. [PMID: 26730492 PMCID: PMC4879121 DOI: 10.1080/07448481.2015.1117465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.
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Affiliation(s)
- A. Jewett
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
| | - T Bell
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
- Council of State and Territorial Epidemiologists, Atlanta, GA
| | - NJ. Cohen
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
| | - K. Buckley
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
| | - V. Leino
- American College of Health Association, Hanover, MD
| | - S. Even
- American College of Health Association, Hanover, MD
| | - S. Beavers
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - C. Brown
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
| | - N. Marano
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Atlanta, GA
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Gibney KB, Brass A, Hume SC, Leder K. Educating international students about tuberculosis and infections associated with travel to visit friends and relatives (VFR-travel). Travel Med Infect Dis 2013; 12:274-82. [PMID: 24100199 DOI: 10.1016/j.tmaid.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/11/2013] [Accepted: 08/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND International students in Victoria, Australia, originate from over 140 different countries. They are over-represented in disease notifications for tuberculosis and travel-associated infections, including enteric fever, hepatitis A, and malaria. We describe a public health initiative aimed to increase awareness of these illnesses among international students and their support staff. METHODS We identified key agencies including student support advisors, medical practitioners, health insurers, and government and professional organisations. We developed health education materials targeting international students regarding tuberculosis and travel-related infections to be disseminated via a number of different media, including electronic and printed materials. We sought informal feedback from personnel in all interested agencies regarding the materials developed, their willingness to deliver these materials to international students, and their preferred media for disseminating these materials. RESULTS Education institutions with dedicated international student support staff and on-campus health clinics were more easily engaged to provide feedback and disseminate the health education materials than institutions without such dedicated personnel. Response to contacting off-campus medical practices was poor. Delivery of educational materials via electronic and social media was preferred over face-to-face education. CONCLUSIONS It is feasible to provide health education messages targeting international students for dissemination via appropriately-staffed educational institutions. This initiative could be expanded in terms of age-group, geographic range, and health issues to be targeted.
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Affiliation(s)
- Katherine B Gibney
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia; Communicable Disease Prevention and Control, Department of Health Victoria, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia.
| | - Amanda Brass
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Sam C Hume
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia
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Kowada A. Cost Effectiveness of Interferon-Gamma Release Assay for School-Based Tuberculosis Screening. Mol Diagn Ther 2012; 16:181-90. [DOI: 10.1007/bf03262207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Estimating the impact of newly arrived foreign-born persons on tuberculosis in the United States. PLoS One 2012; 7:e32158. [PMID: 22384165 PMCID: PMC3287989 DOI: 10.1371/journal.pone.0032158] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States. METHODOLOGY/PRINCIPAL FINDINGS We defined foreign-born persons within 1 year after arrival in the United States as "newly arrived", and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6% (4,783) occurred among immigrants and refugees, 36.6% (4,211) among students/exchange visitors and temporary workers, 13.8% (1,589) among tourists and business travelers, and 7.3% (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of ≥100 cases/100,000 population/year; 235.8 cases/100,000 admissions, 95% confidence interval [CI], 228.3 to 243.3), students/exchange visitors and temporary workers from high-incidence countries (60.9 cases/100,000 admissions, 95% CI, 58.5 to 63.3), and immigrants and refugees from medium-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of 15-99 cases/100,000 population/year; 55.2 cases/100,000 admissions, 95% CI, 51.6 to 58.8). CONCLUSIONS/SIGNIFICANCE Newly arrived nonimmigrant visitors contribute substantially to the burden of foreign-born TB in the United States. To achieve the goals of TB elimination, direct investment in global TB control and strategies to target nonimmigrant visitors should be considered.
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American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States. Am J Respir Crit Care Med 2005; 172:1169-227. [PMID: 16249321 DOI: 10.1164/rccm.2508001] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.
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Hser YI, Gelberg L, Hoffman V, Grella CE, McCarthy W, Anglin MD. Health conditions among aging narcotics addicts: medical examination results. J Behav Med 2005; 27:607-22. [PMID: 15669446 DOI: 10.1007/s10865-004-0005-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The study examined health conditions among an aging cohort of male narcotics addicts. This prospective cohort study (1964-1998) included interviews and medical testing for 108 surviving subjects who had been admitted to the California Civil Addict Program during the years 1962 through 1964. Medical testing results were: 51.9% had high blood pressure, 22.4% showed hyperlipidemia, 13.3% had elevated levels of blood glucose, 33.6% had abnormal pulmonary function, half of the sample had abnormal liver function, and 94.2% tested positive for hepatitis C, 85.6% for hepatitis B, 3.8% for syphilis, and 27.3% for TB. The study empirically demonstrated poor health conditions and high morbidity among surviving narcotics addicts.
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Affiliation(s)
- Yih-Ing Hser
- University of California, Los Angeles, California 90025, USA.
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D'Souza CM, Forman SF, Austin SB. Follow-up evaluation of a high school eating disorders screening program: knowledge, awareness and self-referral. J Adolesc Health 2005; 36:208-13. [PMID: 15737776 DOI: 10.1016/j.jadohealth.2004.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Accepted: 01/26/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To conduct a regional, follow-up evaluation to assess the implementation and effectiveness of the National Eating Disorders Screening Program (NEDSP), conducted in high schools nationwide in the spring of 2000. METHODS Four New England high schools participated in a postscreen evaluation 1 to 2 months after implementation of NEDSP. A 35-item, self-report postscreen survey was administered to students in classrooms with assistance from school health staff and teachers. School staff involved in the screening were also interviewed. Logistic regression was used to estimate the odds that students talked to an adult or peers about their screening score. RESULTS Data from 592 girls and 435 boys were included in the analysis in the four high schools participating in the program evaluation. NEDSP helped to identify students at risk and encouraged students to speak to others about their screening score and eating disorder symptoms. One-quarter of girls and one-fifth of boys reported talking with at least one adult about their EAT-26 screening score. Girls felt more strongly than boys that the program helped them learn about eating disorders, change their thinking related to eating disorders and body image, and talk to friends about eating disorders. Overall, the students felt that the program was helpful and would recommend it to their friends. CONCLUSIONS Early detection of eating disorders in adolescents may shorten the interval between onset of symptoms and treatment, which has the potential to reduce the length of illness and morbidity associated with untreated eating disorders. Our findings suggest that high-school-based screening may be an effective way to facilitate early detection of eating disorder symptoms in adolescents.
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Affiliation(s)
- Cheryl M D'Souza
- Division of Adolescent and Young Adult Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
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Hizel K, Maral I, Karakus R, Aktas F. The influence of BCG immunisation on tuberculin reactivity and booster effect in adults in a country with a high prevalence of tuberculosis. Clin Microbiol Infect 2004; 10:980-3. [PMID: 15522000 DOI: 10.1111/j.1469-0691.2004.00970.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The relationship of age and previous BCG vaccination with tuberculin skin test (TST) reactivity was investigated to assess the interpretation of TST results in the adult population of Turkey, where there is a high prevalence of tuberculosis and a routine BCG vaccination programme. The influences of age and BCG vaccine status on booster reaction were also evaluated. TST was applied (5 tuberculin units of purified protein derivative intradermally) to two healthy adult groups, namely 98 medical students and 187 elderly people in a retirement home. The TST was considered positive if an induration > or = 10 mm in diameter was produced. Subjects (41 elderly people and 39 students) with a reaction < 10 mm in diameter were retested 1 week later. There was no significant difference between the students (59.1%) and elderly subjects (58.8%) with respect to positive TST response. No influence of BCG scars on TST reactivity was observed in either group. The booster effect was seen more commonly in the elderly, but the presence of a BCG scar did not influence the booster effect in either group. It was concluded that a positive TST response and booster reaction in adults in high-prevalence countries may be caused by latent tuberculosis rather than previous vaccination.
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Affiliation(s)
- K Hizel
- Infectious Diseases Department, Gazi University Medical Faculty, Besevler, Ankara, Turkey.
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Koppaka VR, Harvey E, Mertz B, Johnson BA. Risk factors associated with tuberculin skin test positivity among university students and the use of such factors in the development of a targeted screening program. Clin Infect Dis 2003; 36:599-607. [PMID: 12594641 DOI: 10.1086/367664] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2002] [Accepted: 11/26/2002] [Indexed: 11/03/2022] Open
Abstract
The present study evaluated the accuracy of a risk assessment questionnaire (RAQ) for identifying candidates for tuberculin testing. A 33-question RAQ was administered to students before they underwent tuberculin screening at Virginia Commonwealth University (Richmond). Test operating characteristics for the complete and abbreviated RAQs compared to tuberculin skin test (TST) results were determined. Of 5382 students screened, 125 (2.3%) had a positive TST result; 113 (90.4%) of these 125 students had >or=1 affirmative response on the RAQ (i.e., a "positive RAQ"). The prevalence of TST positivity among students not born in the United States was 33.2-fold higher than that among students born in the United States. A 2-question RAQ had a sensitivity of 81.6%, a specificity of 91.0%, and positive and negative predictive values of 17.7% and 99.5%, respectively. Risk assessment can be an accurate means of identifying candidates for tuberculin screening.
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Weis SE, Moonan PK, Pogoda JM, Turk L, King B, Freeman-Thompson S, Burgess G. Tuberculosis in the foreign-born population of Tarrant county, Texas by immigration status. Am J Respir Crit Care Med 2001; 164:953-7. [PMID: 11587977 DOI: 10.1164/ajrccm.164.6.2102132] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The epidemiology of tuberculosis is changing in the United States as a result of immigration, yet the extent to which different classes of immigrants contribute to overall morbidity is unknown. Tuberculosis in nonimmigrant visitors is of particular interest as they are currently exempt from screening requirements. We conducted a prospective survey of all culture-positive tuberculosis patients in Tarrant County, Texas from 1/98 to 12/00. Immigration status of foreign-born patients was classified as permanent residents, undocumented, or nonimmigrant visitors. Of 274 eligible participants, 114 (42%) were foreign-born; of these, 67 (59%) were permanent residents, 28 (25%) were undocumented, and 19 (17%) were nonimmigrant visitors. Among the foreign-born, we observed significant differences by immigration status in multidrug resistance (p = 0.02), human immunodeficiency virus (HIV) infection (p = 0.0007), and hospitalization (p = 0.03 for ever/never, 0.01 for duration). Compared with other immigrants, more nonimmigrant visitors were multi-drug-resistant (16 % versus 11% of undocumented residents and 1% of permanent residents), were HIV-positive (32% versus 0% of undocumented and 5% of permanent residents), were hospitalized (47% versus 36% of undocumented and 19% of permanent residents), and had lengthy hospitalizations (median [midspread] days = 87 [25 to 153] versus 8.5 [4 to 28] for undocumented and 10 [7 to 24 d] for permanent residents). We found nonimmigrant visitors to be an important source of tuberculosis morbidity in Tarrant County. Further studies in other regions of the U.S. are needed to determine if screening and treatment recommendations of persons who spend extended periods in the U.S. should be raised to the standards set for permanent residents.
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Affiliation(s)
- S E Weis
- Department of Medicine, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA.
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