Overseas screening of immigrants and refugees could cut TB cases in US
Reuters, June 4, 2009
New York (Reuters) — Overseas screening for tuberculosis coupled with follow-up evaluation in the US could reduce the number of TB cases among foreign-born individuals in the country, according to a report in The New England Journal of Medicine for June 4.
Roughly 58% of the 13,293 new cases of TB seen in the US in 2007 were in foreign-born persons, lead author Yecai Liu, from the Centers for Disease Control and Prevention, Atlanta, and colleagues note. Moreover, the TB rate in foreign-born individuals is nearly 10 times that seen in US-born persons: 20.6 vs. 2.1 cases per 100,000 population.
The arrival in the US each year of about 400,000 immigrants and 70,000 refugees likely plays a major role in the TB burden among foreign-born persons in the country, the authors state.
An analysis of data gathered by the CDC indicates that from 1999 to 2005, there were 26,075 smear-negative cases of TB and 22,716 cases of inactive TB detected through overseas screening of 2,714,223 US-bound immigrants, resulting in prevalences of 961 and 837 cases per 100,000 persons, respectively.
During the same period, 3923 cases of smear-negative TB and 10,743 cases of inactive disease were found through screening of 378,506 US-bound refugees, yielding prevalences of 1036 and 2838 cases per 100,000 persons, respectively.
Of immigrants and refugees with an overseas diagnosis of smear-negative TB, 7.0% were diagnosed with active pulmonary TB in the US. Of those with an overseas diagnosis of inactive tuberculosis, 1.6% had active TB in the US.
'Overseas screening for TB with follow-up evaluation in the US is a high-yield intervention for identifying tuberculosis in US-bound immigrants and refugees and could reduce the number of TB cases among foreign-born persons in the US,' Liu's team concludes.
EDITORS NOTE: The NEJM of report is available online at: http://content.nejm.org/cgi/content/full/360/23/2406