Tuberculosis among Newly Arrived Immigrants and Refugees in the United States

Details

• Alternative Title:
  Ann Am Thorac Soc
• Personal Author:
  Liu, Yecai ; Phares, Christina R. ; Posey, Drew L. ; Maloney, Susan A. ; Cain, Kevin P. ; Weinberg, Michelle S. ; Schmit, Kristine M ; Marano, Nina ; Cetron, Martin S.
• Description:
  Rationale:
  
  U.S. health departments routinely conduct post-arrival evaluation of immigrants and refugees at risk for tuberculosis, but this important intervention has not been thoroughly studied.
  
  Objectives:
  
  To assess outcomes of the post-arrival evaluation intervention.
  
  Methods:
  
  We categorized at risk immigrants and refugees as: with recent completion of treatment for pulmonary tuberculosis disease overseas (including Mexico and Canada); with suspected tuberculosis disease (chest radiograph/clinical symptoms suggestive of tuberculosis) but negative cultures overseas; or with latent tuberculosis infection diagnosed overseas. Among 2.1 million US-bound immigrants and refugees screened for tuberculosis overseas during 2013–2016, 90,737 were identified as at risk for tuberculosis. We analyzed a national dataset of these at risk immigrants and refugees, and calculated rates of tuberculosis disease for those who completed post-arrival evaluation.
  
  Measurements and Main Results:
  
  Among 4,225 persons with recent completion of treatment for pulmonary tuberculosis disease overseas, 3,005 (71.1%) completed post-arrival evaluation within 1 year of arrival; of these, 22 were diagnosed with tuberculosis disease (732 cases/100,000 persons): 4 sputum culture-positive cases (133 cases/100,000 persons), 13 sputum culture-negative cases (433 cases/100,000 persons), and 5 cases with no reported sputum culture results (166 cases/100,000 persons). Among 55,938 with suspected tuberculosis disease but negative cultures overseas, 37,089 (66.3%) completed post-arrival evaluation; of these, 597 were diagnosed with tuberculosis disease (1610 cases/100,000 persons): 262 sputum culture-positive cases (706 cases/100,000 persons), 281 sputum culture-negative cases (758 cases/100,000 persons), and 54 cases with no reported sputum culture results (146 cases/100,000 persons. Among 30,574 with latent tuberculosis infection diagnosed overseas, 18,466 (60.4%) completed post-arrival evaluation; of these, 48 were diagnosed with tuberculosis disease (260 cases/100,000 persons): 11 sputum culture-positive cases (60 cases/100,000 persons), 22 sputum culture-negative cases (119 cases/100,000 persons), and 15 cases with no reported sputum culture results (81 cases/100,000 persons). Of 21,714 persons for whom treatment for latent tuberculosis infection was recommended at post-arrival evaluation, 14,977 (69.0%) initiated and 8,695 (40.0%) completed treatment.
  
  Conclusions:
  
  Post-arrival evaluation of at risk immigrants and refugees can be highly effective. To optimize yield and impact of this intervention, strategies are needed to improve completion rates of post-arrival evaluation and treatment for latent tuberculosis infection.
  
  
• Subjects:
  Biological Specimen Banks Electronic Health Records Genomics Michigan Research Design
• Keywords:
  Latent Tuberculosis Infection Post-arrival Evaluation Treatment
• Source:
  Ann Am Thorac Soc. 17(11):1401-1412
• Pubmed ID:
  32730094
• Pubmed Central ID:
  PMC8098654
• Document Type:
  Journal Article
• Funding:
  T42 OH008455/OH/NIOSH CDC HHSUnited States/ ; P30 CA046592/CA/NCI NIH HHSUnited States/ ; MC_QA137853/MRC_/Medical Research CouncilUnited Kingdom/ ; MC_PC_12028/MRC_/Medical Research CouncilUnited Kingdom/ ; MC_PC_17228/MRC_/Medical Research CouncilUnited Kingdom/
• Volume:
  17
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:131367e22ff4d261d1fa6c3b4a5da7bd3175a009910f1993805f56f385792e7000a938d0d831b5c423d4a4dae44c8205b085d2b7c07b10b53dac85ab1654c951
• Download URL:
  https://stacks.cdc.gov/view/cdc/105967/cdc_105967_DS1.pdf
• File Type:
  [PDF - 740.89 KB ]