Guidelines for screening for tuberculosis infection and disease during the domestic medical examination for newly arrived refugees
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Guidelines for screening for tuberculosis infection and disease during the domestic medical examination for newly arrived refugees

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      Tuberculosis (TB) rates in the United States have continued to decline, reaching their lowest point on record in 2007 (1). Although TB is decreasing overall in the United States, there is a disproportional increase in TB in foreign-born individuals. For example, in 2007, the TB rate among foreign-born persons in the United States was 9.7 times that of U.S.-born persons (1). In cities that are home to many newly arriving immigrants and refugees, rates of TB can be well above the national average. Additionally, the prevalence of drug-resistant TB and extrapulmonary disease is higher among foreign-born persons, making the diagnosis and management of these cases both challenging and essential for effective prevention and control of TB among newly arriving refugees (2). The rate of TB disease appears to remain high for many years after immigration, making it essential that clinicians identify and treat latent tuberculosis infection (LTBI) prior to the development of TB disease. In addition, because of the high rate of reactivation, health-care providers who serve immigrants and refugees should maintain a high index of suspicion, regardless of the results of medical examinations performed overseas (3).

      This document provides an overview of the overseas medical screening process for refugees relocating to the United States, and outlines guidelines for clinicians evaluating refugees for TB during the medical examination for new arrivals. This document does not replace existing guidelines but is meant to highlight specific needs in refugees and should augment and be used in conjunction with existing guidelines from national authorities (ATS/CDC/IDSA) and state TB control programs.

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