Effect of a Culture-Based Screening Algorithm on Tuberculosis Incidence in Immigrants and Refugees Bound for the United States

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Liu, Yecai ; Posey, Drew L. ; Cetron, Martin S. ; Painter, John A.
• Description:
  Background ; Before 2007, U.S.-bound immigrants and refugees were screened for tuberculosis (TB) by a smear-based algorithm that could not diagnose smear-negative and culture-positive TB. In 2007, the Centers for Disease Control and Prevention began to implement 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 and culture-positive TB cases diagnosed overseas among immigrants and refugees by the culture-based algorithm with the decline of reported TB 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, 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 and culture-positive. Before implementation (2002 to 2006), the annual number of reported TB 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 and culture-positive TB cases diagnosed overseas among U.S.-bound immigrants and refugees by the culture-based algorithm increased from 4 in 2007 to 629 in 2012. ; 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 in U.S.-bound immigrants and refugees may have substantially reduced the incidence of TB among newly arrived, foreign-born persons in the United States. ; Primary Funding Source ; None.
  More +
• Subjects:
  • Article
  • Algorithms
  • Bacteriological Techniques
  • Cross-Sectional Studies
  • Emigrants and Immigrants
  • Follow-Up Studies
  • Humans
  • Incidence
  • Mass Screening
  • Refugees
  More +
• Source:
  Ann Intern Med. 162(6):420-428
• Pubmed ID:
  25775314
• Pubmed Central ID:
  PMC4646057
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  162
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/36490/cdc_36490_DS1.pdf
• File Type:
  [PDF - 1008.10 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:05d06bc0ac390c2b3c33c9a5ee9c26d50b4df012aa30261545dd440fd3aa4316