26364054

PMC6062848

Background

Immigrants and refugees 2–14 years of age entering the United States from countries with estimated tuberculosis (TB) incidence rate ≥20 per 100,000 population are screened for TB. Children with TB disease are treated before US arrival. Children with positive tuberculin skin tests (TST), but otherwise negative TB evaluation during their pre-immigration medical examination, are classified with latent TB infection (LTBI) and are recommended for re-evaluation post-arrival. We examined post-immigration TB evaluation and therapy for children arriving with LTBI.

Methods

We reviewed medical exam data from immigrant children with medical conditions and all refugee children arriving during 2010.

Results

Medical examination data were available for 67,334 children. Of these, 8,231 (12%) had LTBI pre-immigration; 5,749 (70%) were re-evaluated for TB post-immigration, and 64% were retested by TST or IGRA. The pre-immigration LTBI diagnosis was changed for 38% when retested by TST and for 71% retested by IGRA. Estimated LTBI therapy initiation and completion rates were 68% and 12%.

Conclusions

In this population, testing with IGRA may limit the number of children targeted for therapy. Increased pre-immigration TB screening with post-immigration follow-up evaluation leading to completion of LTBI therapy should be encouraged to prevent TB reactivation.

CDC Public Access

CC999999/Intramural CDC HHS/United States

United States