TB Screening of U.S.-bound Immigrants and Refugees

Larry M. Baddour, MD


Journal Watch 

For those diagnosed overseas with sputum smear-negative or inactive TB, follow-up evaluation after U.S. arrival is critical for detecting cases of active pulmonary TB.

In recent years, nearly 60% of new TB cases reported in the U.S. have been among foreign-born people, and 28% of these cases have been diagnosed ≤2 years after the individuals arrived in the U.S. To study the epidemiology of TB in this population, researchers examined screening and follow-up data from the CDC notification system for TB in immigrants and refugees. They focused on cases of smear-negative or inactive TB detected by overseas medical screening from 1999 through 2005.

During the study period, 2,714,223 immigrants underwent overseas medical screening; smear-negative TB was diagnosed in 26,075 and inactive TB in 22,716. Among 378,506 refugees who underwent such screening, 3923 had smear-negative TB and 10,743 had inactive TB. Follow-up evaluation after these immigrants and refugees arrived in the U.S. identified active pulmonary disease in 7.0% of those with an overseas diagnosis of smear-negative TB and in 1.6% of those with an overseas diagnosis of inactive TB. Particular countries of birth accounted for disproportionately high numbers of smear-negative and inactive disease cases; except for Vietnam, the top countries were different for immigrants than for refugees.


The combined approach of overseas TB screening and "after U.S. arrival" follow-up evaluation enhances our ability to detect cases of active pulmonary disease that require treatment. This approach should decrease the number of TB cases among immigrants and refugees and thus reduce the spread of this disease in the U.S.

Unfortunately, the country is now facing a fiscal crisis, with many local and state governments having to consider draconian service reductions. The study findings emphasize the need to ensure that follow-up evaluation programs for TB are not part of the cuts made in public health departments.


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