International Journal of Tuberculosis and Lung Disease
Volume 15, Issue 6, 2011, Pages 761-766+i

Reduced importation of tuberculosis after the implementation of an enhanced pre-immigration screening protocol (Article)

Lowenthal P.* , Westenhouse J. , Moore M. , Posey D.L. , Watt J.P. , Flood J.
  • a California Department of Public Health, Center for Infectious Diseases, Tuberculosis Control Branch, 850 Marina Bay Parkway, Richmond, CA 94804-6403, United States
  • b California Department of Public Health, Center for Infectious Diseases, Tuberculosis Control Branch, 850 Marina Bay Parkway, Richmond, CA 94804-6403, United States
  • c Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, United States
  • d Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, United States
  • e California Department of Public Health, Center for Infectious Diseases, Tuberculosis Control Branch, 850 Marina Bay Parkway, Richmond, CA 94804-6403, United States
  • f California Department of Public Health, Center for Infectious Diseases, Tuberculosis Control Branch, 850 Marina Bay Parkway, Richmond, CA 94804-6403, United States

Abstract

SETTING: Importation of infectious tuberculosis (TB) threatens TB control in California and the United States. OBJECTIVE: To assess the effectiveness of an enhanced pre-immigration screening and treatment protocol to prevent the importation of infectious TB. DESIGN: Retrospective analysis of immigrants ≥15 years of age with TB suspect classifications who were screened for TB in their countries of origin before (pre-intervention cohort) and after (post-intervention cohort) implementation of enhanced pre-immigration screening. Enhanced pre-immigration screening added sputum cultures to the existing screening system based on sputum smears for persons with abnormal chest radiographs. RESULTS: The pre- and post-intervention cohorts included respectively 2049 and 1430 immigrants. The occurrence of tuberculosis ≤6 months after US arrival in this population decreased following the intervention, from 4.2% (86 cases) to 1.5% (22 cases, P < 0.001). Among pre-intervention cohort cases, 14% were sputum acid-fast bacilli (AFB) smear-positive and 81% were sputum culture-positive for TB, compared with 5% sputum AFB smear-positive (P = 0.46) and 68% sputum culture-positive (P = 0.18) among the post-intervention cohort cases. CONCLUSION: The enhanced pre-immigration screening was associated with a decline in the proportion of immigrants with TB suspect classifications identified with TB within 6 months of arrival in the United States. Continued state and national surveillance is critical to monitor the effectiveness of the revised pre-immigration screening as it is implemented in additional countries. © 2011 The Union.

Author Keywords

Immigration Tuberculosis screening Tuberculosis prevention and control

Index Keywords

Vietnam mass screening demography human immigration middle aged controlled study priority journal Aged Databases, Factual Mexico screening United States disease surveillance Young Adult health program Sputum Humans lung tuberculosis Adolescent California male Centers for Disease Control and Prevention (U.S.) female Viet Nam sputum analysis tuberculosis communicable disease control population research Article Retrospective Studies major clinical study adult isoniazid thorax radiography tuberculosis control Emigration and Immigration bacterium culture Philippines
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-79955859480&doi=10.5588%2fijtld.10.0370&partnerID=40&md5=68652256025a20a005baf10a15de8b35
DOI: 10.5588/ijtld.10.0370
ISSN: 10273719
Cited by: 35
Original Language: English