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

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 6; pp. 761 - 766
• Main Authors: LOWENTHAL, P, WESTENHOUSE, J, MOORE, M, POSEY, D. L, WATT, J. P, FLOOD, J
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-06-2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Aged; Bacterial diseases; Biological and medical sciences; California - epidemiology; Centers for Disease Control and Prevention (U.S.); Communicable Disease Control - methods; Databases, Factual; Emigration and Immigration - statistics & numerical data; Female; Human bacterial diseases; Humans; immigration; Infectious diseases; Male; Mass Screening - methods; Medical sciences; Mexico; Middle Aged; Philippines; Pneumology; Radiography; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Sputum - microbiology; Tuberculosis - diagnosis; Tuberculosis - diagnostic imaging; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections; Tuberculosis Prevention And Control; Tuberculosis Screening; United States - epidemiology; Vietnam; Young Adult; tuberculosis screening; Respiratory disease; Mycobacterial infection; Medical screening; Implementation; Infection; Prevention; Control; tuberculosis prevention and control; Tuberculosis; Bacteriosis; Immigration; Pneumology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.10.0370

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.