C R MacIntyre1, A J Plant. 1. Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia. rainam@cmed.wsahs.nsw.gov.au
Abstract
SETTING: A State refugee screening programme in Victoria. OBJECTIVE: To determine the longitudinal incidence of tuberculosis (TB) in South-East Asian refugees in the first five years after re-settlement, and to determine predictors of risk. DESIGN: A retrospective cohort study of 1101 refugees from Laos, Cambodia and Vietnam screened for TB after arrival in Australia, in the 6-month period from July 1989 to January 1990. Incident cases of TB were identified by matching the refugee database with the TB notification database for 1989-1994, giving five years of follow-up data. Preventability was assessed for incident cases by reviewing medical records. MAIN OUTCOME: The development of active tuberculosis in the first five years after re-settlement. RESULTS: The incidence of active TB was 363/100000 during the first year after re-settlement, and 109/100000/year during the first five years. There were no incident cases of TB in refugees with initial skin test reactions <10 mm. Skin test reaction size was the only predictor of risk of TB. CONCLUSIONS: There is a high risk of tuberculosis in South-East Asian refugees, particularly in the first year after re-settlement. This risk decreases with time. Migration stress, concurrent illnesses and poor nutrition may be explanations for this observation. Refugees are at high risk for TB, even after pre- and post-migration screening, emphasising the importance of preventive therapy and follow up in this group.
SETTING: A State refugee screening programme in Victoria. OBJECTIVE: To determine the longitudinal incidence of tuberculosis (TB) in South-East Asian refugees in the first five years after re-settlement, and to determine predictors of risk. DESIGN: A retrospective cohort study of 1101 refugees from Laos, Cambodia and Vietnam screened for TB after arrival in Australia, in the 6-month period from July 1989 to January 1990. Incident cases of TB were identified by matching the refugee database with the TB notification database for 1989-1994, giving five years of follow-up data. Preventability was assessed for incident cases by reviewing medical records. MAIN OUTCOME: The development of active tuberculosis in the first five years after re-settlement. RESULTS: The incidence of active TB was 363/100000 during the first year after re-settlement, and 109/100000/year during the first five years. There were no incident cases of TB in refugees with initial skin test reactions <10 mm. Skin test reaction size was the only predictor of risk of TB. CONCLUSIONS: There is a high risk of tuberculosis in South-East Asian refugees, particularly in the first year after re-settlement. This risk decreases with time. Migration stress, concurrent illnesses and poor nutrition may be explanations for this observation. Refugees are at high risk for TB, even after pre- and post-migration screening, emphasising the importance of preventive therapy and follow up in this group.
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