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.
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.
Authors: Kristine M Schmit; Richard Brostrom; Angela Largen; Alexandra Pyan; Zanju Wang; Sundari Mase; Sapna Morris Journal: J Immigr Minor Health Date: 2019-12
Authors: Anthony T Fojo; Natalie L Stennis; Andrew S Azman; Emily A Kendall; Sourya Shrestha; Shama D Ahuja; David W Dowdy Journal: Lancet Public Health Date: 2017-07
Authors: Mary R Reichler; Awal Khan; Timothy R Sterling; Hui Zhao; Bin Chen; Yan Yuan; Joyce Moran; James McAuley; Bonita Mangura Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Amy L Davidow; Dolly Katz; Smita Ghosh; Henry Blumberg; Ashutosh Tamhane; Anna Sevilla; Randall Reves Journal: Am J Public Health Date: 2015-07-16 Impact factor: 9.308
Authors: Kaylynn Aiona; Phillip Lowenthal; John A Painter; Randall Reves; Jennifer Flood; Matthew Parker; Yunxin Fu; Kirsten Wall; Nicholas D Walter Journal: Public Health Rep Date: 2015 Sep-Oct Impact factor: 2.792
Authors: Nicholas D Walter; John Painter; Matthew Parker; Phillip Lowenthal; Jennifer Flood; Yunxin Fu; Redentor Asis; Randall Reves Journal: Am J Respir Crit Care Med Date: 2014-01-01 Impact factor: 21.405