C R MacIntyre1, A J Plant. 1. Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Australia. Raina.Macintyre@nwhcn.org.au
Abstract
OBJECTIVE: This study aimed to determine whether incident cases of tuberculosis (TB) in a cohort of South-East Asian refugees followed for 5 years after resettlement were potentially preventable and whether prevention of TB was optimal in a state refugee TB screening program in Victoria, Australia. DESIGN: A retrospective cohort study of 1,101 refugees from Laos, Cambodia, and Vietnam screened for TB in the 6-month period from July 1989 to January 1990 was conducted. Incident cases of TB were identified by matching each refugee with the TB notification database for 5 years from the date of initial screening. Preventability was assessed for incident cases by reviewing medical records. Screening guidelines and practice were reviewed. RESULTS: The main outcome was the preventability of cases of active tuberculosis that developed in the study population in the first 5 years after resettlement. The incidence of active TB was 363/100,000 during the first year and 109/100,000/year during the first 5 years. Five of six incident cases were assessed as potentially preventable, which if prevented would have resulted in an annual incidence of 18/100,000 over the first 5 years. Use of a more sensitive skin test definition of infection would have made an additional 245 refugees eligible for prevention and potentially prevented an additional 25 cases of TB over a lifetime. CONCLUSIONS: There is a high incidence of tuberculosis among SE Asian refugees, particularly in the first year after resettlement. A large proportion of TB may be preventable. Improvement in case prevention may be possible with updated guidelines and better implementation of screening policy.
OBJECTIVE: This study aimed to determine whether incident cases of tuberculosis (TB) in a cohort of South-East Asian refugees followed for 5 years after resettlement were potentially preventable and whether prevention of TB was optimal in a state refugee TB screening program in Victoria, Australia. DESIGN: A retrospective cohort study of 1,101 refugees from Laos, Cambodia, and Vietnam screened for TB in the 6-month period from July 1989 to January 1990 was conducted. Incident cases of TB were identified by matching each refugee with the TB notification database for 5 years from the date of initial screening. Preventability was assessed for incident cases by reviewing medical records. Screening guidelines and practice were reviewed. RESULTS: The main outcome was the preventability of cases of active tuberculosis that developed in the study population in the first 5 years after resettlement. The incidence of active TB was 363/100,000 during the first year and 109/100,000/year during the first 5 years. Five of six incident cases were assessed as potentially preventable, which if prevented would have resulted in an annual incidence of 18/100,000 over the first 5 years. Use of a more sensitive skin test definition of infection would have made an additional 245 refugees eligible for prevention and potentially prevented an additional 25 cases of TB over a lifetime. CONCLUSIONS: There is a high incidence of tuberculosis among SE Asian refugees, particularly in the first year after resettlement. A large proportion of TB may be preventable. Improvement in case prevention may be possible with updated guidelines and better implementation of screening policy.
Authors: Lawrence A Palinkas; Sheila M Pickwell; Kendra Brandstein; Terry J Clark; Linda L Hill; Robert J Moser; Abdikadir Osman Journal: J Immigr Health Date: 2003-01