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

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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.

Keywords: immigration; tuberculosis prevention and control; tuberculosis screening

Document Type: Regular Paper


Affiliations: 1: California Department of Public Health, Tuberculosis Control Branch, Richmond, California, USA 2: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: June 1, 2011

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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