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Tuberculosis Among Immigrants and Refugees
Kathryn DeRiemer, MPH;
Daniel P. Chin, MD, MPH;
Gisela F. Schecter, MD, MPH;
Arthur L. Reingold, MD
Arch Intern Med. 1998;158:753-760.
Background Overseas screening of immigrants and refugees applying for a visa to the United States identifies foreign-born individuals who are at high risk for tuberculosis (TB) or who have active TB. The system's effectiveness relies on further medical evaluation and follow-up of foreign-born individuals after their arrival in the United States.
Methods Retrospective cohort study of 893 immigrants and refugees who arrived in the United States from July 1, 1992, through December 31, 1993, with a destination of San Francisco, Calif, and a referral for further medical evaluation.
Main Outcome Measures Time to report to the local health department after arrival and the yield of active and preventable cases of TB from follow-up medical evaluations.
Results Median time from arrival in the United States to seeking care in San Francisco was 9 days (range, 1-920 days). Of 745 immigrants and refugees (83.4%) who sought further medical evaluation, 51 (6.9%) had active TB and 296 (39.7%) were candidates for preventive therapy. Being a refugee was an independent predictor of failure to seek further medical evaluation in the United States. Class B-1 disease status based on overseas TB screening (odds ratio, 3.5; 95% confidence interval, 2.0-6.2) and being from mainland China (odds ratio, 4.4; 95% confidence interval, 1.9-9.9) were independent predictors of TB diagnosed in San Francisco.
Conclusions Timely, adequate medical evaluation and follow-up care of immigrants and refugees has a relatively high yield and should be a high priority for TB prevention and control programs.
From the Division of Public Health Biology and Epidemiology, School of Public Health, University of California at Berkeley (Ms DeRiemer and Dr Reingold); Medical Service, San Francisco General Hospital and Department of Medicine, University of California at San Francisco (Drs Chin and Schecter); and the Division of Tuberculosis Control, Department of Public Health, San Francisco, Calif (Dr Schecter).
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