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Report of the Council on Scientific Affairs

Litjen Tan, PhD; Roy D. Altman, MD; Nancy H. Nielsen, MD, PhD; for the Council on Scientific Affairs, American Medical Association

Arch Intern Med. 2001;161:334-340.

Objective  To assess the desirability of requiring proof of tuberculosis (TB) screening for nonimmigrant visitors to the United States.

Data Sources  Literature review using the MEDLINE database for 1966 to 1999 and the Lexis-Nexis database for 1998 to 1999 on the terms tuberculosis and transmission, combined with the qualifiers foreign visitors, foreign students, foreign born, and policy. Experts in TB control from the Centers for Disease Control and Prevention, Atlanta, Ga, and the Canadian government were consulted. The World Wide Web was searched using the terms tuberculosis and transmission.

Data Extraction  English-language articles with information directly related to control of TB transmission among foreign-born persons were selected.

Results and Conclusions  Eliminating TB in the United States will depend significantly on the ability to control it within the foreign-born population; however, strict border screening guidelines used as exclusionary measures can actually worsen the epidemic. Overseas TB screening of nonimmigrant visitors, who are unlikely to have active TB and even less likely to transmit it, will be of extremely low yield, would significantly deviate from the US "open-door" policy for nonimmigrants, and would have great logistical and political implications. Foreign-born persons 15 years and older who intend to stay in the United States are the high-risk population most likely to affect public health and thus will provide the best yield for TB control resources. Screening and monitoring the nonimmigrant foreign-born population would divert valuable resources from now established, successful TB control programs for foreign-born immigrants.

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