Presently, all immigrants are screened for clinical tuberculosis (TB) via chest radiographs and sputum analysis. The recent IOM report on TB elimination in the United States discusses applying mandatory targeted testing of latent tuberculosis infection (LTBI) for immigrants from 'countries with the greatest TB burdens' seeking permanent residency status; suggesting strategies of withholding green cards for those who fail to comply screening and treatment of LTBI. In 1996, more than half of immigrants into the U.S. from countries with high TB prevalence (>35%) were from Southeast Asia and the Western Pacific. The risk of TB infection for these individuals is estimated to range from five to ten times the population rate of infection for the United States. According to the IOM report, two-thirds of immigrants estimated to have active TB within the first five years of arriving in the U.S were from Southeast Asia and the Western Pacific. This presentation examines whether a mandatory tuberculin skin test screening and LTBI treatment program for newly arrived immigrants is justified within ethical, legal and public health frameworks. Are these measures coercive and do they pose undue burdens to both society and the individual? In countries where BCG vaccination is routinely administered and the presence of other mycobacteria is high, will testing reveal a high number of false positives of LTBI? To what extent would these efforts further alienate immigrants from Southeast Asia and the Western Pacific, particularly if such efforts target only a subset of newly arriving immigrants?
Learning Objectives: At the conclusion of the session, participants will be able to: 1) identify ethical principles for evaluating public health policies 2) assess the impact of policies that target a particular sub-group on access to other preventive care services 3) determine whether policies based on scientific risk are justified within an ethical framework
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.