In 1999, 16 suspected pulmonary TB cases were identified among refugees arriving to DeKalb County (DKC); 3 were <16 years. Twelve had clinically active TB, including the 3 children. Three had history of TB or abnormal chest X-ray with negative bacteriology. The remaining case moved out of the county before diagnosis.
Among the 12 active TB cases, 6 were female; median age was 20 years (range 3, 49). Ten refugees were from sub-Saharan Africa, one from Vietnam, and one from Iraq. Nine cases had positive-tuberculosis cultures; 3 were smear-positive at U.S. evaluation (1 by gastric aspirate). All 12 completed therapy at the health department.
The overseas examination classified 2 cases as clinically active, non-infectious TB (Class B1), 5 as inactive TB (Class B2), 3 as normal, and 2 were not screened (children <15 years). Median time from overseas examination to U.S. entry, and to U.S. examination, was 95 days and 178 days, respectively. Overall DKC refugee TB rate was 490 per 100,000 (12/2451).
This TB rate is >10 times the overall TB rate among foreign-born in the U.S., and the median age is younger. A substantial proportion of TB-infected refugees was not identified overseas; this may be caused by the limited sensitivity of examination and time interval between overseas and U.S. examination, among other factors. For instance, many children are not screened for TB. These findings highlight the need for timely follow-up of all refugee arrivals. Assuring TB treatment in this high-risk group is essential to achieve elimination by 2010.
Learning Objectives: N/A
Keywords: TB, Refugees
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Dekalb Board of Health, Decatur, Georgia
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.