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Screening of Immigrants and Refugees for Pulmonary Tuberculosis in San Diego County, California^*

^* From the Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention (Dr. LoBue), Division of Tuberculosis Elimination, Field Services Branch, Atlanta, GA; and Tuberculosis Control Program (Dr. Moser), County of San Diego Health and Human Services Agency, San Diego, CA.

Correspondence to: Philip A. LoBue, MD, FCCP, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Division of Tuberculosis Elimination, Field Services and Evaluation Branch, Mail Stop E-10, 1600 Clifton Rd, Atlanta, GA 30333; e-mail: pgl5{at}cdc.gov

Study objectives: To evaluate the outcomes of a tuberculosis (TB) screening program for recent immigrants to San Diego County, CA, and to compare the demographic and clinical characteristics of pulmonary TB cases occurring in recently arrived foreign-born persons detected through this screening with those of similar cases found through routine surveillance.

Design: Retrospective review of computer databases and medical records.

Setting: Local public health department.

Patients: Recent immigrants and refugees classified as TB suspects in their country of departure and foreign-born patients with active TB detected through routine surveillance.

Results: Five hundred seventy-one of 658 immigrants and refugees (87%) of completed screening. Thirty-nine subjects (7%) were found to have active TB, and 433 subjects (76%) were found to have latent TB. A diagnosis of active TB was associated with age of 25 to 44 years (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6) and A (odds ratio, 25.7; 95% confidence interval, 1.3 to 512.2) or B1 classifications (odds ratio, 4.3; 95% confidence interval, 1.5 to 12.5). Cases detected through screening comprised 12% of all reported foreign-born persons with active TB. Compared to other recently arrived foreign-born persons with active TB, those detected through immigrant screening were more likely to be Asian and born in the Philippines and less likely to have advanced disease.

Conclusions: Most immigrants and refugees classified as TB suspects by foreign screening completed the US screening process, which had a high yield for detecting active and latent TB. Only a minority of foreign-born persons (12%) with active TB were discovered through this program, however, and additional measures are needed to facilitate early case finding in other foreign-born populations.

Key Words: immigrant • refugee • screening • tuberculosis

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