Am. J. Respir. Crit. Care Med., Volume 156, Number 6, December 1997, 1915-1921

Impact of Immigration on Tuberculosis Infection Among Canadian-born Schoolchildren and Young Adults in Montreal

DICK MENZIES, CHUN HO CHAN, and BILKIS VISSANDJÉE

Departments of Medicine and Epidemiology and Biostatistics, Montreal Chest Institute and Respiratory Epidemiology Unit, McGill University; and Faculté des Sciences Infirmières (Nursing Sciences), Université de Montréal, Montreal, Quebec, Canada

We conducted a cross-sectional tuberculin survey among non-BCG-vaccinated Canadian-born schoolchildren in grades 6 and 10, health professional students, and young adult workers, to estimate the association of tuberculin reactions with indices of contact with tuberculosis. Participants underwent simultaneous tuberculin testing with PPD-T (standard) and PPD-B (from M. intracellulare). Exposure was estimated from questionnaire responses, group, aggregate census, and tuberculosis incidence data. Of 3,710 participants, 88 (2.4%) had positive tuberculin reactions, i.e., of 10+ mm. Positive tuberculin reactions were rarely associated with larger reactions to PPD-B, but were associated with older age (adjusted odds ratio for each 5 years: 1.5 [95% confidence interval, 1.3, 1.8]), household contact (4.2 [1.4, 12.7]), and population group (health professional versus all others: 0.6 [0.3, 1.0]). Estimated annual risk of infection declined by 3% per year. Tuberculin reactions were not associated with any indices of contact in school, work or neighborhood settings with foreign-born from tuberculosis endemic areas, nor with tuberculosis in Canadian-born. There was no evidence of transmission of tuberculosis from affected high risk sub-groups in Montreal to the general population working or attending school.

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