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Published ahead of print on October 12, 2006, doi:10.1164/rccm.200608-1178OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 75-79

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Submitted on August 18, 2006
Accepted on October 6, 2006

Tuberculosis Among Foreign-born Persons in the United States: Achieving Tuberculosis Elimination

Kevin P Cain1*, Connie A Haley2, Lori R Armstrong3, Katie N Garman4, Charles D Wells3, Michael F Iademarco3, Kenneth G Castro3, and Kayla F Laserson5

1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; Tennessee State Department of Public Health, Nashville, TN, USA; Vanderbilt University, Nashville, TN, USA, 3 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA, 4 Tennessee State Department of Public Health, Nashville, TN, USA, 5 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA; KEMRI/CDC Kenya, Kisumu, Kenya

* To whom correspondence should be addressed. E-mail: kcain{at}cdc.gov.

Rationale: In the United States, the number of annual reported cases of tuberculosis among U.S.-born persons declined by 62% from 1993 to 2004, but increased by 5% among foreign-born persons. Over half of all reported cases of tuberculosis in the United States occur among foreign-born persons, most of these due to activation of latent tuberculosis infection. Current guidelines recommend targeting only foreign-born persons who entered the United States within the previous 5 years for latent tuberculosis infection testing. Objective: We sought to assess the epidemiologic basis for this guideline. Methods: We calculated tuberculosis case rates among foreign-born persons, stratified by duration of U.S.-residence and world region of origin. We determined the number of cases using 2004 U.S. tuberculosis surveillance data, and calculated case rates using population data from the 2004 American Community Survey. Measurements and Main Results: In 2004, a total of 14,517 cases of tuberculosis were reported; 3,444 (24%) of these were among foreign-born persons who had entered the United States more than 5 years previously. The rate of tuberculosis disease among foreign-born persons was 21.5/100,000, compared with 2.7/100,000 for U.S.-born persons, and varied by duration of residence and world region of origin. Conclusions: Almost one-quarter of all tuberculosis cases in the United States occur among foreign-born persons who have resided in the United States for longer than 5 years; case rates for such persons from selected regions of origin remain substantially elevated. To eliminate tuberculosis, we must address the burden of latent tuberculosis infection in this high-risk group.
Key words: tuberculosis, emigration and immigration, epidemiology, tuberculin test




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