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Tuberculosis among Foreign-born Persons in the United States

Achieving Tuberculosis Elimination

Division of Tuberculosis Elimination and Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee State Department of Public Health; and Vanderbilt University, Nashville, Tennessee

Correspondence and requests for reprints should be addressed to Kevin Cain, M.D., Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-10, Atlanta, GA 30333. E-mail: kcain{at}cdc.gov

Rationale: In the United States, the number of annual reported cases of tuberculosis (TB) 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 TB in the United States occur among foreign-born persons, most of these due to activation of latent TB infection (LTBI). Current guidelines recommend targeting only foreign-born persons who entered the United States within the previous 5 yr for LTBI testing.

Objective: We sought to assess the epidemiologic basis for this guideline.

Methods: We calculated TB case rates among foreign-born persons, stratified by duration of United States residence and world region of origin. We determined the number of cases using 2004 U.S. TB 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 TB were reported; 3,444 (24%) of these were among foreign-born persons who had entered the United States more than 5 yr previously. The rate of TB 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 TB cases in the United States occur among foreign-born persons who have resided in the United States for longer than 5 yr; case rates for such persons from selected regions of origin remain substantially elevated. To eliminate TB, we must address the burden of LTBI in this high-risk group.

Key Words: emigration and immigration • epidemiology • tuberculin test • tuberculosis

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Over half of all reported tuberculosis (TB) cases in the United States are among foreign-born persons; most of these are due to activation of latent TB infection (LTBI). Only foreign-born persons living in the United States for less than 5 years are targeted for LTBI testing. What This Study Adds to the Field Foreign-born persons have substantially elevated risk of TB even more than 5 years after entering the United States. To eliminate TB, we must begin addressing the burden of LTBI in this high-risk group.

 

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