High Rates of Tuberculosis and Opportunities for Prevention among International Students in the United States
Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years. To characterize the risk of tuberculosis in international students entering the United States and to identify s...
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Published in | Annals of the American Thoracic Society Vol. 13; no. 4; pp. 522 - 528 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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United States
American Thoracic Society
01.04.2016
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Abstract | Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years.
To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population.
Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions.
Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection.
The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis. |
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AbstractList | RATIONALEForeign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years.OBJECTIVESTo characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population.METHODSData were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions.MEASUREMENTS AND MAIN RESULTSTuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection.CONCLUSIONSThe tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis. Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years. To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population. Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions. Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection. The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis. |
Author | Reves, Randall R Collins, Jeffrey M Belknap, Robert W |
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Cites_doi | 10.1177/003335490912400308 10.1080/07448481.2011.596733 10.1164/rccm.201308-1480OC 10.1017/S095026881100286X 10.1056/NEJMoa0809497 10.1093/clinids/23.6.1226 10.1093/aje/kwt246 10.1371/journal.pone.0032158 10.2105/AJPH.2015.302662 10.1001/jama.280.23.2008 10.1056/NEJMra1405427 10.1093/clinids/23.5.954 10.1164/rccm.2508001 10.7326/M14-2082 10.1378/chest.126.6.1777 10.1378/chest.06-2601 10.1371/journal.pone.0027405 10.1371/journal.pone.0082727 10.1164/rccm.201206-1039ED 10.1371/journal.pone.0124116 |
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Snippet | Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United... RATIONALEForeign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the... |
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SubjectTerms | Adolescent Adult Early Diagnosis Emigrants and Immigrants - statistics & numerical data Female Humans Male Mass Screening - methods Sputum - microbiology Students - statistics & numerical data Tuberculosis - diagnosis Tuberculosis - epidemiology United States Universities Young Adult |
Title | High Rates of Tuberculosis and Opportunities for Prevention among International Students in the United States |
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