Overseas Screening for Tuberculosis in Immigrants and Refugees to the United States: Current Status

For many individuals from developing countries, infection with Mycobacterium tuberculosis is almost inevitable. In recent years, there has been an increase in the number of immigrants and refugees from some of these countries, and thus the proportion of these individuals among newly diagnosed cases of tuberculosis has increased. The identification of these patients and the proper management of their cases are important public health priorities. Dr. Nancy Binkin and her colleagues review the data on the epidemiology of tuberculosis in immigrants and refugees and describe the available screening and evaluation programs overseas and in this country. They also highlight the importance of maintaining and expanding health care services in this country that are appropriate and welcoming to foreign-born persons. They clearly demonstrate that the control of tuberculosis in the United States will require a coordinated effort that transcends its borders. —Wafaa El-Sadr Division of Infectious Diseases, Harlem Hospital Center, New York, New York Chair, IDSA Tuberculosis Committee The number of reported cases of tuberculosis (TB) in foreign-born persons in the United States during 1995 was 8,042, 36% of the national total. The overseas screening of immigrants and refugee visa applicants, which relies on a chest radiograph and smear microscopy, is designed to identify future U.S. residents who have active TB or who are at high risk for TB. In this commentary, we summarize current policies and review retrospective evaluations of the screening system currently in place. The system appears to detect most persons who have active TB at the time of screening. However, active TB is actually diagnosed in