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Tuberculosis

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Refugee Health Care

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Abstract

Despite unprecedented overall tuberculosis (TB) control in the US, TB continues to be a global problem, reflected in the fact that incident cases of active TB among foreign-born people in the US are 12 times higher than that of native-born people. As a result, for those applying for refugee status in the US, the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine (CDC/DGMQ) requires a pre-departure medical evaluation that, among other things, is designed to identify people with active, infectious tuberculosis disease. The overseas medical screening does not screen for latent tuberculosis infection (LTBI), and since it is estimated that in the US the number of foreign-born persons with LTBI is nearly 7 million people, the US-based physician has an important role in screening newly-arrived refugees for LTBI. Screening for LTBI can be done using a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA), both of which have advantages and disadvantages. A positive screening test should compel the physician to conduct follow up testing. Based on testing results, refugees are treated for either LTBI or active TB. Treatment of LTBI most commonly consists of daily isoniazid for nine months, but CDC recognizes equivalent efficacy of other alternative regimens also.

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References

  1. WHO. WHO global tuberculosis report 2012. Geneva: World Health Organization; 2012. http://www.who.int/tb/publications/global_report/gtbr12_main.pdf. Accessed Aug 2013.

  2. Flynn JL, Chan J. Tuberculosis: latency and reactivation. Infect Immun. 2001;69:4195–201.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Bernardo J. Tuberculosis. In: Walker P, Barnett E, editors. Immigrant medicine. Philadelphia: Elsevier; 2007. p. 255–71.

    Google Scholar 

  4. CDC. Trends in tuberculosis—United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;61(11):181–5.

    Google Scholar 

  5. CDC. Domestic tuberculosis guidelines. Atlanta: CDC; 2010. http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/tuberculosis-guidelines.html. Accessed Aug 2013.

  6. CDC. CDC immigration requirements: technical instructions for tuberculosis screening and treatment. Atlanta: CDC; 2009. www.cdc.gov/immigrantrefugeehealth/pdf/tuberculosis-ti-2009.pdf. 1-40. Accessed Aug 2013.

  7. Public Health Agency of Canada. Canadian tuberculosis standards. 6th ed. Ottawa, ON: Tuberculosis Prevention and Control, Public Health Agency of Canada, Canadian Lung Association/Canadian Thoracic Society; 2007.

    Google Scholar 

  8. Barnett E. Infectious disease screening for refugees resettled in the United States. Clin Infect Dis. 2004;39:833–41.

    Article  PubMed  Google Scholar 

  9. Watkins RE, Brennan R, Plant AJ. Tuberculin reactivity and the risk of tuberculosis: a review. Int J Tuberc Lung Dis. 2000;4:895–903.

    CAS  PubMed  Google Scholar 

  10. Greenaway C, Sandoe A, Vissandjee B, et al. Canadian Collaboration for Immigrant and Refugee Health. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ. 2011;183(12):E939–51.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Marras TK, Wilson J, Wang EEL, et al. Tuberculosis among Tibetan refugee claimants in Toronto: 1998 to 2000. Chest. 2003;124:915–21.

    Article  PubMed  Google Scholar 

  12. Cain KP, Haley CA, Armstrong LR, et al. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med. 2007;175:75–9.

    Article  PubMed  Google Scholar 

  13. Lee E, Holzman RS. Evolution and current use of the tuberculin skin test. Clin Infect Dis. 2002;34:365–70.

    Article  PubMed  Google Scholar 

  14. CDC. Chapter 3: Testing for tuberculosis infection and disease. In: CDC, editor. Core curriculum on tuberculosis: what the clinician should know. Atlanta: CDC; 2011. p. 45–75.

    Google Scholar 

  15. Pai M, Zwerling A, Menzies D. Systematic review: T-cell–based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med. 2008;149:177–84.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Mazurek GH, Jereb J, Vernon A, et al. Updated guidelines for using the interferon gamma release assays to Mycobacterium tuberculosis infection—United States, 2010. Morb Mortal Wkly Rep. 2010;59(5):1–25.

    Google Scholar 

  17. CDC. Latent tuberculosis infection: a guide for primary health care providers. Atlanta: CDC; 2010. http://www.cdc.gov/tb/publications/ltbi/diagnosis.htm. Accessed Aug 2013.

  18. Oxlade O, Schwartzman K, Menzies D. Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis. Int J Tuberc Lung Dis. 2007;11:16–26.

    CAS  PubMed  Google Scholar 

  19. Pareek M, Bond M, Shorey J, et al. Community-based evaluation of immigrant tuberculosis screening using interferon gamma release assays and tuberculin skin testing: observational study and economic analysis. Thorax. 2013;68(3):230–9.

    Article  PubMed  Google Scholar 

  20. Dasgupta K, Menzies D. Cost-effectiveness of tuberculosis control strategies among immigrants and refugees. Eur Respir J. 2005;25(6):1107–16.

    Article  CAS  PubMed  Google Scholar 

  21. CDC. Treatment for TB disease. Atlanta: CDC; 2011. http://www.cdc.gov/tb/topic/treatment/tbdisease.htm. Accessed Aug 2013.

  22. CDC. Treatment of tuberculosis: American Thoracic Society, CDC, and Infectious Disease Society of America. MMWR Morb Mortal Wkly Rep. 2003;52(RR11):1–77.

    Google Scholar 

  23. Smieja MJ, Marchetti CA, Cook DJ, et al. Isoniazid for preventing tuberculosis in non-HIV infected persons [review]. Cochrane Database Syst Rev. 2000(2):CD001363.

    Google Scholar 

  24. Sterling V, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155–66.

    Article  CAS  PubMed  Google Scholar 

  25. CDC. Treatment of latent TB infection. Atlanta: CDC; 2012. http://www.cdc.gov/tb/topic/treatment/ltbi.htm. Accessed Aug 2013.

  26. CDC. Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep. 2011;60:1650–3.

    Google Scholar 

  27. CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Morb Mortal Wkly Rep. 2005;54(RR15):1–37.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Médecins Sans Frontières, 333, Seventh Avenue, Second Floor, New York, NY, 10001, USA

    Andrew T. Boyd M.D.

  2. Yale Internal Medicine Residency, New Haven, CT, USA

    Andrew T. Boyd M.D.

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  1. Andrew T. Boyd M.D.
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Correspondence to Andrew T. Boyd M.D. .

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Editors and Affiliations

  1. Depts. of Internal Medicine & Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA

    Aniyizhai Annamalai

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Boyd, A.T. (2014). Tuberculosis. In: Annamalai, A. (eds) Refugee Health Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0271-2_5

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  • DOI: https://doi.org/10.1007/978-1-4939-0271-2_5

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