Tuberculosis Screening Among Immigrants Entering the United States: An Analysis of Radiographic Findings of China, Mexico, Nepal, Philippines and Vietnam Public

Abstract

Background

Tuberculosis (TB) is a closely monitored disease by the U.S. Centers for Disease Control and Prevention (CDC). Individuals applying for immigration or refugee visas are required to undergo a pre-arrival medical screening that includes an explicit TB screening component. In 2015, twice as many TB cases were identified in foreign-born persons than U.S.-born.

Methods

An analysis was conducted of deidentified data from 2010-2016 collected by CDC's Division of Global Migration and Quarantine. The data was provided by panel physicians and only included individuals classified as either Class A TB or B1 TB under CDC TB Technical Instructions (TI). The screening data were analyzed to determine the association between chest x-ray (CXR) findings and Class A TB (i.e. active TB disease) designation.

Results

Among the 98,350 individuals included in the study, 9.7% were classified as Class A TB. Fifty-three percent were female, 47% male. Of the individuals included in the study, 5,617 (51%) were from the Philippines, 23% (23,127) from Vietnam, 15% (14,991) from Mexico, 5789 (6%) from Nepal and 3826 (4%) from China. All possible CXR findings, age, gender, and country of screening were included in the model. It was found that gender, age, country of origin and several CXR findings (infiltrate or consolidation, the presence of any cavitary lesion, nodule(s) or mass with poorly defined margins (such as tuberculoma), pleural effusion, miliary findings, discrete linear opacity (fibrotic scar) were predictive of Class A TB classification of those applying for immigrant status.

Conclusions

CXR is an important component of pre-arrival medical screening of those applying for immigration visas. Additional studies should be conducted among applicants to examine the influence of other c-morbid conditions known to be associated with TB disease among applicants applying for immigrant visa to the United States.

Table of Contents

Introduction ... 1

Methods ... 5

Overseas Screening Process ... 6

Radiograph Findings and Classifications ... 6

Study Population ... 8

Statistical Analysis ... 8

Results ... 9

Discussion ... 10

Recommendations ... 12

Bibliography ... 14

Tables and Figures ... i

Appendix ... v

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	Tuberculosis Immigration Screening
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University
Committee Members	Liu, Yecai, Centers for Disease Control and Prevention (CDC) Phares, Christina, Centers for Disease Control and Prevention (CDC)
Partnering Agencies	CDC

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