TB screening efforts sought for immigrants

Officials suggest focus on U.S. cities with many newcomers, border areas


NEW YORK -- With tuberculosis rampant in much of the developing world and immigration from there at a record high, public health officials are calling for large-scale TB screening programs in cities with large immigrant communities and at the nation's borders.

In southeast Texas, where thousands of illegal immigrants are placed in crowded detention centers after trying to cross the border, doctors have installed X-ray machines to help quickly isolate anyone who might be infected with tuberculosis.

In New York City and other metropolitan areas, doctors have set up outreach programs and TB testing at places where immigrants congregate, like churches and English-language schools.

Officials said the goal is to reach and treat those most at risk who come from countries with high rates of TB.

42% of U.S. cases in 1998

The Centers for Disease Control and Prevention and the American Medical Association said recently that the key to eliminating TB in the United States is eliminating it in the country's foreign-born population.

In 1998, immigrants accounted for nearly 42 percent of the 18,361 tuberculosis cases reported nationwide, although they represented only slightly more than 10 percent of the total population.

Problem for all nations

Health officials said the TB rates in specific groups of immigrants reflect the occurrence of tuberculosis in their home countries. The disease is particularly endemic in Latin America, Asia and Africa.

As legal and illegal immigration from those parts of the world has grown -- and as immigrants increasingly travel back and forth on visits to their homelands -- the prevalence of the disease among the foreign-born has become more pronounced.

"Tuberculosis is a problem for the rest of the world," said Dr. Abraham G. Miranda, an infectious disease expert with the Public Health Service, which screens immigrants in the custody of the Immigration and Naturalization Service. "And if it's a problem for the rest of the world, it's a problem for us."

A hidden trend

The trend was largely hidden behind generally positive news on the TB battlefront, where the overall number of tuberculosis cases nationwide has declined steadily since 1992. That was the peak year in a flare-up of the disease that was associated with human immunodeficiency virus infections.

In 1998, 1,067 of the 2,000 cases reported in New York state, or 53 percent, were in people born outside the country. In California, the foreign-born accounted for 70 percent, and in Hawaii for 71 percent, of TB cases. The foreign-born also showed a disproportionately high number of cases of a more dangerous strain of TB that is resistant to many drugs.

Studies of TB in immigrants have found that most patients are infected in their home countries, but develop the active form of the disease once they are in the United States.

The airborne bacteria that spread tuberculosis can lie dormant in a person's lungs for years.

Most people who have been exposed never develop the active form of the disease.

However, about 5 percent do; for reasons, including an underlying medical problem, stress or malnutrition, the bacteria may become active and highly contagious years later.

The emergence of a TB threat that originates outside the country's borders has raised complicated policy and financial issues.

If the public health system goes out and tests people for TB, health officials said, it is also obligated to treat them if the disease is present.

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