Immigrants Represent 40% of Tuberculosis U.S. Cases

While the nation's overall tuberculosis rate has reached an all-time low, the number of cases among immigrants has risen to about 40% of all cases in the United States, indicating that government efforts to eliminate TB should "focus on foreigners," according to a new CDC study. The study, published in today's Journal of the American Medical Association, found that active TB cases among immigrants climbed 2.6% between 1993 and 1998, from 7,402 cases to 7,591. Over the six-year period, the proportion of U.S. TB cases involving immigrants also rose from about 30% to 41.6%. Researchers warned that if TB cases continue to rise at this rate among immigrants, they will account for more than 50% of all U.S. cases by 2002 (AP/Baltimore Sun, 12/13). Dr. Marisa Moore, one of the study's four authors, said, "The figures tell us where the challenge is. The proportion of TB cases among the foreign born is five times higher than it is among native-born Americans."

Tuberculosis specialists have warned "with increasing urgency" in the past several years that the United States "is not immune" to the "global TB crisis," the Washington Times reports. About 8 million contract the disease annually, mostly in developing countries, causing 2 million deaths each year. Most people harbor the disease in an inactive "latent" state that may become active later, while others quickly develop the "debilitating" symptoms that require "many months of expensive drug therapy" to cure (Washington Times, 12/13).

The CDC study findings suggest that some immigrants contract the airborne disease abroad, and carry it in the latent state until moving to the United States, where cases then become active (AP/Baltimore Sun. The United States currently requires immigrants to have chest X-rays showing that they have no active TB, but the test does not always expose latent cases. In addition, many immigrants purchase the clear X-rays of others and present them as their own (Washington Times, 12/13). The Institute of Medicine in May urged that immigrants from countries with high TB rates also be required to take a TB skin test, which detects active and latent cases of TB, before receiving a green card American Health Line, 5/5).

Moore said, "We need to mobilize the resources and political will to continue fighting the disease and tailor prevention and control efforts to meet the threat in at-risk foreign-born populations." Dr. Lee Reichman, executive director of the National Tuberculosis center in Newark, N.J., added, "The study underscores the fact that we're doing a good job in the United States of controlling TB. But we're now at the level that to control TB anywhere we have to control it everywhere. ... We're not doing a good job in keeping down the incidence among persons coming into the country." About two-thirds of U.S. immigrants with TB came from one of six countries -- the Philippines, Vietnam, China, India, Haiti and South Korea. Immigrants from Vietnam represented the highest rate of infection, with 137.7 cases per 100,000 Vietnamese immigrants. In addition, six states reporting the most TB cases accounted for 74.4% of all U.S. cases -- California, New York, Texas, Florida, New Jersey and New York (Washington Times, 12/13).