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Elizabeth A. Talbot, MD; Marisa Moore, MD, MPH; Eugene McCray, MD; Nancy J. Binkin, MD, MPH

JAMA. 2000;284:2894-2900.

Context  Immigration is a major force sustaining the incidence of tuberculosis (TB) in the United States.

Objective  To describe trends and characteristics of foreign-born persons with TB and the implications for TB program planning and policy development.

Design, Setting, and Subjects  Descriptive analysis of US TB surveillance data from case reports submitted from 1993 to 1998.

Main Outcome Measure  Demographic and clinical characteristics of foreign-born persons with TB.

Results  The number of TB cases among foreign-born persons increased 2.6%, from 7402 in 1993 to 7591 in 1998, and the proportion of US cases that were foreign-born increased from 29.8% to 41.6%. During 1993-1998, the TB case rate was 32.9 per 100,000 population in foreign-born persons compared with 5.8 per 100,000 in US-born persons. Six states reported 73.4% of foreign-born cases (California, New York, Texas, Florida, New Jersey, and Illinois). Approximately two thirds of these cases were originally from Mexico, the Philippines, Vietnam, India, China, Haiti, and South Korea. Among those for whom date of US entry was known, 51.5% arrived 5 years or less prior to the diagnosis of TB. Most were male and aged 25 to 44 years. During 1993-1996, the proportion receiving some portion of treatment under directly observed therapy increased from 27.3% to 59.1% and approximately 70% completed therapy in 12 months. The rate of primary resistance to isoniazid was 11.6% and to both isoniazid and rifampin was 1.7%.

Conclusions  As the United States moves toward the goal of TB elimination, success will depend increasingly on reducing the impact of TB in foreign-born persons. Continued efforts to tailor local TB control strategies to the foreign-born community and commitment to the global TB battle are essential.

Author Affiliations: Division of Tuberculosis Elimination, National Center for HIV, STD and TB Prevention (Drs Talbot, Moore, McCray, and Binkin), and the Division of Applied Public Health Training, Epidemiology Program Office (Dr Talbot), Centers for Disease Control and Prevention, Atlanta, Ga.

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