Journal of Immigrant and Minority Health

, Volume 15, Issue 4, pp 673–679 | Cite as

Impact of Port of Entry Referrals on Initiation of Follow-Up Evaluations for Immigrants with Suspected Tuberculosis: Illinois

  • Teal R. Bell
  • NoelleAngelique M. Molinari
  • Sena Blumensaadt
  • Monica U. Selent
  • Michael Arbisi
  • Neha Shah
  • Demian Christiansen
  • Rossanne Philen
  • Benjamin Puesta
  • Joshua Jones
  • Deborah Lee
  • Arnold Vang
  • Nicole J. Cohen
Original Paper

Abstract

US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention’s immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008–September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation.

Keywords

Evaluation Tuberculosis Referral Immigrants 

Notes

Acknowledgments

We thank the Illinois Department of Public Health TB Control Program Regional Nurse Consultants Elaine Darnell, Debra Stephens and Carrie Storrs, and Peter Ward, Illinois Department of Public Health TB Control Program Surveillance Manager, for coordinating data collection efforts with Illinois county health departments; Ashley Dyer, University of Illinois Chicago student, for data collection and entry; and Chicago Quarantine Public Health Officers Shannon Bachar and Lisa Poray for providing immigrant referrals. This study was supported by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention Cooperative Agreement Number 5U38HM000414. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References

  1. 1.
    Centers for Disease Control and Prevention. Trends in tuberculosis—United States. MMWR Morb Mortal Wkly Rep. 2010;2011:333–7.Google Scholar
  2. 2.
    McKenna MT, McCray E, Onorato I. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986–1993. N Engl J Med. 1995;332(16):1071–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Zuber P, Knowles L, Binkin N, Tipple M, Davidson PT. Tuberculosis among foreign-born persons in Los Angeles County, 1992–1994. Tuber Lung Dis. 1996;77:524–30.CrossRefPubMedGoogle Scholar
  4. 4.
    42 CFR Part 34 Medical Examination of Aliens. 2001. http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr34_03.html. Accessed 15 Oct 2011.
  5. 5.
    Centers for Disease Control and Prevention. 1991 Tuberculosis technical instructions for medical examination of Aliens. 2010. http://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/technical-instructions/panel-physicians/tuberculosis.html. Accessed 18 Oct 2011.
  6. 6.
    Liu Y, Weinberg MS, Ortega LS, Painter JA, Maloney SA. Overseas screening for tuberculosis in US-bound immigrants and refugees. N Engl J Med. 2009;360:2406–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention. 2009. Technical instructions for tuberculosis screening and treatment. http://www.cdc.gov/immigrantrefugeehealth/pdf/tuberculosis-ti-2009.pdf. Accessed 18 Oct 2011.
  8. 8.
    Centers for Disease Control and Prevention. Tuberculosis screening and treatment (TB TIs) using cultures and directly observed therapy (DOT) frequently asked questions (FAQ). http://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/tuberculosis-panel-technical-instructions-faq.html. Accessed 20 Oct 2011.
  9. 9.
    Catlos EK, Cantwell MF, Bhatia G, Gedin S, Lewis J, Mohle-Boetani JC. Public health interventions to encourage TB class A/B1/B2 immigrants to present for TB screening. Am J Respir Crit Care Med. 1998;158:1037–41.CrossRefPubMedGoogle Scholar
  10. 10.
    DeRiemer K, Chin DP, Schecter GF, Reingold AL. Tuberculosis among immigrants and refugees. Arch Intern Med. 1998;158:753–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Wells CD, Zuber PL, Nolan CM, Binkin NJ, Goldberg SV. Tuberculosis prevention among foreign-born persons in Seattle–King County, Washington. Am J Respir Crit Care Med. 1997;156:573–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Sciortino S, Mohle-Boetani J, Royce SE, Will D, Chin DP. B notifications and the detection of tuberculosis among foreign-born recent arrivals in California. Int J Tuberc Lung Dis. 1999;3(9):778–85.PubMedGoogle Scholar
  13. 13.
    Zuber P, Binkin N, Azucena I, Marshall K, Tribble S, Tipple M, et al. Tuberculosis screening for immigrants and refugees diagnostic outcomes in the state of Hawaii. Am J Respir Crit Care Med. 1996;154:151–5.CrossRefPubMedGoogle Scholar
  14. 14.
    LoBue PA, Moser KS. Screening of immigrants and refugees for pulmonary tuberculosis in San Diego County, California. Chest. 2004;126(6):1777–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York (Outside the USA) 2013

Authors and Affiliations

  • Teal R. Bell
    • 1
    • 2
  • NoelleAngelique M. Molinari
    • 1
  • Sena Blumensaadt
    • 1
  • Monica U. Selent
    • 1
  • Michael Arbisi
    • 3
  • Neha Shah
    • 1
  • Demian Christiansen
    • 5
  • Rossanne Philen
    • 1
  • Benjamin Puesta
    • 1
  • Joshua Jones
    • 4
  • Deborah Lee
    • 1
  • Arnold Vang
    • 1
  • Nicole J. Cohen
    • 1
  1. 1.Division of Global Migration and QuarantineCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Council of State and Territorial EpidemiologistsAtlantaUSA
  3. 3.Division of Infectious DiseasesIllinois Department of Public HealthSpringfieldUSA
  4. 4.Tuberculosis Control ProgramChicago Department of Public HealthChicagoUSA
  5. 5.Communicable Disease Control UnitCook County Department of Public HealthChicagoUSA

Personalised recommendations