Immigrants and refugees age 2–14 years entering the United States from countries with estimated tuberculosis (TB) incidence rate ≥20 per 100,000 population are screened for TB. Children with TB disease are treated before US arrival. Children with positive tuberculin skin tests (TST), but negative TB evaluation during their pre-immigration examination, are classified with latent TB infection (LTBI) and are recommended for re-evaluation post-arrival. We examined post-immigration TB evaluation and therapy for children arriving with LTBI. We reviewed medical exam data from immigrant children with medical conditions and all refugee children arriving during 2010. Medical examination data were available for 67,334 children. Of these, 8231 (12 %) had LTBI pre-immigration; 5749 (70 %) were re-evaluated for TB post-immigration, and 64 % were retested by TST or IGRA. The pre-immigration LTBI diagnosis was changed for 38 % when retested by TST and for 71 % retested by IGRA. Estimated LTBI therapy initiation and completion rates were 68 and 12 %. In this population, testing with IGRA may limit the number of children targeted for therapy. Increased pre-immigration TB screening with post-immigration follow-up evaluation leading to completion of LTBI therapy should be encouraged to prevent TB reactivation.
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We thank the staff of the CDC’s Electronic Disease Notification (EDN) team for updating and managing the CDC’s notification system for tuberculosis in immigrants and refugees, the staff of CDC’s quarantine stations for collecting information about overseas medical examinations, the panel physicians for performing overseas tuberculosis screening, and the staff of state and local health departments for conducting follow-up evaluations.
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Taylor, E.M., Painter, J., Posey, D.L. et al. Latent Tuberculosis Infection Among Immigrant and Refugee Children Arriving in the United States: 2010. J Immigrant Minority Health 18, 966–970 (2016). https://doi.org/10.1007/s10903-015-0273-2
- Tuberculin skin test
- Interferon gamma release assay