Screening Nonimmigrant Visitors to the United States for Tuberculosis

Tan, Litjen; Altman, Roy D.; Nielsen, Nancy H.

doi:10.1001/archinte.161.3.334

Cited by 14 publications

(5 citation statements)

References 26 publications

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“…After screening 2943 titles and abstracts and 271 full-text articles, 73 unique articles fulfilled our eligibility criteria (figure 1). 14–86 The reasons for excluding full-text articles are provided in figure 1. What all included studies have in common is the goal of finding ‘missing’ TB cases through ACF, while the approaches vary greatly; from contact investigation to screening people in homeless shelters (table 1).…”

Section: Resultsmentioning

confidence: 99%

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Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

et al. 2019

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ObjectiveTo explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation.DesignScoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses.ResultsSeventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO’s ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF.ConclusionWe identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less about how to strengthen those facilitators and how to overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.

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Section: Resultsmentioning

confidence: 99%

“…† Letter to editor,52 observational study,53 perspective33 and editorial 47‡ Population affected by TB outbreak,72 pastoralists,41 healthcare workers,65 prisoners,80 people living in slums,86 street connected youth and young adults85 and non-immigrant visitors 70…”

Section: Methodsmentioning

confidence: 99%

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

et al. 2019

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“…A recent study has reported that during follow-up evaluations in the United States, active pulmonary TB is diagnosed in 7.0% of immigrants and refugees with an overseas diagnosis of smear-negative TB and 1.6% of those with an overseas diagnosis of inactive TB [9]. Due to the large volume of annual admissions and the overall low TB rate, screening for TB in nonimmigrant visitors to the United States is considered to be infeasible and of low-yield [22], [23]. However, this intervention could be effective if it targets those who are from countries with a high incidence of TB, particularly those who also intend to stay in the United States for a long time period.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, it increases the cost and workload for federal governmental agencies, as well as state and local health departments. Secondly, requiring proof of TB screening of nonimmigrant visitors would significantly deviate from the U.S. open-door policy and would have great logistical and political implications [22]. Finally, many high-incidence countries may not have the facility and capacity to implement the TB screening program for U.S.-bound nonimmigrant visitors.…”

Section: Discussionmentioning

confidence: 99%

Estimating the Impact of Newly Arrived Foreign-Born Persons on Tuberculosis in the United States

et al. 2012

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BackgroundAmong approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States.Methodology/Principal FindingsWe defined foreign-born persons within 1 year after arrival in the United States as “newly arrived”, and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6% (4,783) occurred among immigrants and refugees, 36.6% (4,211) among students/exchange visitors and temporary workers, 13.8% (1,589) among tourists and business travelers, and 7.3% (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of ≥100 cases/100,000 population/year; 235.8 cases/100,000 admissions, 95% confidence interval [CI], 228.3 to 243.3), students/exchange visitors and temporary workers from high-incidence countries (60.9 cases/100,000 admissions, 95% CI, 58.5 to 63.3), and immigrants and refugees from medium-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of 15–99 cases/100,000 population/year; 55.2 cases/100,000 admissions, 95% CI, 51.6 to 58.8).Conclusions/SignificanceNewly arrived nonimmigrant visitors contribute substantially to the burden of foreign-born TB in the United States. To achieve the goals of TB elimination, direct investment in global TB control and strategies to target nonimmigrant visitors should be considered.

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“…More than one-half of these students came from Asia-many from countries with the highest TB incidence rates in the world. Current immigration policies do not require TB screening of students before their entry into the United States [36]. Even among foreign-born US residents (e.g., immigrants and naturalized citizens), only a subset undergo TST screening, with the remainder undergoing chest radiography before entry.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Tuberculin Skin Test Positivity among University Students and the Use of Such Factors in the Development of a Targeted Screening Program

et al. 2003

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The present study evaluated the accuracy of a risk assessment questionnaire (RAQ) for identifying candidates for tuberculin testing. A 33-question RAQ was administered to students before they underwent tuberculin screening at Virginia Commonwealth University (Richmond). Test operating characteristics for the complete and abbreviated RAQs compared to tuberculin skin test (TST) results were determined. Of 5382 students screened, 125 (2.3%) had a positive TST result; 113 (90.4%) of these 125 students had >or=1 affirmative response on the RAQ (i.e., a "positive RAQ"). The prevalence of TST positivity among students not born in the United States was 33.2-fold higher than that among students born in the United States. A 2-question RAQ had a sensitivity of 81.6%, a specificity of 91.0%, and positive and negative predictive values of 17.7% and 99.5%, respectively. Risk assessment can be an accurate means of identifying candidates for tuberculin screening.

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Screening Nonimmigrant Visitors to the United States for Tuberculosis

Cited by 14 publications

References 26 publications

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

Estimating the Impact of Newly Arrived Foreign-Born Persons on Tuberculosis in the United States

Risk Factors Associated with Tuberculin Skin Test Positivity among University Students and the Use of Such Factors in the Development of a Targeted Screening Program

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