TB Prevalence
Tuberculosis (TB) rates in the U.S. have continued to decline, reaching their lowest point on record in 2007 [1]. Although TB is decreasing overall in the U.S., there is a disproportional increase in TB in foreign-born individuals. For example, in 2007, the TB rate among foreign-born persons in the U.S. was 9.7 times that of U.S.-born persons [1]. In cities that are home to many newly arriving immigrants and refugees, rates of TB can be well above the national average. Additionally, the prevalence of drug-resistant TB and extrapulmonary disease is higher among foreign-born persons, making the diagnosis and management of these cases both challenging and essential for effective prevention and control of TB among newly arriving refugees [2].

The rate of TB disease appears to remain high for many years after immigration, making it essential that clinicians identify and treat latent tuberculosis infection (LTBI) prior to the development of TB disease. Health-care providers who serve immigrants and refugees should maintain a high index of suspicion, regardless of the results of medical examinations performed overseas [1].

The CDC Guidelines for Screening for Tuberculosis Infection and Disease during the Domestic Medical Examination for Newly Arrived Refugees provide an overview of the overseas medical screening process for refugees relocating to the U.S., and outlines guidelines for clinicians evaluating refugees for TB during the medical examination for new arrivals. This document does not replace existing guidelines but is meant to highlight specific needs in refugees and should augment and be used in conjunction with existing guidelines from national authorities (ATS/CDC/IDSA) and state TB control programs.

Source: CDC Immigrant and Refugee Health

1. Centers for Disease Control and Prevention. Trends in tuberculosis. Morbid Mortal Wkly Rep 2008;57(11):281-285.
2. Oeltmann JE, Varma JK, Ortega L, et al. Multidrug-resistant tuberculosis outbreak among US-bound Hmong refugees, Thailand, 2005. Emerg Infect Dis 2008;14(11). Electronic version, accessed Nov. 10, 2008:
3. Lillebaek T, Andersen AB, Dirksen A, et al. Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis 2002;8(7):679-684.