Infectious Tuberculosis among Newly Arrived Refugees in the United States

Infectious Tuberculosis among Newly Arrived Refugees in the United Statesto the editor: In 2002, 51 percent of persons with tuberculosis in the United States were foreign-born; 19 percent of them had been in the United States for less than one year.1 To prevent persons with potentially infectious tuberculosis from entering the United States and to detect possible noninfectious tuberculosis, immigrants and refugees undergo tuberculosis screening overseas with the use of chest radiography.If radiographs suggest active tuberculosis, sputum smears are examined for acid-fast bacilli.Travel to the United States is deferred if smears are positive.For those with radiologic findings compatible with inactive tuberculosis, examination of smears for acid-fast bacilli is not required.2The ability to detect infectious tuberculosis accurately and to deter it is affected by the sensitivity and specificity of screening tools and the possibility that a new infection or progression of existing disease may occur between the overseas screening evaluation and the evaluation after arrival.