Epidemiology of tuberculosis among the foreign-born in the United States
Mailman School of Public Health
April 7, 2004

Overview

WHO: 1/3 of the world has latent tuberculosis infection (LTBI)

WHO high-burden TB countries, 2004 (>80% of global TB)

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We are not alone

TB in established market countries

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Israel: dramatic changes in a low prevalence country

Surveillance Studies

CDC studies of registry data (1)

CDC studies of registry data (2)

Drug resistance and the foreign-born TB case

Slide 19

CDC studies of registry data (3)

CDC studies of registry data
(3, continued)

CDC studies of registry data
(3, continued)

Surveillance cannot tell us (1)

Surveillance cannot tell us (2)

Surveillance cannot tell us (3)

Are persons with active disease entering the US?

Screening of immigrants as a TB control activity

Some follow-up studies of B notifications (1)

Studies of follow-up (2)

Studies of follow-up (3)

Sciortino S, Mohle-Boetani, et al.1999 (continued)

Screening of international students - NO

Screening of temporary workers - NO

H-1B visa category

Census 2000 estimates of temporary workers by selected countries of origin

Is current transmission taking place in the US?

Molecular epidemiology (1)

Molecular epidemiology (2)

Molecular epidemiology (3)

Molecular epidemiology (4)

Among FB persons with LTBI, who are high risk groups?

“Foreign-born” children

Occupational health

Where does surveillance
go from here?

Where does molecular epidemiology go from here?