Determining TB rates and TB case burden for refugees

DeKalb County, Georgia.

To calculate and compare tuberculosis (TB) rates in refugees to US-born, total foreign-born (refugee and other), and other foreign-born persons and to determine the contribution of refugees to the county TB case burden.

The study included: (1) collection of county TB case numbers and population figures from 1995 through 1999; (2) estimation of the refugee population; (3) comparison of TB rates; and (4) calculation of the refugee TB case burden. Sensitivity analysis was performed on refugee population estimates.

From 1995 through 1999, estimating that refugees made up 10% of the foreign-born population, the average TB rate for refugees was 83.2 per 100,000, compared with 12.7 for US-born persons. From 1997 through 1999, refugees had a seven-fold greater risk of having TB than US-born persons and a two-fold greater risk than other foreign-born persons. Refugees represented respectively 7.6% and 19.3% of the county and foreign-born TB case burdens. For TB rates to be equal among all foreign-born persons, refugees would need to make up 15-25% of the foreign-born population.

Despite overseas screening, refugees have high TB rates, and contribute substantially to the county TB case burden. Enhanced surveillance and targeted programs to address TB in refugees should be a public health priority.