Tuberculosis among newly arrived foreign spouses before obtaining citizenship, Taiwan, 2006-2011

Taiwan's criterion for admissions of new immigrants is a normal chest X-ray (CXR). Subsequent tuberculosis (TB) screening for new foreign spouses is mandatory before acquiring citizenship.

To estimate the TB burden among new-entry foreign spouses and their close contacts.

Of 768 new foreign spouses with TB, of whom 98.6% were female, 721 (94.0%) had come from South-East Asian countries (Viet Nam, Indonesia, Philippines and Thailand) or China. Rates of TB (40.3-176.2 per 100 000/year) among newly emigrant wives aged 20-49 years were 1.7- to 7.3-fold higher than among Taiwanese females of corresponding ages. TB prevalence among the 2698 close contacts of 768 foreign spouse index cases was 1.2%, according to a 2-year follow-up investigation. Respectively 87.9% (675/768) and 11.1% (85/768) of all TB cases had abnormal and normal CXRs; of these, 35.4% (239/675) of patients with an abnormal and 14.1% (12/85) of those with a normal CXR were smear-negative, culture-positive.

Foreign wives from endemic countries had a relatively high risk of TB. Regular TB screening of foreign spouses within at least 1-2 years of entry from TB-endemic regions, rather than after application for citizenship, is recommended. A more sensitive TB test could facilitate better diagnosis.