Multidrug-Resistant Tuberculosis in U.S.-Bound Immigrants and Refugees

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Immigration Health

Background:

• Tuberculosis (TB) disproportionately affects non-U.S.-born individuals in the United States.
• Overseas TB screening has historically reduced TB importation, but its impact on multidrug-resistant TB (MDR-TB) remains understudied.

Purpose of the Study:

• To investigate the epidemiology of MDR-TB among U.S.-bound immigrants and refugees.
• To assess the effectiveness of culture-based overseas TB screening in preventing MDR-TB importation.

Main Methods:

• Analysis of culture-positive TB cases in immigrants/refugees completing overseas treatment (2015-2019).
• Comparison of annual MDR-TB cases in non-U.S.-born individuals pre- and post-implementation of culture-based screening algorithms.

Main Results:

• Of 3,300 culture-positive TB cases, 3.7% had MDR-TB; none had extensively drug-resistant TB.
• Culture-based screening prevented an estimated 24.4 MDR-TB cases annually, a significant improvement over smear-based methods.
• Mean annual MDR-TB cases among non-U.S.-born individuals decreased from 34.6 (1996-2006) to 19.5 (2014-2019).

Conclusions:

• Culture-based overseas TB screening substantially curtails the importation of MDR-TB into the United States.
• The shift to culture-based screening represents a significant advancement in preventing drug-resistant TB among immigrant populations.