Tuberculosis Disease and Infection in US-Bound International Adoptees: 2016 to 2023

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Immigration Health

Background:

• International adoptees undergo tuberculosis (TB) screening overseas before immigration to the US.
• Evaluating the effectiveness of this pre-immigration screening is essential for public health.
• Understanding TB prevalence in this population informs screening strategies.

Purpose of the Study:

• To assess the utility and outcomes of culture-based overseas TB screening in US-bound international adoptees.
• To determine the prevalence of TB disease and latent TB infection (LTBI) in this cohort.
• To evaluate the completion and yield of post-arrival TB evaluations.

Main Methods:

• Cross-sectional analysis of 22,053 international adoptees screened overseas between 2016-2023.
• Analysis included data on TB disease, suspected TB disease, and latent TB infection (LTBI) diagnosed overseas.
• Evaluation of post-arrival follow-up completion rates and diagnostic yield.

Main Results:

• TB disease was diagnosed in 54/100,000 persons, and suspected TB disease in 766/100,000.
• Latent TB infection (LTBI) was diagnosed in 2.5% of those tested overseas.
• Post-arrival evaluation confirmed TB disease in 1.9% of suspected cases and 0% of LTBI cases, with treatment completion rates varying.

Conclusions:

• US-bound international adoptees exhibit a high prevalence of TB disease, comparable to immigrant and refugee children.
• Pre-immigration TB screening is vital for identifying infectious individuals.
• Ensuring timely and complete post-arrival evaluation is critical for managing TB in this population.