Tuberculosis screening for immigrants and refugees. Diagnostic outcomes in the state of Hawaii

The effectiveness of the required overseas tuberculosis (TB) screening for immigrants and refugees to the United States has not been evaluated since new guidelines were introduced in 1991. Using data from the Hawaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we determined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered "normal" overseas, who were evaluated and subsequently diagnosed with active TB within 1 yr of arrival in the United States. Of the 124 TB cases among immigrants and refugees evaluated within 1 yr of arrival, 78 (63%) had been classified overseas as B1, 17 (14%) as B2, and 29 (23%) as "normal." The proportion of TB cases diagnosed after arrival in the United States was 14.0% for B1s and 2.1% for B2s. This proportion decreased with increasing age. A positive skin test was a strong predictor (OR: 10.7; 95% CI: 1.4-80.1) of culture-confirmed TB. These data document that immigrants and refugees with B1 and B2 TB status have a high prevalence of active TB. They should be promptly evaluated after arrival in the United States to determine the need for curative or preventive therapy.