Misconceptions about tuberculosis among immigrants to the United States

Editor—Charatan's story in news extra about tuberculosis among foreign born people in the United States requires clarification.¹ The term immigrant is not used accurately. An immigrant to the United States is a person who is admitted as a lawful permanent resident or who becomes a permanent resident while living there. About 400 000 people qualify in each category annually; about 70 000 refugees enter annually.²

Within the Public Health Service, the Division of Quarantine of the Centers for Disease Control and Prevention writes the guidelines for the medical examination required for all immigrants and refugees and notifies receiving health departments of those who may have tuberculosis (figure). Potential immigrants and refugees who have infectious tuberculosis must be treated until they are not infectious. They are then allowed into the country on condition that they are followed up by the local health department. Those with possible non-infectious tuberculosis are also referred to local health departments; over 90% are evaluated.³

The United States Immigration and Naturalization Service has estimated that five million people born outside the United States were living in the country unlawfully in October 1996.² It has responded to this with increased screening of those who are apprehended and detained. Roughly 155 000 people were placed in Immigration and Naturalization Service detention during fiscal year 1999. The Public Health Service's Division of Immigration Health provides healthcare support to the immigration service by screening detainees for tuberculosis. In the last fiscal year the division screened over 52 000 detainees who were held for at least 48 hours or had symptoms of tuberculosis (G Migliaccio, personal communication, 1999). Other detainees might have been screened for tuberculosis while in correctional systems not covered by the division.

The total number of people born outside the United States who had tuberculosis in the country fell from 7930 in 1995 to 7591 in 1998. During the same period the rates of tuberculosis in people born in the United States and people born outside the United States fell to 4.4/100 000 and 28/100 000, respectively.⁴

The Centers for Disease Control and Prevention has made it a priority for state and local health departments to follow up and treat immigrants and refugees identified as possibly having tuberculosis and for the Division of Quarantine to continue forwarding their medical documentation to relevant health departments.⁵ The recent decline in tuberculosis among people born outside the United States probably reflects successes in tuberculosis screening and follow up. More effort is needed to address the problem of tuberculosis among the roughly five million undocumented people living in the United States to ensure that all segments of the population receive screening and treatment.

Figure.

Arriving immigrants and refugees with chest radiographs suggesting possible current or old healed tuberculosis, fiscal years 1995-7, United States