New TB Screening Of Immigrants To US Has Resulted in Better Detection and Treatment Opportunities Interview with:
Dr.Yecai Liu

Division of Global Migration and Quarantine
Centers for Disease Control and Prevention, Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Response: Since the early 1900s, immigrants and refugees applying for a visa to come to the United States undergo a medical examination that includes tuberculosis (TB) screening. In 2007, CDC began implementing the new screening guidelines, which require people suspected of having TB to receive a much more sensitive sputum culture test to confirm TB to ensure that those individuals who do have TB receive treatment before they arrive in the United States. These requirements have now been completely rolled out to all countries with U.S.-bound immigrants and refugees.

From 2007 through 2012, half of the 3.2 million arrivals of immigrants and refugees to the United States were screened for TB by the new screening guidelines. Out of more than 4,000 TB cases diagnosed by the new screening guidelines during this period, nearly 2,200 were smear-negative and culture positive. These cases would likely have been missed under the previous screening requirements. The results of this study showed that the updated overseas screening guidelines led to a roughly one-third decrease in the annual number of TB cases among foreign-born persons within their first year in the United States.

Medical Research: What should clinicians and patients take away from your report?

Response: When the new screening guidelines issued in 2007 are implemented in all countries, physicians overseas identify more than 600 additional TB cases (i.e., smear-negative and culture-positive TB) annually in immigrants and refugees bound for the United States. That makes this effort one of the largest and most successful interventions for U.S. TB control in the past decade. Without these updated screening guidelines, which use newer, more sensitive tests, these cases might have gone undetected.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: We recommend to conduct cost-effectiveness studies on expanding TB screening in nonimmigrant visitors from countries with a high TB incidence, and studies on diagnosing and treating latent TB infection among foreign-born persons in the United States.



Effect of a Culture-Based Screening Algorithm on Tuberculosis Incidence in Immigrants and Refugees Bound for the United States Interview with: Dr.Yecai Liu (2015). New TB Screening Of Immigrants To US Has Resulted in Better Detection and Treatment Opportunities