Azariyas A. Challa, MD, PhD
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=L15-0263.
Challa AA. Tuberculosis Incidence in Immigrants and Refugees. Ann Intern Med. 2015;163:149-150. doi: 10.7326/L15-5111
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Published: Ann Intern Med. 2015;163(2):149-150.
TO THE EDITOR:
Liu and colleagues (1) attribute the recent decline in tuberculosis (TB) cases among newly arrived, foreign-born persons in the United States to the increase in smear-negative/culture-positive cases diagnosed overseas among immigrants and refugees, as a result of the Centers for Disease Control and Prevention's implementation of the culture-based algorithm. This observation seems plausible until one considers that many foreign-born persons, including visitors, students, temporary workers, and unauthorized aliens, are not screened before admittance to the United States (2). In fact, immigrants and refugees constitute only approximately one third of the estimated 1.3 million foreign-born persons who enter the United States yearly for a long-term stay (3). The authors did not provide specific data about the number of reported TB cases in immigrants and refugees and therefore cannot exclude with certainty the possibility that changes unrelated to overseas screening may have caused the observed decrease in the incidence of TB in newly arrived, foreign-born persons between 2007 and 2012.
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