Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 573-577

Tuberculosis Prevention Among Foreign-born Persons in Seattle-King County, Washington

CHARLES D. WELLS, PATRICK L. F. ZUBER, CHARLES M. NOLAN, NANCY J. BINKIN, and STEFAN V. GOLDBERG

Division of Tuberculosis Elimination, National Center for HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Seattle-King County Department of Public Health, Tuberculosis Control Program, Seattle, Washington

The purpose of this study was to evaluate the outcomes of classified immigrant and refugee (I&R) screening and of contact investigation (CI) of foreign-born TB cases in Seattle-King County (SKC), Washington. We reviewed I&R evaluations from the SKC TB clinic for 1992-1994 and contact evaluation records for 54 randomly selected U.S.-born and foreign-born pulmonary TB patients from 1993. Among 942 I&R evaluated, 693 (74%) had positive tuberculin skin tests (TST). Preventive therapy (PT) was prescribed for 324 (34%) and treatment for 49 (5%). The remaining 377 were dismissed, of whom 96% did not meet American Thoracic Society PT criteria. Contacts of foreign-born cases were more numerous (6.0 versus 3.4 per case, p = 0.04), and significantly more likely to be TST-positive (50% versus 18%) and to be started on PT (40% versus 23%). The large number of I&R eligible for treatment or PT emphasizes the benefit of prompt evaluation of new arrivals. CI provides an excellent opportunity to screen foreign-born persons at high risk for active TB.

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