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 evaluat ed since new guidelines were introduced in 1991. Using data from the H awaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we deter mined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered ''normal'' overseas, who were ev aluated and subsequently diagnosed with active TB within 1 yr of arriv al in the United States. Of the 124 TB cases among immigrants and refu gees evaluated within 1 yr of arrival, 78 (63%) had been classified ov erseas as B1, 17 (14%) as B2, and 29 (23%) as ''normal.'' The proporti on 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 ag e. 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.