TUBERCULOSIS AMONG FOREIGN-BORN PERSONS IN NEW-YORK-CITY, 1992-1994 -IMPLICATIONS FOR TUBERCULOSIS-CONTROL

OBJECTIVE: To study the pattern of transmission of tuberculosis (TB) a mong foreign-born persons living in New York City. DESIGN: A retrospec tive multicenter study comparing 158 foreign-born patients to 231 US-b orn patients diagnosed with TB between 1992 and 1994. The patients wer e stratified according to their Mycobacterium tuberculosis isolate DNA fingerprint patterns. RESULTS: Nineteen (16%) of 122 isolates from fo reign-born TB patients and 75 (42%) of 180 isolates from US-born TB pa tients had DNA fingerprint patterns (cluster patterns) indicative of r ecent exogenous transmission (P < 0.001). All cluster pattern strains from foreign-born cases were identical to those found among US-born pa tients. The likelihood of infection with a cluster pattern strain amon g foreign-born persons increased with duration of residence in the US, and was significantly associated with being homeless (P < 0.05), or h aving multidrug-resistant TB (P = 0.00072). CONCLUSION: Although most (84%) cases of TB among foreign-born persons in New York City appear t o result from reactivation of infections they acquired abroad, the one s who acquire new infections become infected with strains that are alr eady circulating among the US-born TB patients in New York City, and t hey have risk factors similar to those faced by US-born tuberculosis p atients.