Tuberculosis in the foreign-born population of Tarrant County, Texas by immigration status

The epidemiology of tuberculosis is changing in the United States as a resu lt of immigration, yet the extent to which different classes of immigrants contribute to overall morbidity is unknown. Tuberculosis in nonimmigrant vi sitors is of particular interest as they are currently exempt from screenin g requirements. We conducted a prospective survey of all culture-positive t uberculosis patients in Tarrant County, Texas from 1/98 to 12/00. Immigrati on status of foreign-born patients was classified as permanent residents, u ndocumented, or nonimmigrant visitors. Of 274 eligible participants, 114 (4 2%) were foreign-born; of these, 67 (59%) were permanent residents, 28 (25% ) were undocumented, and 19 (17%) were nonimmigrant visitors. Among the for eign-born, we observed significant differences by immigration status in mul tidrug resistance (p = 0.02), human immunodeficiency virus (HIV) infection (p = 0.0007), and hospitalization (p = 0.03 for ever/never, 0.01 for durati on). Compared with other immigrants, more nonimmigrant visitors were multi- drug-resistant (16% versus 11% of undocumented residents and 1% of permanen t residents), were HIV-positive (32% versus 0% of undocumented and 5% of pe rmanent residents), were hospitalized (47% versus 36% of undocumented and 1 9% of permanent residents), and had lengthy hospitalizations (median [midsp read] days = 87 [25 to 153] versus 8.5 [4 to 28] for undocumented and 10 [7 to 24 d] for permanent residents). We found nonimmigrant visitors to be an important source of tuberculosis morbidity In Tarrant County. Further stud ies in other regions of the U.S. are needed to determine if screening and t reatment recommendations of persons who spend extended periods in the U.S. should be raised to the standards set for permanent residents.