Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2012;7(2):e32158. doi: 10.1371/journal.pone.0032158. Epub 2012 Feb 27.
Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States.
METHODOLOGY/PRINCIPAL FINDINGS: We defined foreign-born persons within 1 year after arrival in the United States as "newly arrived", and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6% (4,783) occurred among immigrants and refugees, 36.6% (4,211) among students/exchange visitors and temporary workers, 13.8% (1,589) among tourists and business travelers, and 7.3% (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of ≥100 cases/100,000 population/year; 235.8 cases/100,000 admissions, 95% confidence interval [CI], 228.3 to 243.3), students/exchange visitors and temporary workers from high-incidence countries (60.9 cases/100,000 admissions, 95% CI, 58.5 to 63.3), and immigrants and refugees from medium-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of 15-99 cases/100,000 population/year; 55.2 cases/100,000 admissions, 95% CI, 51.6 to 58.8).
CONCLUSIONS/SIGNIFICANCE: Newly arrived nonimmigrant visitors contribute substantially to the burden of foreign-born TB in the United States. To achieve the goals of TB elimination, direct investment in global TB control and strategies to target nonimmigrant visitors should be considered.
在美国每年入境的约 1.635 亿外国出生者中，仅有 50 万移民和难民需要进行海外结核病（TB）筛查。目前尚不清楚未筛查的非移民访客在多大程度上导致了美国的外国出生者的 TB 负担。
方法/主要发现：我们将入境后 1 年内的外国出生者定义为“新到者”，并利用美国国土安全部、美国疾病控制与预防中心和世界卫生组织的数据来估计美国新到外国出生者中的 TB 发生率。在 2001 年至 2008 年期间，估计有 11500 例结核病发病病例，包括 291 例耐多药结核病发病病例，在美国 20989738 人年期间，有 1479542654 名新到外国出生者发生 11500 例发病病例。在估计的 11500 例结核病发病病例中，41.6%（4783 例）发生在移民和难民中，36.6%（4211 例）发生在学生/交换访客和临时工中，13.8%（1589 例）发生在游客和商务旅行者中，7.3%（834 例）发生在没有 I-94 表（例如，入境-离境记录）的加拿大和墨西哥非移民访客中。发病率最高的前 3 个新到外国出生人群中，每 100000 名入境者中估计的结核病发病病例数最多，分别是来自高发病率国家（例如，2008 年世卫组织估计的结核病发病率≥100 例/100000 人/年；235.8 例/100000 人，95%置信区间[CI]，228.3 至 243.3）、来自高发病率国家的学生/交换访客和临时工（60.9 例/100000 人，95%CI，58.5 至 63.3）以及来自中发病率国家（例如，2008 年世卫组织估计的结核病发病率为 15-99 例/100000 人/年；55.2 例/100000 人，95%CI，51.6 至 58.8）的移民和难民。
结论/意义：新到的非移民访客极大地增加了美国外国出生者的结核病负担。为了实现结核病消除的目标，应考虑对全球结核病控制进行直接投资并制定针对非移民访客的战略。
