Recommendations for prevention and control of tuberculosis among foreign-born persons. Report of the Working Group on Tuberculosis among Foreign-Born Persons. Centers for Disease Control and Prevention.

During 1986-1997, the number of tuberculosis (TB) cases among foreign-born persons in the United States increased by 56%, from 4,925 cases (22% of the national total) to 7,702 cases (39% of the national total). As the percentage of reported TB cases among foreign-born persons continues to increase, the elimination of TB in the United States will depend increasingly on the elimination of TB among foreign-born persons. On May 16-17, 1997, CDC convened a working group of state and city TB-control program staff, as well as representatives from CDC's Division of TB Elimination and Division of Quarantine, to outline problems and propose solutions for addressing TB among foreign-born persons. The Working Group on Tuberculosis Among Foreign-Born Persons considered a) epidemiologic profiles of TB cases among foreign-born persons, b) case finding, screening, and preventive therapy for the foreign born, c) TB diagnosis and management for the foreign born, d) opportunities for collaborations with community-based organizations (CBOs) to address TB among the foreign born, and e) TB-related training needs. The Working Group's deliberations and the resulting recommendations for action by federal agencies, state and local TB-control programs, CBOs, and private health-care providers form the basis of this report. For each of the five topics of discussion, the group identified key issues, problems, and constraints and suggested solutions in the form of recommendations, which are detailed in this report. The Working Group made the following recommendations: * The epidemiology of TB among foreign-born populations differs considerably from area to area. To tailor TB-control efforts to local needs, TB-control programs should develop epidemiologic profiles to identify groups of foreign-born persons in their jurisdictions who are at high risk for TB. * The priorities of TB control among the foreign born should be the same as those for control of TB among other U.S. populations - completion of treatment by persons infected with active TB, contact tracing, and screening and provision of preventive therapy for groups at high risk. Screening and preventive therapy should be limited to areas where completion of therapy rates and contact-tracing activities are currently adequate. * Based on local epidemiologic profiles, selective screening should be conducted among populations identified as being at high risk for TB. Screening should target groups of persons who are at the highest risk for TB infection and disease, accessible for screening, and likely to complete preventive therapy. The decision to screen for infection, disease, or both should be based on the person's age and time in the United States, prior screening, and locally available resources for the provision of preventive therapy. * TB-control programs should direct efforts towards identifying impediments to TB diagnosis and care among local foreign-born populations, devising strategies to address these barriers, and maximizing activities to ensure completion of treatment. * Providing TB preventive therapy and other TB-related services for foreign-born persons is often impeded by linguistic, cultural, and health-services barriers. TB-control programs can help overcome these barriers by establishing partnerships with CBOs and by strengthening training and education efforts. Collaborations with health-service CBOs should center on developing more complementary roles, more effective coordination of services, and better use of existing resources for serving the foreign born. TB-related training should be linked to overall TB-control strategies for the foreign born. Training and education should be targeted to providers, patients, and community workers.