Successful Tuberculosis Prevention in Foreign-born Adolescents

The rise of TB cases among foreign-born persons is partly due to the rise in immigrants to the United States,2 especially those from Asian and Latin American countries where TB rates are up to twenty times greater than that of the United States.3 Of the foreign-born TB cases, 44% were Asian or Pacific islanders and 36% were Latino or Hispanics. Mexico alone accounted for 23% of all foreign-born TB cases. The rise is also partly due to inadequate medical outreach to immigrants. As the Center for Disease Control (CDC) declared in 1998, “efforts to provide screening and preventive therapy for the foreign-born are limited.”4 Linguistic and cultural barriers often make outreach to immigrant communities difficult. Patients’ failure to follow through on treatment is another important barrier to eliminating TB both internationally and in the United States. This failure results not only in an increase of new TB cases5 and the emergence of drug-resistant strains,6 but also in higher overall treatment costs. The increase in TB cases among foreign-born patients suggests that they face particular challenges in completing care. Therefore, in order to effectively control TB in the United States, we must develop and deliver to foreign-born persons tailored intervention programs that cross cultural barriers and encourage patients to complete care. Although only individuals with active TB are infectious, 1 in 10 persons with latent tuberculosis infection (LTBI) may develop the disease if they are not treated.7 The CDC estimates that 7 million foreign-born persons are infected with TB and that 140,000 to 210,000 will develop the disease unless they complete preventive therapy. SUCCESSFUL TUBERCULOSIS PREVENTION IN FOREIGN-BORN ADOLESCENTS by Donald E. Morisky, Astou Coly, and Michael Kim L at i n o P o l i c y & I s s u e s B r i e f