1656. The risk of tuberculosis among students in the U.S. on an exchange visa
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • JCollins IDSA Poster.pdf (946.2 kB)
  • Background: Tuberculosis (TB) epidemiology in the United States (US) has changed over the last 20 years, with most cases now occurring in foreign-born individuals who arrive with latent TB infection.  Active TB is potentially preventable in these persons, but many foreign residents, including several million exchange students, are not screened for TB.  US immigration statistics indicate that the number of entering student residents has more than doubled over the last 10 years.  The number and proportion of reported TB cases, mode of TB case detection and potential screening strategies in short-term residents on student or exchange visas have yet to be described.

    Methods: Data was collected previously by the Tuberculosis Epidemiologic Studies Consortium from 20 geographically diverse sites around the US.  A large database with a cohort of foreign-born patients diagnosed with active TB between 2004 and 2007 was used for analysis.  Descriptive statistics are presented and an incidence rate was calculated using immigration data from study jurisdictions.

    Results: 1263 foreign-born TB cases of known visa status were identified, of which 46 (3.6%) occurred in student residents.  The annual TB incidence rate per 100,000 in student residents was double the rate in the general foreign-born population, 47 vs. 22.  The median age at diagnosis was 26.5 years (24.1, 29.4) and 35 students (76%) were diagnosed with pulmonary TB.  Twelve (26%) were diagnosed through a screening program and 34 (74%) were diagnosed due to TB symptoms.  Those students whose TB case was identified by screening programs were more likely to be diagnosed within 1 year of arrival to the US than those diagnosed due to TB symptoms (9 (75%) vs 10 (30%), p< 0.001).  Rates of culture positive disease were similar between screened and unscreened individuals, but cases identified by screening were significantly less likely to be smear-positive (2 (18%) vs 15 (63%), p=0.05).

    Conclusion: These findings suggest that screening student residents for TB after arrival to the US may be an effective strategy to identify early active TB cases as well as latent TB infection prior to progression to active disease.

    Jeffrey Collins, MD, MPH1, Randall Reves, MD, MSc1,2 and Robert Belknap, MD1,2, (1)University of Colorado School of Medicine, Aurora, CO, (2)Denver Health and Hospital, Denver, CO

    Disclosures:

    J. Collins, None

    R. Reves, None

    R. Belknap, None

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