68. Chest Radiograph Screening for Pulmonary Tuberculosis Disease Among US Immigration and Customs Enforcement Detainees: Early Detection, Rapid Intervention
Session: Oral Abstract Session: Advances in Epidemiology and Diagnosis of Mycobacterial Diseases
Thursday, October 27, 2016: 9:00 AM
Room: 275-277
Background:  Screening for pulmonary tuberculosis (PTB) disease among the incarcerated is an essential infection control practice. U.S. Immigration and Customs Enforcement (ICE) detains individuals from high TB prevalence countries making such a screening program essential to prevention of spread among detainees, staff and surrounding communities. The chest radiograph provides a rapid and sensitive screening test which allows for the swift isolation and treatment of suspected cases.

Methods:  ICE detainees with confirmed PTB disease identified by intake screening and reported during 2014 were included in the analysis. Clinical presentation, demographics, microbiologic data, and comorbid conditions were examined for all PTB disease cases identified. Additionally, this study investigated the univariate and multivariable associations between age, sex, HIV status, clinical presentation, and the expression of symptoms prior to diagnosis of confirmed TB disease.

Results: 147 eligible subjects with confirmed PTB disease were included in the analysis. The largest proportion of cases were from Honduras (25%), Guatemala (24%) and Mexico (19%). Based on the estimated total population of detainees screened in 2014, the rate of PTB disease was 102 per 100,000. The majority of subjects with confirmed TB disease were asymptomatic at intake into ICE custody (72%), and 20% of those with TST results were asymptomatic and TST negative. In the multivariate analysis only cavitary disease was independently associated with being symptomatic. No statistically significant associations were observed between age, sex, or HIV status and symptomatic status.

Conclusion: In our study, over two-thirds of those identified with confirmed PTB disease in ICE custody were asymptomatic. Furthermore, the case rate identified in this study, 102 per 100,000, is considerably higher than the overall US TB disease case rate in 2014 (3.0 per 100,000), the rate for foreign-born persons living in the US (15.4 per 100,000) as well as the rate for their countries of nationality (21-57 per 100,000). This would indicate that our PTB screening practices identify PTB disease earlier preventing disease progression in the individual as well as spread within the detention setting and surrounding communities.

Nicole Boardman, MPH1,2, Tiffany Moore, RN, MSNed1, Jennifer Freiman, MPH, CPH1, Deborah Schneider, BSN1, Diana Elson, DrPH, MA1 and Edith Lederman, MD, MPH, FIDSA1, (1)ICE Health Service Corps, Washington, DC, (2)San Diego State University Graduate School of Public Health, San Diego, CA


N. Boardman, None

T. Moore, None

J. Freiman, None

D. Schneider, None

D. Elson, None

E. Lederman, None

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