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164-PA12 Immigration and the resurgence of tuberculosis in the United States
124 Tubercle and Lung Disease: Supplement 2
has been registered. The analysis of the structure of patients treated at the Institute of Lung Diseases and Tuberculosis in Sremska Kamenica shows that patients with tuberculosis nowadays make 30%, while in former years they made less than 9% of the total number of patients. The age structure of TB patients is particularly alarming: relatively young people, the median age being 39 yrs, are most frequently affected, having rather severe, cavernous lung lesions bilaterally. What they all have in common are extremely bad economic conditions preventing them from having proper medical care. It is the reason of detecting the disease in its advanced stage in the majority of refugees. A significant increase of inflammatory tuberculosis, both pulmonary and extrapulmonary, is also evidenced (larynx, lymph nodes, urogenital tract). The lack of antituberculotics caused an increase in the mortality from tuberculosis, the phenomenon of resistant chronic patients, spreading among children and uncontrollable expansion of the epidemic.
129-PA12 Epidemiologic characteristics of tuberculosis in the area of increasing migration of people - the analysis of our material Ciric, Z., Zivk°vic, D., Stankovi~ l., Pejti~ T. Clinic of Lung Diseases and TBC, Knez Selo, Nig, Yugoslavia
Tuberculosis is a serious, infectious disease. The main cause of the disease is a patient with acute tuberculosis (other causes are less important). Great migrations of people determine the epidemiologic situation. In our part of the country, the migration of people has increased for the last five years due to war and economic and social changes so that lung tuberculosis appears to have some epidemiologic clinic characteristics. Our clinic did the analysis of patients (pts) with tuberculosis who were under treatment in the period from 1990 to 1994. The number of patents with tuberculosis in relation to the overall number of hospitalized patients was: in 1990, 8.8%; in 1991, 10.1%; in 1992, 6.8%; in 1993, 6.2% and in 1994, 4.02%. 63.4% of pts with acid-resistant bacil analyzed by direct microscopy of sputum proved the diagnosis which can be related to far-advanced lesions at the moment of finding out the disease. More than twothirds of pts were active working people (77.33%) age 25-64. Most pts were recently diagnosed (88.7%), then recidivists (8.8%) and chronic pts (2.5%). The most common type of tuberculosis according to radiologic image is cavitary phtisis (57.6%) while 36.1% were without cavitation; there were 2.7% hematogenous forms and 3.5% tuberculosis pleurisy. The average treatment of our pts lasted for 74.97 days after which we improved the condition in 94.1% of our pts while 2.4% of pts died. 3.5% of pts gave up treatment on their own. Our conclusion is that morbidity decreases but the younger population is more and more susceptible to the disease. More serious and far-advanced cases of tuberculosis have been registered, which prolongs the period
of treatment. It is necessary to improve the ways of early discovery of pts, especially in the areas with increasing migration of people. 164-PA12 Immigration and the resurgence of tuberculosis in the United States McKenna, M., McCray, E., Onorato, L Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Background: Immigration has become the most important factor influencing the stagnation in the decline in the incidence of tuberculosis (TB) seen in many developed countries. However, the impact of immigration on the epidemiology of TB in the United States has not been extensively evaluated. Methods: We analyzed data from the national TB surveillance system at CDC. Since 1986 information on the country of origin has been requested for every patient reported to this surveillance system. Population estimates were derived using special samples from the decennial censuses. Results: The proportion of TB cases who were foreignborn increased from 21.6 to 31.3 percent from 1986 to 1994. Over this nine year period most foreign-born patients were from Southeast Asia (19,197 cases) and Latin America (24,434 cases). The incidence rate among foreign-born persons was almost quadruple the rate seen in native-born residents (30.9 versus 8.0 per 100,000 person-years). Among foreign-born persons the most important risk factors were world region of origin with persons from Southeast Asia having the highest rates (81.3 per 100,000 person-years), and less than five years residence in the US. Conclusions: International migration has greatly contributed to the resurgence of TB in the US. Control of this disease in developed countries cannot be achieved unless greater attention is afforded the global burden of TB. 166-PA12 Follow-up of immigrants and refugees radiologicaily identified as having tuberculosis before entry into United States Zuber, P.L.F., Binkin, N.J., Tipple, M.A. Centers for Disease Control and Prevention, Atlanta, USA
Immigrants and refugees (I&R) to the United States (US) are required to undergo overseas radiological screening for tuberculosis (TB) before being issued a visa. Persons suspected of active TB who are smearnegative and those with inactive TB are permitted to enter the US but are notified to health departments at the time of entry. We reviewed the US follow-up of persons identified by screening who arrived in Hawaii (1992-93) and Los Angeles (LA) (1993), both areas where the majority of reported TB cases are among the foreignborn. We also evaluated the proportion of reported TB cases who had been identified by the screening procedures. In Hawaii, 902 (97%) of 931 arrivals with
has been registered. The analysis of the structure of patients treated at the Institute of Lung Diseases and Tuberculosis in Sremska Kamenica shows that patients with tuberculosis nowadays make 30%, while in former years they made less than 9% of the total number of patients. The age structure of TB patients is particularly alarming: relatively young people, the median age being 39 yrs, are most frequently affected, having rather severe, cavernous lung lesions bilaterally. What they all have in common are extremely bad economic conditions preventing them from having proper medical care. It is the reason of detecting the disease in its advanced stage in the majority of refugees. A significant increase of inflammatory tuberculosis, both pulmonary and extrapulmonary, is also evidenced (larynx, lymph nodes, urogenital tract). The lack of antituberculotics caused an increase in the mortality from tuberculosis, the phenomenon of resistant chronic patients, spreading among children and uncontrollable expansion of the epidemic.
129-PA12 Epidemiologic characteristics of tuberculosis in the area of increasing migration of people - the analysis of our material Ciric, Z., Zivk°vic, D., Stankovi~ l., Pejti~ T. Clinic of Lung Diseases and TBC, Knez Selo, Nig, Yugoslavia
Tuberculosis is a serious, infectious disease. The main cause of the disease is a patient with acute tuberculosis (other causes are less important). Great migrations of people determine the epidemiologic situation. In our part of the country, the migration of people has increased for the last five years due to war and economic and social changes so that lung tuberculosis appears to have some epidemiologic clinic characteristics. Our clinic did the analysis of patients (pts) with tuberculosis who were under treatment in the period from 1990 to 1994. The number of patents with tuberculosis in relation to the overall number of hospitalized patients was: in 1990, 8.8%; in 1991, 10.1%; in 1992, 6.8%; in 1993, 6.2% and in 1994, 4.02%. 63.4% of pts with acid-resistant bacil analyzed by direct microscopy of sputum proved the diagnosis which can be related to far-advanced lesions at the moment of finding out the disease. More than twothirds of pts were active working people (77.33%) age 25-64. Most pts were recently diagnosed (88.7%), then recidivists (8.8%) and chronic pts (2.5%). The most common type of tuberculosis according to radiologic image is cavitary phtisis (57.6%) while 36.1% were without cavitation; there were 2.7% hematogenous forms and 3.5% tuberculosis pleurisy. The average treatment of our pts lasted for 74.97 days after which we improved the condition in 94.1% of our pts while 2.4% of pts died. 3.5% of pts gave up treatment on their own. Our conclusion is that morbidity decreases but the younger population is more and more susceptible to the disease. More serious and far-advanced cases of tuberculosis have been registered, which prolongs the period
of treatment. It is necessary to improve the ways of early discovery of pts, especially in the areas with increasing migration of people. 164-PA12 Immigration and the resurgence of tuberculosis in the United States McKenna, M., McCray, E., Onorato, L Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Background: Immigration has become the most important factor influencing the stagnation in the decline in the incidence of tuberculosis (TB) seen in many developed countries. However, the impact of immigration on the epidemiology of TB in the United States has not been extensively evaluated. Methods: We analyzed data from the national TB surveillance system at CDC. Since 1986 information on the country of origin has been requested for every patient reported to this surveillance system. Population estimates were derived using special samples from the decennial censuses. Results: The proportion of TB cases who were foreignborn increased from 21.6 to 31.3 percent from 1986 to 1994. Over this nine year period most foreign-born patients were from Southeast Asia (19,197 cases) and Latin America (24,434 cases). The incidence rate among foreign-born persons was almost quadruple the rate seen in native-born residents (30.9 versus 8.0 per 100,000 person-years). Among foreign-born persons the most important risk factors were world region of origin with persons from Southeast Asia having the highest rates (81.3 per 100,000 person-years), and less than five years residence in the US. Conclusions: International migration has greatly contributed to the resurgence of TB in the US. Control of this disease in developed countries cannot be achieved unless greater attention is afforded the global burden of TB. 166-PA12 Follow-up of immigrants and refugees radiologicaily identified as having tuberculosis before entry into United States Zuber, P.L.F., Binkin, N.J., Tipple, M.A. Centers for Disease Control and Prevention, Atlanta, USA
Immigrants and refugees (I&R) to the United States (US) are required to undergo overseas radiological screening for tuberculosis (TB) before being issued a visa. Persons suspected of active TB who are smearnegative and those with inactive TB are permitted to enter the US but are notified to health departments at the time of entry. We reviewed the US follow-up of persons identified by screening who arrived in Hawaii (1992-93) and Los Angeles (LA) (1993), both areas where the majority of reported TB cases are among the foreignborn. We also evaluated the proportion of reported TB cases who had been identified by the screening procedures. In Hawaii, 902 (97%) of 931 arrivals with