Infectious Disease: Tuberculosis
Bhutanese Refugee Health Profile
Of more than 44,000 refugees screened for active TB during visa medical examinations conducted by IOM in Nepal, fewer than 400 (0.8%) were sputum smear or culture positive for Mycobacterium tuberculosis. Of those who were culture positive and submitted for drug susceptibility testing, nearly 90% were pansusceptible, fewer than 4% were isoniazid (INH) resistant, approximately 2% were monoresistant to a drug other than INH or rifampin, fewer than 2% were poly-resistant but not multi-drug resistant (MDR), and fewer than 1% were MDR TB. 1
Approximately 8% of Bhutanese refugees arrive in the United States with a class B1 TB designation (TB fully treated using Directly Observed Therapy, or abnormal chest x-ray [CXR] with negative sputum smears and cultures, or extrapulmonary TB). Of these, fewer than 1% had extrapulmonary TB.
During the visa medical examinations, tuberculin skin tests (TST) are routinely performed on children aged 2–14 years (whereas all adults receive chest x-rays). Children who have a positive TST and latent TB infection are designated as TB class B2. Approximately 8% of children examined by IOM in Nepal during 2008–2011 had a positive TST with >10 mm induration. Adult contacts of infectious TB case-patients are also screened using a TST. Of 357 adult contacts screened by IOM in Nepal, 1.1% were classified with class B2 TB]. 2 During post-arrival screening exams inTexas, however, all refugees (adults and children) are administered either a TST or interferon-gamma release assay (IGRA) test. Of these refugees, 22% of 569 children aged 2–14 years had a positive TST or IGRA while 48% of 1,905 adults aged 15 years and over had a positive TST or IGRA. 2