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CDC Telebriefing Transcript
Tuberculosis Morbidity Among U.S.-Born and Foreign-Born Populations with Dr. Ken Castro

February 7, 2002

CDC MODERATOR: Hello. Today's topic is TB among U.S.- and foreign-born populations. Joining us is Dr. Kenneth Castro, and that's spelled C-a-s-t-r-o. He is the Director of CDC's TB Elimination Program. He'll be make a few brief remarks, and then he will turn it over for questions.

Also joining Dr. Castro is Lilia Manangan. She is the lead author of this week's MMWR. Her name is spelled L-i-l-i-a, M-a-n-a-n-g-a-n.

We also have an expert from our international TB program. His name is Michael Qualls. He may be called on to ask questions as well. His last name is spelled Q-u-a-l-l-s. They will identify themselves when they are answering questions.

Right now I'm going to turn it over to Dr. Castro.

DR. CASTRO: Thanks, Cynthia, and good afternoon to all of you who joined us. What I'd like to do is start out with the good news. As we reported in June, there were 16,377 new persons diagnosed with tuberculosis reported to CDC from all 50 states and the District of Columbia. This is for the year 2000, representing a decrease of 7 percent since 1999. This last decrease highlights the progress we have made in reducing tuberculosis in the United States since the epidemic last peaked in 1992.

Today's article in the Morbidity and Mortality Weekly Report explores the 2000 data reported in depth, allowing for a closer examination of the reasons for the overall decrease, as well as some concerning trends among individuals born outside the United States.

The data released today suggest that the overall declines can be attributed in large part to improvements in treatment of persons with tuberculosis. The overall decrease in tuberculosis cases and case rates are consistent with today's finding that an increased number of tuberculosis patients are initially receiving a regimen of four antibiotics, completing treatment within one year, and are being treated with directly observed therapy.

These findings are very encouraging and suggest that our nation is well on the way to eliminating tuberculosis. However, to achieve this goal, this latest data also make clear that we must address a key challenge, that is, improving the screening and treatment for individuals born in other countries.

The 2000 data indicated that while the number of reported tuberculosis cases has decreased substantially among U.S.-born individuals from 19,225 cases in 1992 to 8,714 cases in 2000, the number of cases of foreign-born U.S. population actually increased from 7,270 cases in 1992 to 7,554 cases in 2000.

The 2000 tuberculosis case rate was seven times greater in the foreign-born compared with the U.S.-born population. Also, foreign-born individuals now represent 46 percent of all tuberculosis cases reported in the United States compared to 27 percent of cases eight years ago.

The data also indicate that while cases of multi-drug-resistant tuberculosis have been significantly reduced over this same time interval, remaining cases are increasingly concentrated among the foreign-born population. In the year 2000, 72 percent of 141 persons reported with multi-drug-resistant tuberculosis occurred in foreign-born individuals compared with 31 percent of nearly 500 cases seen in the year 1993.

We are currently taking multiple steps both abroad and in the United States to improve tuberculosis programs for foreign-borns and diminish the impact of a global tuberculosis epidemic. I will now highlight these steps.

First, to improve overseas screening for those who are moving to the United States, we are evaluating screening methods and updating the guidelines for embassy-hired doctors who conduct the screening around the world.

Second, CDC is taking steps to move from a paper-based system that alerts local health departments of recent arrivals who may be affected with tuberculosis to an electronic system which would much more efficiently public health authorities. Ultimately, it would help recent international arrivals access medical care and complete antibiotic therapy, if needed, before they get sick with full-blown or active tuberculosis, which, by the way, is the infectious form of this disease.

Third, we're looking closely--we're working closely with Mexico to control the spread of tuberculosis along the U.S.-Mexico border. In fact, Mexican Minister of Health and Secretary of Health and Human Services met recently in El Paso to discuss initiatives that would ensure that tuberculosis patients are fully treated as they move across the U.S.-Mexico border. They have proposed a binational tuberculosis card that would allow patients to access and complete therapy no matter what side of the border they end up going to.

Fourth, CDC is supporting demonstration projects to evaluate the effective of screening and treatment programs tailored to recent
arrivals who may be infected with latent tuberculosis. For example, demonstration projects are taking place in San Francisco, in Seattle, and in Boston.

And, lastly, we are strengthening our collaboration with the World Health Organization which has identified as of last year 23 high-burden countries which account for 80 percent of global tuberculosis cases. CDC is providing technical assistance to help these countries control their TB epidemics.

These activities are especially important because tuberculosis is the second leading infectious killer of young adults in the world, yet it is both treatable and preventable. Furthermore, tuberculosis is an airborne disease which knows no borders and can spread as people travel to different parts of the globe.

With that, I would like to invite and take any questions you might have. Thank you.

OPERATOR: Ladies and gentlemen, if you would like to ask a question, please press 1 on your touch-tone phone. You will hear a tone indicating you've been placed in queue, and you may remove yourself from queue by pressing the pound key. If you're on a speakerphone, please pick up your handset before pressing the numbers. Once again, if you have a question, please depress the 1 on your touch-tone phone at this time.

We have a question in queue from Miriam Gail Brown from Connecticut Post. Please go ahead.

QUESTION: Hi. Thank you, everybody, for being here, first of all. I was wondering what kind of response the CDC is getting initially from the countries and embassies you've consulted with about the screening process and exactly what would it entail.

DR. CASTRO: Well, the embassies have existing agreements, and they hire clinicians to provide the medical evaluations for persons who apply for either immigrant of refugee visas. And what we're trying to do is strengthen that process, so this is not a new mechanism but actually improving of something that's already taking place.

One area that we have seen is very much needed is to beef up the training and the written guidance that's provided to these clinicians as persons apply to enter the United States. So, in general, they've been very receptive to this concept and proposal. As I indicated, it's not novel. It's been in place for several years. And what we're trying to do is strengthen that.

QUESTION: Okay. Is there--is there anything--can I ask a follow-up question?

DR. CASTRO: By all means.

QUESTION: Okay. From talking to some of the public health authorities here in Connecticut, they mentioned to me that they already get advisories when people with refugee status come here, so they have some sense of what's going on--you know, screening for them. But what about illegal--illegal immigrants, illegal aliens? Is there anything that can be done to encourage them to be tested or screened or anything?

DR. CASTRO: You're touching on a very important challenge that we're confronted with. Obviously, persons who do not apply to come in through the immigrant or refugee process do not get the medical screening. Furthermore, to add insult to injury, very often they don't have access to care when they feel ill, wherever they may happen to reside in the United States. And to try to address that, we're working with local health department-sponsored TB programs trying to figure out ways to provide access to care as people come through their doors. You know, and there are--anything that we can do to facilitate this process is going to be crucial.

We have heard descriptions how in California in the past, when there were moves and propositions to limit access to individuals of a legal status, that might have brought people underground, which further then facilitates TB transmission. So the challenge is to make sure that we provide access.

Also, other activities that are taking place, mostly related to Mexican-born individuals, is that as people end up crossing the border and they come to the attention of clinicians in the United States, we have some mechanisms to facilitate the exchange of information to find out if they were ever treated before.

For example, there is a Cure TB out of San Diego and TB Net sponsored by Migrant Health Clinicians Network as mechanisms to exchange information about TB patients, while at the same time safeguarding the confidentiality of that information.

So those are some examples, but you point to a very important problem that I don't think we're adequately addressing yet.

QUESTION: Okay. Thank you very much.

CDC MODERATOR: The next question?

OPERATOR: And, again, if there are any additional questions, please press 1 at this time.

A question in queue from Jeremy Olson from Omaha World Herald. Please go ahead.

QUESTION: My question was in reference (?) targeting any specific populations in Omaha. A rise in tuberculosis cases has been triggered to the increase in the Sudanese population. And I was curious to know if your efforts are focused on any specific populations, or if it's really kind of a global approach.

DR. CASTRO: Well, no, we do focus--when you look at the United States overall, the vast majority (?) foreign-born TB cases come from the Western Pacific region, Mexico, you know, so this would be Mexico, Philippines, Vietnam, by and large. So we are targeting these specific countries.

Then the other effort is, as I mentioned earlier, working with the World Health Organization, targeting those 23 countries that they have identified as contributing to 80 percent of global tuberculosis cases.

I apologize that I don't have specific information about the specific foreign-born population in Omaha, but what you're pointing at is crucial, and that is for local health departments to have a better understanding of the profile of their foreign-born patients because then they can work with either community-based organizations, refugee health agencies, to make sure that these populations are adequately treated and addressed, issues having to do with both language and cultural barriers that will need to be overcome when serving these populations.

QUESTION: Thank you.

OPERATOR: Once again, if you have a question, please depress the 1 at this time.


OPERATOR: No one is in queue at this time. Please continue.

CDC MODERATOR: Do we have any other questions?

OPERATOR: No one is queuing up at this time.

CDC MODERATOR: Okay. Then I want to thank everybody for calling in today, and obviously everybody has gotten their questions answered. If you have any other additional questions when you are writing your reports, please give us a call at 404-639-8895.

Thank you.

OPERATOR: Ladies and gentlemen, that does conclude your conference for today. Thank you for your participation and using AT&T Executive Teleconference. You may now disconnect.

[Whereupon, the conference call was concluded.]

Listen to the telebriefing

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