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CDC Telebriefing Transcript
Tuberculosis Morbidity Among U.S.-Born and Foreign-Born Populations with Dr.
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
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
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
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
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
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
With that, I would like to invite and take any questions you might have.
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
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
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
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
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
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.
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.