Identifying and treating latent cases of TB before they become infectious is key to eliminating the disease. More than 40 percent of all new cases in the United States are among the foreign-born coming from nations with high rates of the disease. Risk of developing active tuberculosis is highest during their first five years in this country. Without aggressive interventions, these individuals soon could account for the majority of new TB cases in the United States. For these reasons, it is imperative to require more stringent testing of immigrants from high-risk countries before they are allowed to enter the United States.
Current procedures require that prospective immigrants get chest X-rays to screen for active cases.
But skin testing for latent infections also should be a part of the visa application process. Immigrants with suspected disease or infection could enter the United States, and should then be required to undergo evaluation and therapy before becoming permanent residents. In total, approximately 250,000 potential immigrants per year would be included in this enhanced screening program, which could prevent an estimated 2,100 cases of tuberculosis. But mandatory screening and treatment is not needed for the approximately 7 million foreign-born individuals with latent TB cases who already reside in the United States. Instead, culturally sensitive and foreign-language outreach programs should be designed to encourage these people to receive treatment.