Differences in Contributing Factors to Tuberculosis Incidence in U.S.-born and Foreign-born Persons
- 1 December 1998
- journal article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 158 (6), 1797-1803
- https://doi.org/10.1164/ajrccm.158.6.9804029
Abstract
To determine the factors contributing to tuberculosis incidence in the U.S.-born and foreign-born populations in San Francisco, California, and to assess the effectiveness of tuberculosis control efforts in these populations, we performed a population-based molecular epidemiologic study using 367 patients with strains of Mycobacterium tuberculosis recently introduced into the city. IS6110-based and PGRS-based restriction fragment length polymorphism (RFLP) analyses were performed on M. tuberculosis isolates. Patients whose isolates had identical RFLP patterns were considered a cluster. Review of public health and medical records, plus patient interviews, were used to determine the likelihood of transmission between clustered patients. None of the 252 foreign-born cases was recently infected (within 2 yr) in the city. Nineteen (17%) of 115 U. S.-born cases occurred after recent infection in the city; only two were infected by a foreign-born patient. Disease from recent infection in the city involved either a source or a secondary case with human immunodeficiency virus (HIV) infection, homelessness, or drug abuse. Failure to identify contacts accounted for the majority of secondary cases. In San Francisco, disease from recent transmission of M. tuberculosis has been virtually eliminated from the foreign-born but not from the U.S.-born population. An intensification of contact tracing and screening activities among HIV-infected, homeless, and drug-abusing persons is needed to further control tuberculosis in the U.S.-born population. Elimination of tuberculosis in both the foreign-born and the U.S. -born populations will require widespread use of preventive therapy.Keywords
This publication has 20 references indexed in Scilit:
- Patterns of Tuberculosis Transmission in Central Los AngelesJAMA, 1997
- Long-term Risk of Tuberculosis Among Foreign-born Persons in the United StatesJAMA, 1997
- DNA fingerprinting with two probes decreases clustering of Mycobacterium tuberculosis.American Journal of Respiratory and Critical Care Medicine, 1997
- A Multi-institutional Outbreak of Highly Drug-Resistant TuberculosisJAMA, 1996
- A Computer-Assisted Molecular Epidemiologic Approach to Confronting the Reemergence of TuberculosisThe American Journal of the Medical Sciences, 1996
- The Epidemiology of Tuberculosis among Foreign-Born Persons in the United States, 1986 to 1993New England Journal of Medicine, 1995
- The Epidemiology of Tuberculosis in San Francisco -- A Population-Based Study Using Conventional and Molecular MethodsNew England Journal of Medicine, 1994
- An Outbreak of Tuberculosis with Accelerated Progression among Persons Infected with the Human Immunodeficiency VirusNew England Journal of Medicine, 1992
- Resurgent Tuberculosis in New York City: Human Immunodeficiency Virus, Homelessness, and the Decline of Tuberculosis Control ProgramsAmerican Review of Respiratory Disease, 1991
- A Prospective Study of the Risk of Tuberculosis among Intravenous Drug Users with Human Immunodeficiency Virus InfectionNew England Journal of Medicine, 1989