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 tuberculosis in immigrants

Jan 18, 2022

Immigration and Health

How Is Tuberculosis Linked to Immigrants

Tuberculosis (TB) is a highly infectious, fatal airborne virus that has plagued the world for ages. Only COVID has lately surpassed the rate of tuberculosis infection and mortality. Around one-third of the world's population is infected with tuberculosis, with China, India, and Africa bearing the brunt of the disease load.

In Dr. Steven Wittenberg Gordon’s experience, around a quarter of the applicants he works with are infected with TB. Genetic predisposition, vitamin D insufficiency, and co-morbidities such as diabetes mellitus and HIV, which disproportionately afflict migrants and ethnic minorities, have been found to enhance vulnerability to infection with Mycobacterium tuberculosis (M. TB).

Furthermore, deportation while on treatment and poor adherence can result in drug-resistant illness, poor results, and the spread of infection. Migrants in detention centers or trafficking people sometimes dwell in poor circumstances for long periods, exposing them to tuberculosis.

Symptoms of Tuberculosis in Immigrants

TB can affect any part of the body, but the lungs account for most cases. Respiratory failure due to lung disorder is the most common cause of death. Other symptoms include:

  • Fever
  • Chills
  • Night sweats
  • Lethargy
  • Lack of appetite
  • Weight loss
  • Coughing up blood
  • Shortness of breath
  • Breathing discomfort

Because the weight loss associated with active tuberculosis can be particularly severe, the disease is sometimes referred to as "consumption."

Screening Practices for Tuberculosis in Immigrants

In the first part of the twentieth century, tuberculosis was a frequent and leading cause of mortality in the United States, killing one in every seven Americans. The United States has worked hard to eradicate tuberculosis (TB) via extensive screening, monitoring, and treatment programs.

To avoid the reintroduction of tuberculosis into the United States, every candidate aged two and up must undergo TB screening as part of their immigration medical examination. A blood test known as the IGRA test is used for screening TB in immigrants. Earlier and infamously unreliable user-dependent skin tests like PPD or TST are no longer in use.

Our Tuberculosis Control with a Special Focus on Immigrants

A latent or asymptomatic or inactive phase (LTBI) and an active or symptomatic phase (ATBI) are the two stages of tuberculosis (TB). In otherwise healthy people, around 10% of infections proceed to active tuberculosis, which is lethal and contagious. Hence, we focus on treating TB during the latent phase to reduce the conversion rate.

A vaccine called BCG is commonly used for preventing TB in many countries, but we don’t use it as it is not effective in adulthood and causes false-positive TST readings. Our first duty is to check the results of the IGRA test, and if it’s positive, we proceed to a chest X-ray to check the severity of the infection. If the chest x-ray is abnormal or the applicant is symptomatic, we send them to the local health department for additional testing, which might take months.

Proven active tuberculosis infection is a medically disqualifying illness that must be treated before an immigration status adjustment is made and a report produced. Proven latent tuberculosis infection is a Class B non-medically disqualifying condition, which allows for a status modification. We strongly advise treatment for LTBI, although it is not necessary for immigration purposes.

If you are an immigrant and want to know more about the treatment of TB or immigration medical exams, contact us today. In honor of his father, a Holocaust survivor and refugee, Dr. Gordon has dedicated 80 percent of his private practice to immigrants. Hence, he is committed to taking good care of you.

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