title: Tuberculosis among Tibetan immigrants from India and Nepal in Minnesota, 1992-1995.
abstract: OBJECTIVE
  To study screening outcomes among a group of Tibetan immigrants at high risk for developing active tuberculosis (TB) after arrival in Minnesota.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 191 Tibetan immigrants undergoing medical screening.
  
  
  METHODS
  Occurrence and treatment outcomes of active TB.
  
  
  METHODS
  A health maintenance organization and a public TB clinic in Minneapolis, Minn.
  
  
  RESULTS
  Positive (induration, > or =10 mm) tuberculin skin test results were documented in 98% of Tibetans, compared with 44% of Vietnamese, 10% of Hmong, and 51% of Russian refugees in Minnesota (P<.001 for each group). Sixteen active cases (8.4%) were confirmed by isolation of Mycobacterium tuberculosis; however, 5 (31%) were culture-negative on initial screening in Minnesota. Seven cases (44%) were diagnosed during initial screening efforts, and 9 cases (56%) were diagnosed a mean of 19 months (range, 10-27 months) after their initial medical evaluation. Of these 9 cases, 6 (38% of all Tibetan cases) had isolates resistant to 1 or more antituberculous drugs, and 3 (19% of all Tibetan cases) were multidrug resistant (MDR TB). All 3 MDR TB cases were culture-negative on initial screening; these cases constituted 75% of the MDR TB isolates in Minnesota in 1994. The presence of MDR TB was associated with a known history of active TB in Asia (P<.02). Any abnormality on chest radiograph noted either during the Immigration and Naturalization Service screening evaluation in India (relative risk [RR], 5.2; P=.006) or on arrival in Minnesota (RR, 6.8; P=.005) was associated with an increased risk of subsequent active TB.
  
  
  CONCLUSIONS
  Tuberculosis infection is nearly universal among Tibetans settling in Minnesota. A single screening evaluation failed to detect the majority of TB cases among Tibetans. Even in the face of negative M tuberculosis cultures, persons with a history of active TB require particularly close follow-up.
authors.affiliation: Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis 55454-1015, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Truong
authors.forename: L L
authors.initials: LL
authors.lastname: Hedemark
authors.forename: J K
authors.initials: JK
authors.lastname: Mickman
authors.forename: L B
authors.initials: LB
authors.lastname: Mosher
authors.forename: S E
authors.initials: SE
authors.lastname: Dietrich
authors.forename: P W
authors.initials: PW
authors.lastname: Lowry
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016358:Contact Tracing; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008297:Male; D008400:Mass Chest X-Ray; D008403:Mass Screening; D008910:Minnesota / Q000453:epidemiology; D009390:Nepal / Q000208:ethnology; D012036:Refugees; D012189:Retrospective Studies; D012307:Risk Factors; D018609:Tibet / Q000208:ethnology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents