title: Tuberculosis among Tibetan refugee claimants in Toronto: 1998 to 2000.
abstract: OBJECTIVE
  Between 1998 and 2000, approximately 525 Tibetan people previously living in the United States claimed refugee status in Canada, many of whom were referred to our centers for completion of tuberculosis (TB) screening. We reviewed TB-related outcomes in this cohort, to compare our experience with previously published work, and to assess follow-up after a stay in a low-incidence region.
  
  
  METHODS
  We performed a retrospective study of all patients of Tibetan origin assessed at our centers (St. Michael's Hospital and West Park Healthcare Centre, both in Toronto) for completion of TB screening, referred because of abnormal chest radiographic findings or positive tuberculin skin test (TST) result. We compared rates of active and drug-resistant TB in our cohort with local and national rates, as well as those previously published in similar groups.
  
  
  RESULTS
  One hundred eighty-nine individuals were referred to us for assessment, and 181 records were available for review. The mean duration of stay in Canada prior to presentation was 2.6 months, after having spent a mean of 11 months in the United States. Thirty-two percent of patients gave a history of previous TB, and 97% were TST positive. Culture-positive TB was diagnosed in 24 patients (13%, 4,571 per 100,000), 12 patients had at least one drug resistance (50% of cases), and 4 patients were resistant to at least isoniazid and rifampin (multidrug resistant, 17% of cases).
  
  
  CONCLUSIONS
  People from highly TB endemic areas retain a very high risk of active TB and drug resistance, despite an intervening period in a low-prevalence country. It is important to maintain a high degree of suspicion for TB in all people from high-incidence areas. Treatment of all cases of latent TB infection or ongoing medical surveillance is likely justified in this population.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ted.marras@utoronto.ca
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Marras
authors.forename: Jean
authors.initials: J
authors.lastname: Wilson
authors.forename: Elaine E L
authors.initials: EE
authors.lastname: Wang
authors.forename: Monica
authors.initials: M
authors.lastname: Avendano
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Yang
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D009864:Ontario; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018609:Tibet / Q000208:ethnology; D014374:Tuberculin Test; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents