title: Tuberculosis in a low-incidence US area: local consequences of global disruptions.
abstract: METHODS
  Tuberculosis (TB) in the United States is increasingly concentrated among foreign-born persons. The northeastern states, including Connecticut, are among those with the highest proportion of foreign-born patients.
  
  
  METHODS
  This retrospective analysis of surveillance data from Connecticut for 1996 through 2005 compared TB case rates and risk factors among US-born and foreign-born persons.
  
  
  RESULTS
  Between 1996 and 2005, TB cases declined by 8.7% in foreign-born persons and by 53.6% in US-born persons. The median annual incidence rate for foreign-born persons was 19.7 cases per 100000 population compared with 1.5 for US-born persons. Refugees had the highest TB rate (116 cases/100000) in the first year of their arrival. Resistance to any drug was more common among foreign-born persons (15.0%) than among US-born persons (9.3%). Although the proportion of multidrug-resistant TB was highest among foreign-born persons with prior TB (5.6%), most cases occurred in those without prior TB. Risk factors for TB, such as human immunodeficiency virus infection, drug use, incarceration and homelessness, were more common among US-born TB patients than among foreign-born patients.
  
  
  CONCLUSIONS
  Although TB case rates for US-born persons in Connecticut have declined dramatically, foreign-born persons, including refugees fleeing conflict, contribute disproportionately to the TB burden. Future efforts to eliminate TB must be directed toward immigrants and refugees.
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mark.lobato@ct.gov
authors.forename: M N
authors.initials: MN
authors.lastname: Lobato
authors.forename: M H
authors.initials: MH
authors.lastname: Mohamed
authors.forename: J L
authors.initials: JL
authors.lastname: Hadler
mesh_terms: D000328:Adult; D003237:Connecticut / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D006801:Humans; D012036:Refugees / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000208:ethnology*; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology