title: High Rates of Tuberculosis and Opportunities for Prevention among International Students in the United States.
abstract: BACKGROUND
  Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years.
  
  
  OBJECTIVE
  To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population.
  
  
  METHODS
  Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions.
  
  
  RESULTS
  Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection.
  
  
  CONCLUSIONS
  The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Collins
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado; and.|3 Denver Health and Hospital, Denver, Colorado.
authors.forename: Randall R
authors.initials: RR
authors.lastname: Reves
authors.affiliation: 2 Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado; and.|3 Denver Health and Hospital, Denver, Colorado.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Belknap
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D013183:Sputum / Q000382:microbiology; D013334:Students / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D014481:United States; D014495:Universities; D055815:Young Adult
keywords: early diagnosis; emigrants and immigrants; mass screening; universities