title: Improved Detection of Tuberculosis and Multidrug-Resistant Tuberculosis among Tibetan Refugees, India.
abstract: The incidence of tuberculosis (TB) among Tibetan refugees in India is 431 cases/100,000 persons, compared with 181 cases/100,000 persons overall in India in 2010. More than half of TB cases in these refugees occur among students, monks, and nuns in congregate settings. We sought to increase TB case detection rates for this population through active case finding and rapid molecular diagnostics. We screened 27,714 persons for symptoms of TB and tested 3,830 symptomatic persons by using an algorithm incorporating chest radiography, sputum smear microscopy, culture, and a rapid diagnostic test; 96 (2.5%) cases of TB were detected (prevalence 346 cases/100,000 persons). Of these cases, 5% were multidrug-resistant TB. Use of the rapid diagnostic test and active case finding enabled rapid detection of undiagnosed TB cases in congregate living settings, which would not have otherwise been identified. The burden of TB in the Tibetan exile population in India is extremely high and requires urgent attention.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Dierberg
authors.forename: Kunchok
authors.initials: K
authors.lastname: Dorjee
authors.forename: Fulvio
authors.initials: F
authors.lastname: Salvo
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Cronin
authors.forename: J'Belle
authors.initials: J
authors.lastname: Boddy
authors.forename: Daniela
authors.initials: D
authors.lastname: Cirillo
authors.forename: Tsetan
authors.initials: T
authors.lastname: Sadutshang
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chaisson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012036:Refugees; D018609:Tibet / Q000208:ethnology; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: India; TB; Tibet; Xpert MTB/RIF; active case finding; bacteria; incidence; multidrug-resistant tuberculosis; prevalence; rapid molecular diagnostics; refugees; tuberculosis; tuberculosis and other mycobacteria