title: Is Universal Screening Necessary? Incidence of Tuberculosis among Tibetan Refugees Arriving in Calgary, Alberta.
abstract: Background. Canadian policy requires refugees with a history of tuberculosis (TB) or abnormal chest radiograph to be screened after arrival for TB. However, Tibetan refugees are indiscriminately screened, regardless of preimmigration assessment. We sought to determine the incidence of latent (LTBI) and active TB, as well as treatment-related outcomes and associations between preimmigration factors and TB infection among Tibetan refugees arriving in Calgary, Alberta.Design. Retrospective cohort study including Tibetan refugees arriving between 2014 and 2016. Associations between preimmigration factors and incidence of latent and active TB were determined using Chi-square tests.Results. Out of 180 subjects, 49 percent had LTBI. LTBI was more common in migrants 30 years of age or older (P= 0.009). Treatment initiation and completion rates were high at 90 percent and 76 percent, respectively. No associations between preimmigration factors and treatment completion were found. A case of active TB was detected and treated.Conclusion. Within this cohort, the case of active TB would have been detected through the usual postsurveillance process due to a history of TB and abnormal chest radiograph. Forty-nine percent had LTBI, compared to previously quoted rates of 97 percent. Tibetan refugees should be screened for TB in a similar manner to other refugees resettling in Canada.
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Rachel
authors.identifier: 0000-0003-4449-4447
authors.initials: R
authors.lastname: Lim
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Jarand
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Field
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000416:Alberta / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008403:Mass Screening; D013902:Radiography, Thoracic; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D018609:Tibet / Q000208:ethnology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents