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.
Highlights
Increasing globalization and population mobility call for joint efforts among developed and developing countries aimed at the elimination of tuberculosis (TB)
One patient had a history of nontuberculous mycobacterium (NTM) infection, another had TB lymphadenitis, and a third patient had TB uveitis in the past; all had treatment
We found that the diagnosis of latent tuberculosis infection (LTBI) was significantly associated with age greater than 30 years
Summary
Increasing globalization and population mobility call for joint efforts among developed and developing countries aimed at the elimination of tuberculosis (TB). In 2012, immigrants and refugees accounted for 64 percent of reported cases of active TB in Canada [1]. Most cases of active TB are due to reactivation of latent tuberculosis infection (LTBI), rather than primary infection [2]. Canadian policy requires refugees with a history of tuberculosis (TB) or abnormal chest radiograph to be screened after arrival for TB. 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. Associations between preimmigration factors and incidence of latent and active TB were determined using Chi-square tests. 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.
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