Need for continuing tuberculosis surveillance in previously screened new immigrants.

Abstract

Despite the advent of effective chemotherapy and improvement in socioeconomic conditions, tuberculosis remains a highly prevalent disease in certain countries. There are an estimated 30 million cases in the world, with an annual incidence of 10 million and a mortality of 3 million. 1 Although the new case rate in the United States in 1989 was 9.5:100,000, tuberculosis was nevertheless the leading cause of death among the 38 communicable diseases reported to the Centers for Disease Control. 2 The general trend toward a decline in tuberculosis incidence has slowed recendy. This decrease has been attributed in part to the reactivation of tuberculosis in persons immunosuppressed by the human immunodeficiency virus. 3 In the initial postindependence period, Israel experienced a high case rate of tuberculosis (216:100,000 in 1950), largely resulting from massive immigration from non-Western countries.4 More recendy (1980 1985) the risk of infection has gradually declined to an average annual case rate of 6.3:100,000.5•6 In contrast with the low national incidence, Halperin recendy reported a relatively high incidence in an Israeli family practice.7 During a 3-year period (19841986) 10 cases of active tuberculosis occurred among recent Ethiopian immigrants wh~ h~d negative chest radiographs and tuberculosIs skin tests when they entered Israel an average of 1.7 years before diagnosis. In an effort to assess the immigration screening program and find an explanation for these cases, we reviewed the results of the primary screening at entrance. to .the co~­ try of all new immigrants to our dIstnct dunng this period.