Abstract
BackgroundForeign-born individuals comprise >50% of tuberculosis (TB) cases in the U.S. Since anti-TB drug resistance is more common in most other countries, when evaluating a foreign-born individual for TB, one must consider the risk of drug resistance. Naturally, clinicians query The Global Project on Anti-tuberculosis Drug Resistance Surveillance (Global DRS) which provides population-based data on the prevalence of anti-TB drug resistance in 127 countries starting in 1994. However, foreign-born persons in the U.S. are a biased sample of the population of their countries of origin, and Global DRS data may not accurately predict their risk of drug resistance. Since implementing drug resistance surveillance in 1993, the U.S. National TB Surveillance System (NTSS) has accumulated systematic data on over 130,000 foreign-born TB cases from more than 200 countries and territories. Our objective was to determine whether the prevalence of drug resistance among foreign-born TB cases correlates better with data from the Global DRS or with data on foreign-born TB cases in the NTSS.Methods and FindingsWe compared the prevalence of resistance to isoniazid and rifampin among foreign-born TB cases in the U.S., 2007–2009, with US NTSS data from 1993 to 2006 and with Global DRS data from 1994–2007 visually with scatterplots and statistically with correlation and linear regression analyses. Among foreign-born TB cases in the U.S., 2007–2009, the prevalence of isoniazid resistance and multidrug resistance (MDR, i.e. resistance to isoniazid and rifampin), correlated much better with 1993–2006 US surveillance data (isoniazid: r = 0.95, P<.001, MDR: r = 0.75, P<.001) than with Global DRS data, 1994–2007 (isoniazid: r = 0.55, P = .001; MDR: r = 0.50, P<.001).ConclusionSince 1993, the US NTSS has accumulated sufficient data on foreign-born TB cases to estimate the risk of drug resistance among such individuals better than data from the Global DRS.
Highlights
Since 2001, over half of the tuberculosis (TB) cases in the United States (U.S.) have occurred in people who were born outside the U.S and the prevalence of drug resistance is up to 6fold higher among foreign-born than U.S.-born TB cases [1,2]
Since 1993, the United States (US) National TB Surveillance System (NTSS) has accumulated sufficient data on foreign-born TB cases to estimate the risk of drug resistance among such individuals better than data from the Global Drug Resistance Surveillance (DRS)
The World Health Organization (WHO)/International Union Against Tuberculosis and Lung Diseases (IUATLD) Global Project on Anti-Tuberculosis Drug Resistance Surveillance (DRS) (Global DRS) reported that among all incident TB cases in 2008 globally, 3.6% are estimated to have multidrug-resistant (MDR) TB, defined as TB caused by strains of Mycobacterium tuberculosis (MTB) that are resistant to at least isoniazid (INH) and rifampin (RIF) [3]
Summary
Since 2001, over half of the tuberculosis (TB) cases in the United States (U.S.) have occurred in people who were born outside the U.S and the prevalence of drug resistance is up to 6fold higher among foreign-born than U.S.-born TB cases [1,2]. Since anti-TB drug resistance is more common in most other countries, when evaluating a foreign-born individual for TB, one must consider the risk of drug resistance. Global DRS data may be used to guide evaluation and management of foreign-born TB cases in the U.S because they provide population-based estimates of the patterns of drug resistance in the countries where the Global DRS has been carried out. Foreign-born individuals comprise .50% of tuberculosis (TB) cases in the U.S Since anti-TB drug resistance is more common in most other countries, when evaluating a foreign-born individual for TB, one must consider the risk of drug resistance. Clinicians query The Global Project on Anti-tuberculosis Drug Resistance Surveillance (Global DRS) which provides population-based data on the prevalence of anti-TB drug resistance in 127 countries starting in 1994.
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