Tuberculosis and the Immigrant Community
Tuberculosis (TB) is a highly infectious, potentially fatal airborne disease that has plagued the world for centuries. Only recently has COVID-19 surpassed TB in infection and mortality rates. Approximately one-third of the world's population is infected with TB, with China, India, and African countries bearing the brunt of the disease burden.
About a quarter of the applicants that Dr. Ungar works with are infected with TB. Factors such as genetic predisposition, vitamin D deficiency, and co-morbidities like diabetes mellitus and HIV—which disproportionately affect migrants and ethnic minorities—have been found to increase vulnerability to Mycobacterium tuberculosis infections.
Moreover, deportation during treatment and poor adherence can lead to drug-resistant illness, poor outcomes, and the spread of infection. Migrants in detention centers or those being trafficked often live in poor conditions for extended periods, increasing their exposure to TB.
The Symptoms of Tuberculosis in Immigrants
While TB can affect any part of the body, it most commonly targets the lungs. Respiratory failure due to lung damage is the leading cause of death.
Other symptoms include:
Fever
Chills
Night sweats
Fatigue
Loss of appetite
Weight loss
Coughing up blood
Shortness of breath
Chest discomfort
Due to the severe weight loss associated with active TB, the disease is sometimes referred to as "consumption."
Screening Practices for Tuberculosis in Immigrants
In the early 20th century, TB was a common and leading cause of death in the United States, claiming one in seven American lives. The U.S. has since worked diligently to eradicate TB through extensive screening, monitoring, and treatment programs. To prevent TB reintroduction, all immigration candidates aged two and older must undergo TB screening as part of their medical examination. A blood test called the IGRA is now used for screening, replacing the earlier, less reliable skin tests like PPD or TST.
Our Tuberculosis Control with a Special Focus on Immigrants
TB has two stages: a latent or asymptomatic phase (LTBI) and an active or symptomatic phase (ATBI). In otherwise healthy individuals, about 10% of infections progress to active TB, which is lethal and contagious. Therefore, we focus on treating TB during the latent phase to reduce the conversion rate.
While many countries use the BCG vaccine to prevent TB, we don't employ it as it's ineffective in adults and causes false-positive TST readings. Our primary step is to check the IGRA test results. If positive, we proceed with a chest X-ray to assess the infection's severity. For abnormal X-rays or symptomatic applicants, we refer them to the local health department for further testing, which may take several months.
Proven active TB infection is a medically disqualifying condition that must be treated before an immigration status adjustment is made and a report issued. Proven latent TB infection is a Class B non-medically disqualifying condition, allowing for status modification. While we strongly recommend LTBI treatment, it's not mandatory for immigration purposes.