Background In the United States, an increasingly disproportionateburden of tuberculosis among the foreign-born population hasled to calls for improvements in the detection and treatmentof latent infection in new immigrants. Current treatment guidelinesdo not take into account global differences in drug-resistancepatterns or their implications for the treatment of immigrants.The use of multinational surveillance systems to guide the managementof latent infection according to region-specific drug-resistanceprofiles could improve the efficiency of efforts to reduce theburden of tuberculosis in immigrants to the United States.
Methods We constructed a decision-analysis model by using ahypothetical cohort of all documented immigrants entering theUnited States from developing nations. Region-specific drug-resistanceprofiles were derived from data on 30,388 cases of infection.The model examined the effectiveness and cost effectivenessof four strategies: no intervention or tuberculin skin testingfollowed by treatment with isoniazid, treatment with rifampin,or treatment with rifampin plus pyrazinamide for those witha positive test result.
Results A strategy of detecting and treating latent tuberculosisinfection was cost-saving among immigrants from Mexico, Haiti,sub-Saharan Africa, South Asia, and developing nations in EastAsia and the Pacific. This strategy was highly cost effectiveamong immigrants from other developing nations. Rifampin pluspyrazinamide was the preferred strategy for treating latentinfection in immigrants from Vietnam, Haiti, and the Philippines.
Conclusions For new immigrants to the United States from developingnations, a strategy of detecting and treating latent tuberculosisinfection would lead to substantial health and economic benefits.Because of the high prevalence of resistance to isoniazid, treatmentwith a rifampin-containing regimen should be strongly consideredfor immigrants from Vietnam, Haiti, and the Philippines.
Source Information
From the Department of Public Health (K.K.), the Department of Medicine, Division of International Medicine and Infectious Diseases (K.K.), and the Department of Pharmacy (M.B.), New York Presbyterian Hospital and Weill Medical College of Cornell University, New York; the Program in General Public Health (K.K.) and the Department of Health Policy and Management (J.G.Z.), Joseph L. Mailman School of Public Health, and the International Center for Health Outcomes and Innovation Research (J.G.Z.), Columbia University, New York; and the Sophie Davis School of Biomedical Education, City University of New York, New York (P.M.).
Address reprint requests to Dr. Khan at the Inner City Health Research Unit, St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada, or at km.khan{at}utoronto.ca.
Management of Latent Tuberculosis Infection in Immigrants
Marks S. M., Ijaz K., Iademarco M. F., Sterling T., Munsiff S. S., Frieden T. R., Menzies D., Schwartzman K., Jenny-Avital E. R., Khan K., Muennig P., Zivin J. G.
Extract |
Full Text |
PDF
N Engl J Med 2003;
348:1289-1292, Mar 27, 2003.
Correspondence
This article has been cited by other articles:
Neumann, P. J., Jacobson, P. D., Palmer, J. A.
(2008). Measuring the Value of Public Health Systems: The Disconnect Between Health Economists and Public Health Practitioners. Am. J. Public Health
98: 2173-2180
[Abstract][Full Text]
Menzies, D., Long, R., Trajman, A., Dion, M.-J., Yang, J., Al Jahdali, H., Memish, Z., Khan, K., Gardam, M., Hoeppner, V., Benedetti, A., Schwartzman, K.
(2008). Adverse Events with 4 Months of Rifampin Therapy or 9 Months of Isoniazid Therapy for Latent Tuberculosis Infection: A Randomized Trial. ANN INTERN MED
149: 689-697
[Abstract][Full Text]
Khan, K., Wang, J., Hu, W., Bierman, A., Li, Y., Gardam, M.
(2008). Tuberculosis Infection in the United States: National Trends over Three Decades. Am. J. Respir. Crit. Care Med.
177: 455-460
[Abstract][Full Text]
Rathore, M. H., Alvarez, A.
(2007). Is it Time to Revisit Short-Course Therapy for Latent TB Infection?. AAP Grand Rounds
18: 66-66
[Full Text]
Menzies, D., Pai, M., Comstock, G.
(2007). Meta-analysis: New Tests for the Diagnosis of Latent Tuberculosis Infection: Areas of Uncertainty and Recommendations for Research. ANN INTERN MED
146: 340-354
[Abstract][Full Text]
Cain, K. P., Haley, C. A., Armstrong, L. R., Garman, K. N., Wells, C. D., Iademarco, M. F., Castro, K. G., Laserson, K. F.
(2007). Tuberculosis among Foreign-born Persons in the United States: Achieving Tuberculosis Elimination. Am. J. Respir. Crit. Care Med.
175: 75-79
[Abstract][Full Text]
Page, K. R., Sifakis, F., Montes de Oca, R., Cronin, W. A., Doherty, M. C., Federline, L., Bur, S., Walsh, T., Karney, W., Milman, J., Baruch, N., Adelakun, A., Dorman, S. E.
(2006). Improved Adherence and Less Toxicity With Rifampin vs Isoniazid for Treatment of Latent Tuberculosis: A Retrospective Study.. Arch Intern Med
166: 1863-1870
[Abstract][Full Text]
Brewin, P., Jones, A., Kelly, M., McDonald, M., Beasley, E., Sturdy, P., Bothamley, G., Griffiths, C.
(2006). Is screening for tuberculosis acceptable to immigrants? A qualitative study. J Public Health (Oxf)
28: 253-260
[Abstract][Full Text]
Caws, M., Duy, P. M., Tho, D. Q., Lan, N. T. N., Hoa, D. V., Farrar, J.
(2006). Mutations Prevalent among Rifampin- and Isoniazid-Resistant Mycobacterium tuberculosis Isolates from a Hospital in Vietnam.. J. Clin. Microbiol.
44: 2333-2337
[Abstract][Full Text]
Gany, F., Changrani, J.
(2005). GANY AND CHANGRANI RESPOND. Am. J. Public Health
95: 1675-1675
[Full Text]
Schwartzman, K., Oxlade, O., Barr, R. G., Grimard, F., Acosta, I., Baez, J., Ferreira, E., Melgen, R. E., Morose, W., Salgado, A. C., Jacquet, V., Maloney, S., Laserson, K., Mendez, A. P., Menzies, D.
(2005). Domestic Returns from Investment in the Control of Tuberculosis in Other Countries. NEJM
353: 1008-1020
[Abstract][Full Text]
Reichman, L. B., Lardizabal, A., Hayden, C. H.
(2004). Considering the Role of Four Months of Rifampin in the Treatment of Latent Tuberculosis Infection. Am. J. Respir. Crit. Care Med.
170: 832-835
[Full Text]
Menzies, D., Dion, M.-J., Rabinovitch, B., Mannix, S., Brassard, P., Schwartzman, K.
(2004). Treatment Completion and Costs of a Randomized Trial of Rifampin for 4 Months versus Isoniazid for 9 Months. Am. J. Respir. Crit. Care Med.
170: 445-449
[Abstract][Full Text]
Cazzadori, A., Allegranzi, B., Scardigli, A., Favari, F., Concia, E.
(2004). Is the Recommendation Not To Use Rifampin Plus Pyrazinamide for Latent Tuberculosis Treatment Always Imperative?. Chest
126: 657-658
[Full Text]
Dahle, U. R
(2004). Compulsory screening of immigrants for TB and HIV: Screening could detect latent infection. BMJ
328: 897-897
[Full Text]
ADA COUNCIL ON SCIENTIFIC AFFAIRS,
(2004). Combating antibiotic resistance. Journal of the American Dental Association
135: 484-487
[Abstract][Full Text]
Menzies, D.
(2003). Screening immigrants to Canada for tuberculosis: Chest radiography or tuberculin skin testing?. CMAJ
169: 1035-1036
[Full Text]
Weir, E., Fisman, D. N.
(2003). Latent tuberculosis: revised treatment guidelines. CMAJ
169: 937-938
[Full Text]
Chen, L. H., Barnett, E. D., Wilson, M. E.
(2003). Preventing Infectious Diseases during and after International Adoption. ANN INTERN MED
139: 371-378
[Abstract][Full Text]
(2003). ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB. Evid. Based Med.
8: 131-131
[Full Text]
Marras, T. K., Wilson, J., Wang, E. E. L., Avendano, M., Yang, J. W.
(2003). Tuberculosis Among Tibetan Refugee Claimants in Toronto: 1998 to 2000. Chest
124: 915-921
[Abstract][Full Text]
(2003). OTHER ARTICLES NOTED (25 Oct 02 to 17 Jan 03). Evid. Based Nurs.
6: e1-7
[Full Text]
Marks, S. M., Ijaz, K., Iademarco, M. F., Sterling, T., Munsiff, S. S., Frieden, T. R., Menzies, D., Schwartzman, K., Jenny-Avital, E. R., Khan, K., Muennig, P., Zivin, J. G.
(2003). Management of Latent Tuberculosis Infection in Immigrants. NEJM
348: 1289-1292
[Full Text]
Jasmer, R. M., Nahid, P., Hopewell, P. C.
(2002). Latent Tuberculosis Infection. NEJM
347: 1860-1866
[Full Text]
Previous
