U.S. Immigrants Bearing More of the TB Burden

(Page 2)

Also, adding a sputum culture test (actually growing TB in culture) to the standard sputum smear (looking at sputum under a microscope) would have prevented the importation of about 250 cases of TB a year (there are about 7,000 TB cases among foreign-born persons annually in the United States).

"This is a nice, balanced study that gives a good perspective about what we could do potentially to reduce the incidence of TB in the U.S.," said Jeffrey Cirillo, an associate professor of microbial and molecular pathogenesis at Texas A&M Health Science Center College of Medicine, in College Station. "This is focusing us in the right direction."

Still, Cain acknowledged, "That is a relatively small piece of the overall problem, so clearly more needs to be done."

According to Cirillo, one-third of the world's population is infected with TB and a person dies from the respiratory illness every 15 to 20 seconds. Nine million people become infected with the TB bacterium each year, and 2 million die.

"We recognize national borders but microbes, including TB, don't," Cain said. "As long as TB is out of control globally, as it is, this will be a problem in the U.S. If you breathe, you're at risk for TB. This can affect anyone."

A second paper in the same issue of JAMA explored the difficulty of tackling TB in vulnerable, HIV-positive populations in "resource-limited" areas of the world.

The authors, from the University of California, San Francisco, proposed several strategies, including intensified efforts to identify HIV-positive patients with TB; treating individuals with active TB; making the antibacterial drug isoniazid and antiretroviral therapy more available; implementing TB infection control; and making sure health-care workers record and report TB cases.

More information

For more on tuberculosis, head to the U.S. Centers for Disease Control and Prevention.