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Description
Persons detained by the United States Immigration and Customs Enforcement (ICE) are often from countries with high prevalence of tuberculosis (TB) infection, and therefore TB disease. Screening for pulmonary TB (PTB) disease upon intake into ICE custody presents a unique opportunity to diagnose and begin treatment for persons in this subpopulation who may otherwise go undiagnosed and untreated. All ICE detainees with confirmed or suspected PTB disease reported to ICE Health Service Corps headquarters in 2014 as part of the ongoing active TB surveillance program were reviewed. Detainees with confirmed PTB disease identified during intake screening and reported during 2014 were included in the analysis. Clinical presentation, demographics, microbiologic data, and comorbid conditions were examined. Univariate analysis and multivariate modeling was used to investigate associations between age, sex, HIV status, clinical presentation, and the expression of symptoms prior to diagnosis of TB disease. 147 eligible subjects with confirmed PTB disease were included in the analysis. The largest proportions were from Honduras (25%), Guatemala (24%) and Mexico (19%). Based on the estimated total population of detainees screened in 2014, the rate of TB disease among detainees screened was 102 per 100,000. 73% of subjects with confirmed TB disease were asymptomatic at diagnosis. Subjects who were symptomatic had 16.7 (4.4-62.8) times higher odds of having cavitary lesions and had 2.3 (1.0-5.1) times higher odds of being smear positive. The incidence rate identified in this study, 102 per 100,000, is considerably higher than the equivalent rate for the overall US (3.0 per 100,000), for foreign-born persons living in the US (15.4 per 100,000), and for persons in their countries of nationality (21- 57/100,000); however, this value is consistent with previous surveillance conducted on the ICE detainee population. The statistically significant associations observed between reporting symptoms and the presence of cavitary lesions and/or AFB sputum smear positivity indicate that those who are symptomatic at intake have higher odds for infectivity. Conversely, since the majority of those identified with confirmed TB disease were asymptomatic, it can be concluded that the screening program effectively identifies PTB disease prior to more serious disease progression.
