Date of Award

Fall 5-15-2015

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Ruiyan Luo

Second Advisor

Dr. Sheryl Strasser



Background: According to Centers for Disease Control and Prevention (CDC) tuberculosis (TB) report TB case rate dropped from 3.2 to 3.0 per 100,000 person in 2013 in the U.S, which was a 4.3% decrease from 2012, but the proportion of total cases occurring in foreign-born persons reached to 65% of the national case total. This proportion has been increasing since 1993. Studies found that progression of latent tuberculosis infection (LTBI) to active TB (reactivation TB) contributed a large proportion to TB cases among foreign-born persons and posed a huge challenge to TB elimination in the U.S. The Division of Global Migration and Quarantine (DGMQ) in CDC provides Tuberculosis Screening and Treatment Technical Instructions (TB TI) for U.S.-bound immigrant and refugee overseas medical screening. The 2007 TB TI made several changes to enhance overseas medical screening for TB. One of them is requiring applicants aged 2-14 years who live in countries with a World Health Organization (WHO)-estimated TB incidence rate equal or higher than 20 cases per 100,000 population to have a tuberculin skin test (TST) or interferon gamma release assay (IGRA) to detect TB/LTBI.

Objectives: To assess LTBI prevalence among immigrant and refugee children aged 2-14 years who arrived in the United States in 2008-2012 and to explore demographic and geographic predictors among LTBI cases.

Methods: Using DGMQ data from 2008-2012, LTBI prevalence was calculated. Regression analyses were used to examine predictors of LTBI risk based upon geographic and select demographic characteristics (country of origin, sex, country-specific LTBI prevalence rate).

Results:LTBI prevalence of all 199 immigrant and refugee arrival countries vs top 16 arrival countries were 6.30% and 8.76%, respectively. Top 16 arrival countries contributed to 68.40% arrivals but contributed to 95.08% of LTBI cases. LTBI prevalence of both populations showed an increasing trend in 2008-2012. The highest five prevalence countries were the Philippines (42.74%) Vietnam (9.35%), Mexico (8.71%), Bhutan (8.31%) and China (7.80%). Regression coefficient estimates (i.e., log odds) for country of origin predictor were significant (p

Conclusions: Diagnosing and treating LTBI and continuing the battle against TB globally are critical to TB elimination in the U.S. 2007 TB TI has contributed to detecting LTBI cases, should be implemented vigorously in immigrant and refugee overseas medical screening. Receiving states should address their follow-up gaps to ensure the completion of TB/LTBI treatment. Resources need to be allocated properly to states with high TB/LTBI burden.