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Tuberculosis in South-East Asian refugees after resettlement--can prevention be improved by better policy and practice?

OBJECTIVE
This study aimed to determine whether incident cases of tuberculosis (TB) in a cohort of South-East Asian refugees followed for 5 years after resettlement were potentially preventable and whether prevention of TB was optimal in a state refugee TB screening program in Victoria, Australia.


DESIGN
A retrospective cohort study of 1,101 refugees from Laos, Cambodia, and Vietnam screened for TB in the 6-month period from July 1989 to January 1990 was conducted. Incident cases of TB were identified by matching each refugee with the TB notification database for 5 years from the date of initial screening. Preventability was assessed for incident cases by reviewing medical records. Screening guidelines and practice were reviewed.


RESULTS
The main outcome was the preventability of cases of active tuberculosis that developed in the study population in the first 5 years after resettlement. The incidence of active TB was 363/100,000 during the first year and 109/100,000/year during the first 5 years. Five of six incident cases were assessed as potentially preventable, which if prevented would have resulted in an annual incidence of 18/100,000 over the first 5 years. Use of a more sensitive skin test definition of infection would have made an additional 245 refugees eligible for prevention and potentially prevented an additional 25 cases of TB over a lifetime.


CONCLUSIONS
There is a high incidence of tuberculosis among SE Asian refugees, particularly in the first year after resettlement. A large proportion of TB may be preventable. Improvement in case prevention may be possible with updated guidelines and better implementation of screening policy.