# Tuberculosis Disease Among Nonimmigrant Visa Holders Reported to US Quarantine Stations, January 2011–June 2016

## TL;DR

The study found that some non-immigrant visa holders in the US have tuberculosis, suggesting expanded screening could help reduce TB in the country.

## Contribution

The study identifies a potential gap in TB prevention by highlighting undiagnosed cases among non-immigrant visa holders.

## Key findings

- 114 cases of tuberculosis were reported among long-term non-immigrant visa holders from 2011 to 2016.
- 16% of these cases involved multidrug-resistant tuberculosis.
- Long-term non-immigrant visa holders were over-represented in TB cases despite being a small proportion of admissions.

## Abstract

US-bound immigrants and refugees undergo a mandatory overseas medical examination that includes tuberculosis screening; this exam is not routinely required for temporary visitors applying for non-immigrant visas (NIV) to visit, work, or study in the United States. US health departments and foreign ministries of health report tuberculosis cases in travelers to Centers for Disease Control and Prevention Quarantine Stations. We reviewed cases reported to this passive surveillance system from January 2011 to June 2016. Of 1252 cases of tuberculosis in travelers reported to CDC, 114 occurred in travelers with a long-term NIV. Of these, 83 (73%) were infectious; 18 (16%) with multidrug-resistant tuberculosis (MDR TB) and one with extensively drug-resistant tuberculosis (XDR TB). We found evidence that NIV holders are diagnosed with tuberculosis disease in the United States. Given that long-term NIV holders were over-represented in this data set, despite the small proportion (4%) of overall non-immigrant admissions they represent, expanding the US overseas migration health screening program to this population might be an efficient intervention to further reduce tuberculosis in the United States.