Impact of International TB Control Efforts on TB Elimination in the US

This project examines the effects of immigration trends on TB epidemiology in the United States.

The national TB epidemic is increasingly being sustained by new TB cases among recent migrants, with 64% of new cases in the US coming from this foreign-born population (Alami et al. 2014). The trajectory of this trend will depend on several factors that impact both latent and active prevalence among migrants, including many beyond US borders. These include updated screening procedures of potential migrants to reduce the number of new active cases and TB control measures in sender countries. Recent changes in immigration patterns will also impact US TB incidence as the TB epidemiology differs between major sender countries.

We will extend our TB transmission model to include immigration data, including TB control scenarios in migrant sender countries, changes in immigration policy and screening procedures, and epidemiological trends in sender countries.

Our major research questions include:

• How is the epidemiology of TB in the United States influenced by trends in TB epidemiology in major sender countries?
• What would be the impact on the US TB epidemic—both in terms of magnitude and timing—of improved TB control in major sender countries? What would be the impact on domestic TB control spending?
• How does the magnitude of effects that might be generated through better TB control in major sender countries compare to TB control measures that might be implemented domestically?

Reference:

Alami, N. et al., 2014. Trends in Tuberculosis — United States, 2013. MMWR, 63(11), pp.229–233.