To the Editor.
—The review of tuberculosis (TB) surveillance data by Dr Cantwell and colleagues1 highlights non—US-born individuals as the source of 60% of the total increase in TB cases in the United States and acknowledges specific concerns about overseas diagnosis of TB and follow-up after immigration to the United States. The large potential contribution of active TB cases by migrants is demonstrated by data retrieved from the Immigration Examination Clinic in Manila, Philippines, and a brief summary of current screening procedures.One purpose for the immigration medical examination is to exclude applicants with infectious TB.2 This is determined by an abnormal chest roentgenogram (CXR) and whether or not the sputum smear is positive or negative for tubercle bacilli. An applicant with a stable, abnormal CXR and negative sputum smears is eligible to migrate to the United States. An applicant with an abnormal CXR or series suggestive of active
Bayuk J. Tuberculosis Screening of Applicants for US Immigration. JAMA. 1995;273(4):286-287. doi:10.1001/jama.1995.03520280030028