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December 27, 1995

Screening for Tuberculosis-Reply

Author Affiliations

Baylor College of Medicine Houston, Tex

JAMA. 1995;274(24):1913-1914. doi:10.1001/jama.1995.03530240022032

In Reply.  —Dr Bayuk has correctly pointed out several of the current problems and debates concerning TB control among immigrants to the United States. Currently, 32% of all US TB cases occur among non—US-born persons.1 The rate of TB disease among non—US-born children is 13 times the rate among US-born children. Most children immigrating through established channels get neither a tuberculin skin test nor a chest radiograph since children rarely have contagious TB. However, some of the children with undetected TB infection will develop contagious TB after arrival in the United States, often within 5 years of arrival and at higher than expected rates.2While most countries (all but the United States and the Netherlands) have relied on BCG vaccination to try to prevent TB, the United States has emphasized detection of asymptomatic infection and treatment with chemotherapy. Both approaches have severe limitations. The BCG vaccines have limited

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