Tuberculosis control among people in U.S. Immigration and Customs Enforcement custody.

BACKGROUND: People detained by United States Immigration and Customs Enforcement (ICE) are a high-risk population for tuberculosis (TB). Detainees are screened for TB upon intake, and TB patients are reported to the Division of Immigration Health Services (DIHS). METHODS: TB case reports were reviewed for ICE detainees reported to DIHS during 2004-2005. Case counts and frequency distributions are presented. Case counts are stratified by demographic characteristics, release status, laboratory and clinical findings, HIV/AIDS status, and drug resistance. Case rates were calculated for patients housed at facilities with DIHS staffing. Duration of treatment and of ICE custody is provided. Analyses were conducted in 2006. RESULTS: During 2004 and 2005, 76 and 142 TB patients were reported, respectively. The TB case rate was 82.6/100,000 in 2004 and 121.5/100,000 in 2005. The culture-confirmed case rate of 55.8/100,000 in 2005 was 2.5 times higher than the case rate in the U.S. foreign-born population. Of 218 patients, 127 (58.3%) had Mycobacterium tuberculosis-positive sputum cultures, 70 (32.1%) had acid-fast bacilli-positive sputum smears, and 36 (16.5%) were symptomatic at diagnosis. Patients from Mexico, Honduras, Guatemala, and El Salvador accounted for 184 cases (84.4%) and 184 patients (84.4%) were repatriated. TB patients spent an average 82.6 days in treatment before release or repatriation. CONCLUSIONS: Screening at intake to ICE custody has helped DIHS staff in diagnosing TB and starting patients on treatment, but patients are usually deported before completing therapy. Because of deportation, and sometimes re-entry into the United States, unique collaborations are required to support completion of treatment.

Human cargo: health conditions of Chinese migrants interdicted offshore by U.S. authorities.

During the eight month period between April and December 1999, the United States Coast Guard intercepted seven boats carrying migrants from the People's Republic of China destined for the United States. These migrants were processed by the United States Immigration and Naturalization Service in three locations: Tinian Island, Midway Island, and Guatemala. Emergency Medical Response Teams from the United States Public Health Service, Division of Immigration Health Services, were deployed to conduct initial health screenings of the 913 migrants on board these ships and provide on-going health care until the individuals were repatriated or relocated. The distributions of demographic characteristics of the population and the health conditions observed are presented. Differences in health conditions observed by temporary detention location, sex, and age group were assessed. The majority of migrants were males younger than age 30. Few serious illnesses were observed. The most prevalent conditions included skin rashes, fungal rashes, upper respiratory infections, abdominal discomfort, scabies, abrasions, skin lesions, headache, pain and/or injuries, dental problems, and ear problems. For many health conditions, statistically significant differences were observed by location. For nearly all conditions for which differences were observed by sex, these differences were accounted for by a greater proportion of females presenting with the condition.

Can cervicography be improved? An evaluation with arbitrated cervicography interpretations.

OBJECTIVE: The purpose of this study was to estimate the optimal performance of cervicography. We compared an arbitrated cervigram classification with an arbitrated referent diagnosis of cervical neoplasia. STUDY DESIGN: From an initial group of 8460 women, a stratified sample of cervigrams from 3645 women and histologic information from 414 women underwent arbitration. Interobserver agreement was assessed for cervicography and the referent diagnosis. Sensitivity, specificity, and predictive values were estimated for initial and arbitrated cervicography results, compared with the initial and arbitrated referent diagnoses. RESULTS: For the detection of arbitrated high-grade lesions or cancer, arbitrated cervicography yielded an overall sensitivity of 63.9% and a specificity of 93.7%. Significantly higher sensitivity was associated with younger age and age-related visual characteristics. CONCLUSION: Optimization of the cervigram classification improved performance over a single interpretation in this population but suggested the limits of static visual screening.