Tuberculosis Disease and Infection in US-Bound International Adoptees: 2016 to 2023

Objective The objective of this study was to evaluate required culture-based overseas tuberculosis (TB) screening in US-bound international adoptees. Methods We conducted a cross-sectional analysis of 22 053 international adoptees who underwent TB screening overseas and arrived in the United States during 2016 to 2023. Results Of 22 053 international adoptees (aged younger than 18 years) screened for TB overseas, 12 (54 cases/100 000 persons) were diagnosed with TB disease, and 169 (766 cases/100 000 persons) had suspected TB disease (defined for this analysis as a chest radiograph or clinical signs/symptoms suggestive of TB or known HIV infection but negative sputum culture results overseas). Of 15 386 persons who underwent a tuberculin skin test (TST) or interferon-γ release assay (IGRA) overseas, 390 (2.5%) were diagnosed with latent TB infection (LTBI). Among 12 persons who initiated treatment of TB disease overseas, 10 (83.3%) completed post-arrival evaluation in the United States; of these, none were diagnosed with TB disease after arrival. Among 169 persons diagnosed overseas with suspected TB disease, 108 (63.9%) completed post-arrival evaluation; of these, 2 (1.9%) were diagnosed with TB disease. Among 390 persons diagnosed overseas with LTBI, 220 (56.4%) completed post-arrival evaluation; of these, none were diagnosed with TB disease. Of 150 persons diagnosed with LTBI at post-arrival evaluation, 137 (91.3%) were recommended for treatment; of these, 104 (75.9%) initiated and 79 (57.7%) completed treatment. Conclusions US-bound international adoptees have a similarly high prevalence of TB disease compared with US-bound immigrant and refugee children, highlighting the importance of TB screening before immigration and ensuring timely recommended post-arrival evaluation.