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.