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. 2016 Mar;22(3):463-8.
doi: 10.3201/eid2203.140732.

Improved Detection of Tuberculosis and Multidrug-Resistant Tuberculosis among Tibetan Refugees, India

Kerry L Dierberg, Kunchok Dorjee, Fulvio Salvo, Wendy A Cronin, J'Belle Boddy, Daniela Cirillo, Tsetan Sadutshang, Richard E Chaisson

Improved Detection of Tuberculosis and Multidrug-Resistant Tuberculosis among Tibetan Refugees, India

Kerry L Dierberg et al. Emerg Infect Dis. 2016 Mar.

Abstract

The incidence of tuberculosis (TB) among Tibetan refugees in India is 431 cases/100,000 persons, compared with 181 cases/100,000 persons overall in India in 2010. More than half of TB cases in these refugees occur among students, monks, and nuns in congregate settings. We sought to increase TB case detection rates for this population through active case finding and rapid molecular diagnostics. We screened 27,714 persons for symptoms of TB and tested 3,830 symptomatic persons by using an algorithm incorporating chest radiography, sputum smear microscopy, culture, and a rapid diagnostic test; 96 (2.5%) cases of TB were detected (prevalence 346 cases/100,000 persons). Of these cases, 5% were multidrug-resistant TB. Use of the rapid diagnostic test and active case finding enabled rapid detection of undiagnosed TB cases in congregate living settings, which would not have otherwise been identified. The burden of TB in the Tibetan exile population in India is extremely high and requires urgent attention.

Keywords: India; TB; Tibet; Xpert MTB/RIF; active case finding; bacteria; incidence; multidrug-resistant tuberculosis; prevalence; rapid molecular diagnostics; refugees; tuberculosis; tuberculosis and other mycobacteria.

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Figures

Figure
Figure
Diagnostic algorithm for improved detection of tuberculosis (TB) and multidrug-resistant TB (MDR TB) among Tibetan refugees, India. GeneXpert, Xpert MTB/RIF test (Cepheid, Sunnyvale, CA, USA). MTB, Mycobacterium tuberculosis; RIF, rifampin; –, negative; +, positive.
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