The authors wrote, “Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection disproportionately affect non–U.S.-born persons. Early identification and treatment are critical to reduce transmission, morbidity, and mortality, but little is known about screening in the United States.”
In September 2022, the researchers conducted this cross-sectional study in a large integrated California health system and evaluated TBI and HBV screening among patients aged ≥18 years who were born in countries with high TB burden (TB disease incidence rates ≥20/100,000 population) and/or HBV burden (hepatitis B surface antigen seroprevalence >2%).
The researchers noted that the countries with elevated TB burden among KPNC members are Mexico, the Philippines, China, India, Vietnam, El Salvador, and South Korea. The countries with high hepatitis B burden among KPNC members are the Philippines, China, Vietnam, and South Korea.
The results revealed that of the 510,361 non–U.S.-born persons born in countries with an elevated TB burden, 322,027 (63.1%) were from countries with a high HBV burden, and 188,334 (36.9%) were from countries with only a high TB burden. Moreover, among individuals from high TB and HBV burden countries, 29.6% were screened for TBI, 64.5% for HBV, 23.4% for both infections, and an estimated 9.9% of the cohort had TBI, and 3.1% had HBV infection. Among individuals born in countries with only a high TB burden, 27.9% were screened for TBI, and 7.5% had TBI.
Based on their findings, the authors concluded that in individuals born outside the U.S. in countries with an elevated prevalence of TB and HBV, observations revealed low screening rates and a high prevalence of TBI and chronic HBV infection. The authors also noted that testing for both TBI and HBV in high-risk populations could augment outcomes by recognizing individuals needing TBI treatment, HBV treatment, or HBV vaccination. They added that expanding screening efforts is critical for diminishing health disparities and the overall disease burden.
In a press release, senior author Jacek Skarbinski, MD, a research scientist working in the Kaiser Permanente Division of Research and infectious diseases physician with The Permanente Medical Group, stated, “Both of these infections are prevalent in people born in high-burden countries and can lead to severe disease or even death. We have a lot of tools and strategies to prevent and treat both infections to help people lead healthier lives.”
“This is really a key demographic to focus on,” stated lead author Jenna Wick, MD, who carried out the work while a medical resident with KPNC and is now an infectious diseases fellow at Stanford University. Dr. Wick added, “Multiple factors contribute to low screening rates, but there is a great opportunity to use this information to identify patients who could benefit from prevention or treatment.”
Dr. Skarbinski added, “We have treatment for latent TB infection that greatly reduces your risk of ever developing active TB disease. For hepatitis B, we have screening and prevention strategies, including immunization. There’s huge preventive value to testing for these infections.”
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