Tuberculosis in illegal foreign fishermen: whose public health are we protecting?

Abstract

OBJECTIVE: To document demographic details, prevalence of tuberculosis (TB), and completion of TB treatment in illegal foreign fishermen detained in Australia. DESIGN AND PARTICIPANTS: Clinical audit of 1471 illegal foreign fishermen who underwent health assessments in Darwin between 28 September 2005 and 31 December 2006. MAIN OUTCOME MEASURES: Demographic details, diagnoses of smear-positive and culture-positive TB, drug sensitivity results and treatment completion. RESULTS: 1471 illegal fishermen underwent health assessments, including chest x-ray screening. All were male and 93.8% were from Indonesia. Of the 31 fishermen (2.1%) admitted to hospital with chest x-rays suggestive of TB, 20 were diagnosed with TB (15 culture-proven; 5 according to clinical and radiological criteria) and 18 commenced treatment. There were 8 smear-positive cases and one multidrug-resistant TB case. The prevalence of culture-positive TB was very high at 1020 per 100 000 patients. All fishermen were deported before treatment completion, and all were lost to follow-up. CONCLUSIONS: The health assessment process successfully detected cases of TB in illegal foreign fishermen, enabling treatment to commence and the local public's health to be protected. Treatment completion in illegal foreign fishermen may be as low as zero; deporting fishermen before curative treatment is completed undermines TB control efforts and may lead to an emergence of drug resistance and an increased burden of active TB disease in our region.