Tuberculosis Surveillance Report
Arizona, 2006

Arizona Department of Health Services
Bureau of Epidemiology and Disease Control
Office of Infectious Disease Services
October 2007

Tuberculosis Control Program
150 North 18th Avenue, Suite 140
Phoenix, Arizona 85007
(602) 364-4750

I.

Purpose of the Report

The Tuberculosis Annual Surveillance Report is designed to be a source of data
regarding tuberculosis (TB) in Arizona for purposes of prevention and control of the
disease through interventions, new or changes in policies, rules and statutes, allocation
of funds and planning services. The target audience includes government agencies,
health care organizations and providers and other interested parties or individuals. The
program can provide more detailed information upon request.

II.

TB Surveillance, Prevention, and Control in Arizona

The Arizona Department of Health Services (ADHS) Tuberculosis Control Program
(TBCP) is assigned the responsibility of monitoring, controlling and preventing infection,
disease, and death associated with TB statewide through surveillance, data analyses,
health education, dissemination of guidelines, consultation, and rule making. Tracking
TB disease, completion of therapy, and drug susceptibility results of new TB cases are
at the heart of the work of the TBCP. Other critical functions include monitoring the
contacts of cases with active TB. To that end, the program maintains registries to
monitor: (1) the occurrence, distribution, characteristics (risk factors), and trends of TB
morbidity; (2) completion of therapy; (3) TB drug-resistance patterns; and (4) the followup of persons exposed to active TB cases to ensure absence of latent TB infection
(LTBI) or medical evaluation and completion of preventive therapy if positive for LTBI.
The TBCP assesses the burden of disease/infection and the characteristics, distribution
and the risk factors associated with disease. The local health departments (county and
tribal) and the Indian Health Service units provide the direct patient care (tests, medical
evaluation, therapy, and contact investigations). Local health departments also
coordinate with private and other public providers (e.g., correctional health) who provide
these services to patients with active TB disease or LTBI.
The Arizona State Public Health Laboratory provides testing services including acid-fast
bacillus (AFB) smear, culture, identification, and drug susceptibility testing for clinical
mycobacterial samples statewide and serves as a reference laboratory for all isolates
suspected to be positive for TB. The State Laboratory also performs drug susceptibility
testing on all first time positive isolates.
We acknowledge with gratitude the efforts of all public and private providers (clinicians
and laboratorians) who make this report possible via their consistent and timely
reporting of disease and drug susceptibility results.

2

III.

Demographics

A.

Incidence of TB

Arizona reported 315 cases of active tuberculosis (TB) in 2006, ranking 11th among
reporting states in the U.S. This reflects a 12% increase from the previous year. While
the U.S. has seen a 34 % decline in the number of TB cases for the past 10 years
(1997-2006), Arizona has documented a relatively stable number of cases with a mean
of 279 cases and a range between 254 and 315 cases in the ten year period. (Table 1
and Figure 1). However, due to significant population growth in the past 10 years, TB
rates in Arizona have decreased from 6.2 cases per 100,000 population in 1997 to 5.0
in 2006.
Table 1. Tuberculosis Cases and Case Rates per 100,000 Population,
Arizona and United States, 1997-2006
United Statesa

Arizona
Year

Cases

Populationb,c

Rate

Cases

Rate

1997

296

4,736,990

6.2

19,851

7.4

1998

254

4,883,342

5.2

18,361

6.8

1999

262

5,023,823

5.2

17,531

6.4

2000

261

5,130,632

5.1

16,377

5.8

2001

289

5,306,966

5.4

15,989

5.6

2002

263

5,456,453

4.8

15,078

5.2

2003

295

5,580,811

5.3

14,871

5.1

2004

272

5,580,811

4.9

14,511

4.9

2005

281

6,044,985

4.6

14,093

4.8

2006

315

6,239,482

5.0

13,767

4.6

a

Data from U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, available at:
http://www.cdc.gov/tb/surv/
Population denominators for 1995-2003 are estimates from the National Center for Health Statistics
(http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm), with the exception of year 2000, which was taken from the
2000 U.S. Census
c
Population denominators for 2004 - 2006 are estimates provided by the Arizona Department of Economic Security
b

3

Figure 1. Tuberculosis Case Rates per 100,000 population,
Arizona and United States, 1997 - 2006
8.0

Cases per 100,000

7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year
Arizona

B.

United States

2010 Target (1/100,000)

Location

Four of Arizona’s 15 counties accounted for 93% of the state’s TB cases (Figure 2).
Maricopa County, which includes Phoenix, the fifth largest U.S city, led the state with
171 cases (54%). Pima County, a U.S.-Mexico border county that includes Tucson,
Arizona’s second largest urban area, had 35 cases (11%). Yuma County, the border
county on the western side of Arizona had 52 cases (17%). Pinal County, which
contains Arizona’s two largest state prison facilities, four private prisons, Immigration
and Customs Enforcement Service Processing Center (ICE-SPC), and a county jail, had
34 cases (11%). Correctional facilities in Pinal County diagnosed 26 of the 38 (69%)
cases diagnosed in a correctional facility. There were no TB cases reported in Greenlee
and Graham Counties in 2006, and the former has not reported a TB case in six years.
Figure 2 depicts the number of TB cases and case rates by county in 2006. While
Maricopa County has the highest number of TB cases, the TB case rate is lower (4.5
case per 100,000 population), based on the large population in the jurisdiction. La Paz
County has the highest TB case rate of 14 cases per 100,000 population, but has only 3
cases and a small population of 19,517. Yuma and Pinal Counties have high TB case
rates as well and each has a substantial number of cases and population size.

4

5

C.

Age/Gender/Race/Ethnicity

The majority of TB cases (60%) in Arizona in 2006 were in the 25 to 64 year old age
groups with a mean and median age of 41.6 and 40 years, respectively (Figure 3). Of
great concern is the percentage of cases among persons under the age of 25 (23%).
There were also a significant number of cases in individuals over the age of 65. This
group comprised 17% of the total cases. Males accounted for 67% of cases (n=211).
The breakdown by race/ethnicity was 62% Hispanic; 17.8% White, non-Hispanic; 7.3%
Black, non-Hispanic; 9.5% Asian; and 3.5% Native American. The highest TB case rate
occurred in Asians with 18.5 cases per 100,000 (n=30) (Figure 4). However, the Asian
population in Arizona is small, which translates to a high rate but small number of
cases. The TB case rate for Hispanics was 11.5 cases per 100,000 (n=195) (Table 2).

Figure 3. Tuberculosis Cases by Age Group and Gender, Arizona,
2006
80

Number of Cases

70
60
50
40
30
20
10
0
0-4

5-14

15-24

25-44

45-64

65+

Age Group
Male

Female

6

Figure 4. TB Case Rates by Race/Ethnicity, Arizona, 2006
20

18.5

18

Rates per 100,000

16
14
11.5

12

9.3

10
8
6

3.3

4
2

1.5

0
White Non-Hispanic

Hispanic

African Am erican

Native Am erican

Asian or Pacific
Islander

7

Table 2. Tuberculosis Cases by Ethnicity, Gender and Age Group, Arizona, 2006
<5
American Indianc
Male
Female
Total
Asian
Male
Female
Total
Black, Not Hispanic
Male
Female
Total
Hispanic or Latino
Male
Female
Total
Native Hawaiianc
Male
Female
Total
White, Not Hispanic
Male
Female
Total
More than one race
Male
Female
Total
Total by Gender
Male
Female
Total by Age Group
No.
(%)
Ratea,b

5-14

Age Group
15-24 25-44

45-64

65+

Total by Ethnicity
No.
(%)
Ratea,b

0
0
0

0
0
0

0
0
0

2
1
3

2
2
4

3
1
4

7
4
11

(3.5)

3.3

0
0
0

1
1
2

3
2
5

5
4
9

7
5
12

2
0
2

18
12
30

(9.5)

18.5

0
2
2

2
0
2

0
1
1

5
7
12

5
0
5

1
0
1

13
10
23

(7.3)

9.3

12
11
23

7
5
12

10
13
23

55
18
73

35
6
41

13
10
23

132
63
195

(62.0)

11.5

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

(0.0)

0

0
0
0

0
0
0

2
0
2

6
3
9

19
1
20

14
11
25

41
15
56

(17.8)

1.5

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

(0.0)

0.0

12
13

10
6

15
16

73
33

68
14

33
22

211
104

(67.0)
(33.0)

6.8
3.3

25
(7.9)
5.2

16
(5.1)
1.8

31
(9.8)
3.5

106
(33.7)
6.0

82
(26.0)
5.8

55
(17.5)
6.9

315
5.0

a

Rate per 100,000 population
b
Population denominators for 2006 are estimates provided by the Arizona Department of Economic Security
c
Includes Pacific Islanders

8

D.

TB in Children <5 Years of Age

Active TB in young children is indicative of ongoing transmission in the community and,
more importantly, of missed opportunities for preventive therapy. This group accounted
for 25 (7.9%) of all cases. Children <5 years of age had a case rate of 5.2 cases per
100,000 compared to the overall rate of 5.0 cases per 100,000 in Arizona. Nationwide,
children <5 years of age had a rate of 2.4 cases per 100,000 and comprised 3.4% of
overall cases in 2005, the most recent year for which data is available. Additionally,
92% of pediatric (<5 years of age) TB cases in 2006 occurred among Hispanics in
Arizona (Table 2). Of the 25 pediatric cases, 22 were born in the United States and 3
were foreign born. Mexico was the country of origin for two of the three foreign born
pediatric cases.
E.

Site of Infection

Pulmonary TB with no additional site of disease accounted for 254 (81%) of all cases in
2006 (Table 3). Extrapulmonary disease accounted for 39 (12%) of all cases. Both
pulmonary and extrapulmonary disease accounted for 22 (7%) of all cases.

Table 3. Tuberculosis Cases by Form of Disease and Vital Status at Diagnosis,
Arizona, 2006
Form of Disease

Alive at
Diagnosis
No.

a

(%)

Diagnosis After
Death
No.

Total Cases

(%)

No.

(%)

Pulmonary

249

(98.0)

5

(2.0)

254

(100.0)

Extrapulmonaryb
Persons with Both Pulmonary and Extrapulmonary
c
Disease
Total (%)

37

(94.9)

2

(5.1)

39

(100.0)

22

(100.0)

0

(0.0)

22

(100.0)

308

(97.8)

7

(2.2)

315

(100.0)

a

Includes cases with pulmonary listed as major site of disease and no additional site of disease
b
Includes cases with pleural, lymphatic, bone and/or joint, meningeal, peritoneal, or other site, excluding pulmonary, listed as the major
site of disease
c
Includes miliary cases

IV.

Risk Factors

A.

Foreign-Born Cases

Table 4 indicates that the single most important risk factor (among those widely used
nationwide) associated with TB was being foreign born (57% of all cases). Sixty eight
percent of foreign born cases were from Mexico (Figure 5). Over the last ten years
there has been an increasing trend in the percentage of foreign born individuals in
relation to overall number of cases in Arizona (Figures 6 and 7).

9

Table 4. Tuberculosis Cases by Selected Risk Factors, Arizona, 2000-2006
2000

2001

2002

2003

2004

2006

2005

Cases

(%)

Cases

(%)

Cases

(%)

Cases

(%)

Cases

(%)

Cases

(%)

Cases

(%)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

2

(0.6)

6

(2.3)

5

(1.7)

3

(1.1)

3

(1.0)

6

(2.2)

1

(0.4)

9

(2.9)

9

(3.4)

6

(2.1)

8

(3.0)

4

(1.4)

10

(3.7)

5

(1.8)

11

(3.5)

11

(4.2)

11

(3.8)

10

(3.8)

5

(1.7)

7

(2.6)

11

(3.9)

7

(2.2)

20

(7.7)

22

(7.6)

27

(10.3)

24

(8.1)

31

(11.4)

20

(7.1)

17

(5.4)

46

(17.6)

61

(21.1)

41

(15.6)

57

(19.3)

48

(17.6)

29

(10.3)

38

(12.1)

7

(2.7)

12

(4.2)

7

(2.7)

5

(1.7)

10

(3.7)

7

(2.5)

10

(3.2)

21

(8.0)

16

(5.5)

19

(7.2)

39

(13.2)

36

(13.2)

40

(16.4)

38

(14)

39

(14.9)

45

(15.6)

32

(12.2)

36

(12.2)

21

(7.7)

23

(8.2)

29

(9.2)

147

(56.3)

134

(46.4)

137

(52.1)

172

(58.3)

156

(57.4)

170

(60.5)

181

(58)

18

(6.9)

12

(4.2)

18

(6.8)

17

(5.8)

23

(8.5)

20

(7.1)

15

(4.8)

13

(5.0)

8

(2.8)

12

(4.6)

13

(4.4)

19

(7.0)

12

(4.3)

9

(8.5)

Occupation
Correctional
Facility Worker
Health Care
Worker
Migrant Farm
Worker

Reported
Behaviors
Injecting Drug
a
Use
Non-injecting
a
Drug Use
Excess Alcohol
Usea
Type of
Residence
Long Term
b
Care Facility
Correctional
Facilitye
Homelessa

Country of
Birth
Foreign Bornc

Underlying
Disease
HIV infection,
d
All Ages
HIV infection,
25-44 Years
Oldd

Total Cases

261

289

263

295

272

281

315

a

Within one year prior to diagnosis of tuberculosis
Residence at time of diagnosis
Includes persons born outside the United States and its territories
d
Tuberculosis cases with a reported positive HIV test result; the percent positive represents HIV co-infection among all verified TB cases,
including those not tested for HIV infection

b
c

10

Figure 5. Country of Origin for Foreign-born TB Cases
Arizona, 2006

Philippines
7%

Mexico
66%

Honduras
3%
Vietnam
4%
Somalia
4%
Guatemala
Other 3%
13%

Figure 6. Percentage of TB Cases Occurring in Foreign-Born
Persons, Arizona, 1995 - 2006

Percentage of Cases

100%
80%
60%
40%
20%
0%
1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year
U.S.

Foreign

11

Figure 7. Foreign-Born TB Cases Compared to U.S.-born Cases,
Arizona, 1995-2006
200

Number of Cases

180
160
140
120
100
80
60
40
20
0
1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year
U.S.

Foreign

B. Correctional Facilities and Related Risk Factors
Individuals at high risk of exposure to TB are those in correctional facilities, those with a
history of drug/alcohol abuse and those with a history of homelessness (Table 4).
Arizona had one of the highest percentages (12.1%) of cases diagnosed in correctional
facilities nationally in 2006 (Figure 8). Routine evaluation for TB of all inmates during
intake allows for diagnosis of both latent and active infection in this population. Eightynine percent (34/38 cases) of the correctional TB cases were foreign born with Mexico
being reported as the country of origin in 58% (22/38 cases). Ninety five percent (36/38
cases) of the correctional TB cases were Hispanic in race while one was Asian and one
was Caucasian. Inmate TB screening requirements in correctional facilities were
implemented in 2004 to address the problem of tuberculosis in this setting. Additionally,
the TB program has been working closely with correctional health staff on TB education
and regulation implementation.

12

45

16

40

14

35

12

30

10

25

8

20

6

15

4

10
5

Percent

Number

Figure 8. Number and Percent of TB Cases Diagnosed in
Correctional Facilities, Arizona and the U.S., 1995-2006

16

18

23

14

18

21

16

19

39

36

40

38

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

0

2
0

Year
Number

C.

AZ Percent

US Percent

TB/HIV

Co-infection with HIV in individuals with TB is a major concern due to the fact that
immune system suppression by HIV can impact the body’s ability to fight TB.
Individuals with co-infection have higher mortality and are susceptible to increased drug
resistance leading to longer and more complex treatment regimens. HIV testing results
were available for 207 of 274 (76%) TB cases 14 years of age and older in 2006 (Table
5). Of these, 15 (5.5%) cases of active TB had documented HIV co-infection. Nine of
the 15 (60%) cases were between the ages 25 and 44 reflecting 8.5% of cases in this
age group. Additionally 2 cases of co-infection occurred in individuals in correctional
facilities.

13

Table 5. Proportion of Reported Tuberculosis Cases with HIV Test
Results and HIV Co-infection by Age Group, U.S. and Arizona, 19952006
25-44 Years Old
Year

1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

HIV Test
Results Knowna

14 Years and Older
HIV Test
Results Knowna

HIV Positiveb

HIV Positiveb

U.S.

AZ

U.S.

AZ

U.S.

AZ

U.S.

AZ

(%)

(%)

(%)

(%)

(%)

(%)

(%)

(%)

(52)
(57)
(60)
(61)
(63)
(63)
(63)
(65)
(67)
(67)
(65)
*

(53)
(65)
(69)
(77)
(84)
(74)
(82)
(85)
(93)
(89)
(84)
(85)

(26)
(25)
(21)
(20)
(19)
(17)
(16)
(16)
(16)
(14)
*
*

(19)
(13)
(10)
(16)
(10)
(14)
(9)
(14)
(15)
(18)
(13)
(9)

(36)
(41)
(44)
(45)
(48)
(50)
(50)
(53)
(55)
(56)

(33)
(44)
(45)
(47)
(60)
(63)
(66)
(61)
(71)
(79)
(83)
(76)

(13)
(12)
(11)
(10)
(10)
(9)
(9)
(9)
(9)
(8)
*
*

(8)
(5)
(4)
(6)
(6)
(7)
(4)
(7)
(6)
(8)
(7)
(6)

*

a

Includes cases with positive, negative and indeterminate HIV test results. Rhode Island reported HIV test results
1998-2001; California reporting of HIV status is incomplete and only includes persons also reported with AIDS
b

Based on reported HIV positive status among all reported tuberculosis cases, including those not tested

V.

Completion of Therapy

Directly observed therapy (DOT) is the standard of care for administering TB
medications. In DOT, health care workers observe the patient take his/her medications
to ensure compliance. Due to the length of time to complete treatment for TB, 2004
data are the most recent finalized data available. In 2004, 226 of 262 (86%) cases who
were started on treatment had either DOT or a combination of DOT and selfadministered treatment (Table 6).
Table 6. Use of Directly Observed Therapy (DOT), Arizona, 2000-2004
2000
DOT
Both DOT and SelfAdministered
Self-Administered Only
Unknown
Not Available
Totalb

2001

2002a
No.
%

2003
No.
%

2004
No.
%

175

(70)

210

(74)

195

(74)

No.
157

%
(64)

No.
186

%
(67)

40

(16)

40

(14)

34

(14)

24

(9)

31

(12)

50
0
0
247

(20)
(0)
(0)
(100)

51
1
1
279

(18)
(0)
(0)
(100)

40
1
1
251

(16)
(0)
(0)
(100)

31
1
18
284

(11)
(0)
(6)
(100)

18
4
14
262

(7)
(2)
(5)
(100)

a

Completion data for 2002 is preliminary
Includes persons alive at diagnosis with an initial drug regimen of one or more drugs

b

14

Arizona TB programs strive to achieve the CDC’s goal of completion of therapy within
one year for 90% of active TB cases In 2004, 74% of cases completed treatment within
one year and 85% of cases completed therapy overall (Figure 9). Completion of therapy
within one year was 64% among inmates, 81% among homeless cases, and 85%
overall. These highlight the challenges to ensure completion of therapy among inmates
and also the successes with the homeless persons with TB in Maricopa County. State
and local programs are working to improve completion of therapy performance.
Figure 9. Completion of TB Therapy
Arizona, 1995-2004
100

Percent Complete

90
80
70
60
50
40
30
20
10
0
1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Year
Overall Completion

VI.

% Complete within 1 year

Drug Susceptibility

Initial drug susceptibility testing was obtained on 208 of 229 (91%) culture-positive TB
cases in Arizona in 2006. INH resistance occurred among 18 of 208 (8.7%) culture
confirmed cases. Foreign-born individuals accounted for 65% of the drug resistant
cases. Multi-drug resistant TB (MDR TB) is TB that is resistant to at least two of the first
line anti-TB drugs; isoniazid and rifampin. Three multi-drug resistant cases were
identified in 2006. All multi-drug resistant cases since 2000 occurred among foreignborn persons (Table 7).

15

Table 7. Tuberculosis Cases Resistant to INH and Other Anti-TB Drugs,
Arizona, 2000–2006
Year

Cases

Culture
Confirmed

2000

261

228

Other
Resistance

Total
Resistance

Drug
Sensitivity
Testing

INH
Resistanta

No.

(%)

No.

(%)

No.

(%)

No.

(%)

No.

(%)

221

(96.9)

17

(7.7)

3

(1.4)

19

(8.6)

36

(16.3)

MDRb

c

d

2001

289

228

226

(99.1)

12

(5.3)

3

(1.3)

18

(8.0)

30

(13.3)

2002

263

212

209

(98.6)

11

(5.3)

1

(0.5)

24

(11.5)

35

(16.7)

2003

295

228

227

(99.6)

14

(6.2)

2

(0.9)

19

(8.4)

33

(14.5)

2004

272

206

204

(99.0)

20

(9.8)

2

(1.0)

24

(11.8)

44

(21.6)

2005
281
207
177
(85.5)
22
(12.4)
1
(0.6)
20
(11.3)
2006
315
229
208
(90.8)
18
(8.7)
3
(1.4)
9
(4.3)
a
Isolates may also be resistant to other drugs, including rifampim, includes initial and final susceptibility result
b
Resistant to at least isoniazid and rifampin, includes initial and final susceptibility results
c
Other patterns of drug resistance excluding INH resistance
d
Isolates with resistance to any first or second line TB drug

42
27

(23.7)
(13.0)

VII. Activities
A.

International Referral and Case Management

The TBCP coordinates with international referral agencies to ensure continuity of care
for individuals with TB or suspected of having TB who migrate to or from the United
States. CureTB facilitates the referral process with health officials from Mexico. TBNet
facilitates the referral process for all other countries. In 2006, approximately 59
individuals were referred to CureTB or TBNet. Final treatment outcome is still
unavailable.
B.

Class B1/B2 Referrals

Individuals immigrating to the United States are evaluated for TB as part of the
admission process. An immigrant found to have active TB that is not infectious is
classified as a Class B1. Those with a chest x-ray that suggests a history of TB disease
that is not currently active are classified as Class B2. The state of residence for those
that are suspected of having TB infection is notified of all class B1 and B2 individuals
identified. These referrals are then forwarded to the appropriate county of jurisdiction
so that further evaluation and treatment for infection may be pursued. In 2006, ADHS
received 151 class B notifications that were forwarded to counties for follow up.
C.

Border Health Activities

Meetings/Conferences
On March 1, 2006 the TBCP held a Binational Planning Meeting with the ADHS Office
of Border Health, the Secretaría de Salud Pública de Sonora (SSPS) and the Director of

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the Office of Border Health for Sonora. Discussed were issues related to how both
states handle TB control, and ways in which to improve TB control along the border.
On June 8, 2006 ADHS hosted a teleconference to discuss TB issues between Arizona
and the Secretaría de Salud Pública de Sonora, Sonora. Topics of discussion were
how to help build TB laboratory capacity in Sonora, Arizona State Public Health
Laboratory ongoing testing for tuberculosis of sputum samples from Sonora, the TB
Binational Card, the Meet and Greet Program, multi-drug resistant TB patients, pediatric
TB, and how to coordinate our two programs. Communication, coordination, legal,
immigration, and public health issues were discussed. All agencies’ roles were
identified.
“Meet and Greet” Program
The goal of the Arizona “Meet and Greet” program is to ensure continuity of care for
individuals being treated for TB who are being deported to Mexico. A “Meet and Greet”
requires coordination between the ADHS TBCP, ADHS Office of Border Health, Sonora
Health Officials, Immigration and Customs Enforcement (ICE), local health departments,
and the correctional facility or detention center that is housing the individual. The
Department successfully completed six “Meet and Greets” in 2006. A Meet and Greet
Workshop on July 19, 2006, was hosted by ADHS to discuss and improve the Meet and
Greet Protocol that had been developed between the states of Arizona and Sonora to
arrange for continuity of care for Mexican nationals with TB who are deported by US
Immigration and Customs Enforcement (ICE) through the port of Nogales. The
agencies that were involved included the US Department of Immigration Health
Services, ICE, US Quarantine Division, US Border Patrol, US Marshal Service, Border
County Health Departments, County Jails, TBNet, Director of Disease Prevention and
Control for SSPS, Epidemiologists for the Hospital General of Nogales, Mexican
National Institute of Immigration, Mexican Consulate, and the ADHS Border Health
Office.

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