In many industrialized countries, an increasing proportion of tuberculosis patients are immigrants. Immigrants account for 50% of the incidence in the Netherlands (12). Control policies with regard to immigrant tuberculosis usually rely on chest x-ray screening and treatment of active tuberculosis. A supplemental approach, recommended by the Institute of Medicine (14), is to conduct tuberculin skin testing and to apply preventive treatment of latent infections. Whether all tuberculin skin test–positive immigrants should be treated, or only selected high-risk groups such as immigrants with radiographic evidence of inactive disease, is under debate (15). Adherence to preventive treatment is also a point to consider (15). To answer the question of why the incidence rates remain high,.
