Summary
In 2024, 15% of tuberculosis (TB) cases in King County occurred in individuals born in Vietnam. We interviewed a sample of Vietnamese residents on their experiences with TB and found that general TB knowledge was lacking despite the high burden. However, individuals were receptive to speaking about TB and learning from U.S. healthcare worker’s recommendations. As TB is the leading infectious cause of death worldwide, it is critical for providers to improve education, screening, and treatment for TB, particularly among this high TB-burden community. We also noted a gap in knowledge of the BCG vaccine and trend of vaccine hesitancy, which have important implications for patient education in advance of a new, licensed preventative TB vaccine for adults by 2030.
Recommendations
- For all individuals from Vietnam, screen for latent TB using blood tests (e.g., QuantiFERON) and maintain a high index of suspicion for active TB with a matching clinical picture given high endemicity of TB in this community
- To improve receptivity for treating latent TB, analogize LTBI as a “sleeping”, asymptomatic form that can wake up and cause serious disease later
- Normalize LTBI as being common, not contagious, and not requiring isolation to reduce stigma
- Communicate openly with patients about how they are taking their medications to ensure adherence and help address any side effects decreasing adherence
- When communicating with patients, use their preferred dialect and method of translation, and avoid complex medical jargon, hand gestures, or casual touch
- Adopt a clinic intake phone-line that streamlines interpreter services for non-English-speaking individuals to schedule an appointment
- Inquire about vaccine hesitancy and counsel patients on a new, upcoming TB vaccine preventing TB disease in adults
Methods
The following sections are based on interviews with twelve Vietnamese community members in King County, Washington and supplemented by data from literature review. The interviews were conducted by EthnoMed staff in 2024 with English translation as needed by a Caseworker Cultural Mediator from Harborview Hospital. Three participants spoke fluent English with the rest speaking native Vietnamese. One participant had previously received treatment for active TB disease. Most participants were elderly.
Burden of Disease in Vietnam
2024 TB Statistics in Vietnam (1)
– Total TB incidence: 184,000
– Total TB incidence (rate per 100,000 per year): 182
– Total TB deaths: 12,000
– HIV-positive TB incidence (number): 5,200
– HIV-positive TB incidence (rate per 100,000): 5.1
– Total Population: 101 million
2024 TB Statistics in USA
Proportion of TB cases in King County, WA among individuals born in Vietnam: 15%
TB in the Vietnamese Language
Vietnamese is the predominant language spoken in Vietnam. Vietnamese has three dialects – North, Central, and South – which can differ in pronunciation and sometimes in meaning. This is an important consideration for patients when selecting an interpreter. French and English are common second languages taught in schools. Some minority languages include Tày, Muong, Cham, Khmer, Chinese, Nùng, and Hmong (2). In King County, Vietnamese is the second most common, foreign primary language of Seattle Public School students.
In Vietnamese, TB is frequently referred to as lao phổi. Lao directly translates to tuberculosis and phổi means lung. The term bệnh lao is an umbrella term referring to TB in general. Latent TB is called lao tiềm ẩn, which means hidden TB. Less often, respondents recognized the English acronym “TB”, but never the English word “tuberculosis.” (3)
Most of the older respondents were exclusively Vietnamese-speaking, using the southern dialect. The majority of these respondents came over during the southern Vietnam diaspora as described below. Some of the respondents were younger and spoke sufficient English. Accordingly, healthcare providers should be aware of the need for interpreter resources to ensure effective communication, particularly for older patients. Providers can inquire which form of translation (phone, video, or in-person) is preferred if available and ask patients if the dialect spoken by the interpreter works for them. Respondents noted that effective communication with the provider in their language motivated them to be tested or treated for TB.
It was also recommended to avoid medical jargon both on behalf of the patient and interpreter and use simple explanations instead. For example, latent TB can be described as ‘sleeping.’ For this community, other general considerations are to avoid hand gestures like pointing, hands in pockets or on the hips, as well as informal touching like back patting. Practitioners should also solicit permission before examining patients and ask the patient if they would like anyone else to be present in the room. (4)
Bacillus Calmette-Guerin (BCG) Vaccination
BCG was adopted into Vietnam’s National Immunization Schedule in 1981 alongside tetanus, diphtheria, hepatitis B, polio, measles, and pertussis vaccines as part of The Expanded Program on Immunization (EPI) (5). As of 2023, over 95% of infants born in Vietnam received the BCG vaccine annually as a single dose at birth (6).
During our interviews, most respondents were not sure if they had been vaccinated with BCG vaccine or if the BCG prevented TB in adults. One participant noted, “We have people who believe in the [BCG] vaccine and some who believe it’s a conspiracy.” Another participant further commented on vaccine hesitancy in the wake of the COVID pandemic: “Everyone is still hung up on COVID and the side effect of the vaccine. I still meet a lot of people who say ‘I still have this lingering cough, numbness, loss of taste because I took the vaccine.’ It’s a relatively big problem in our community, because, especially for the older generation, so many people think they have these symptoms because of the vaccine…”
As several vaccines preventing TB disease in adults are now in late-stage clinical trials (7), it will be important for vaccine providers to begin discussing these potential TB vaccines and address any reasons for vaccine hesitancy in advance.
Knowledge of TB Pathophysiology, Diagnosis and Treatment
Most of the respondents were familiar with TB. Of these, most recognized cough or cough with blood as hallmark symptoms of TB disease. Some also mentioned fever, sweats, difficulty breathing, and weight loss. Many older community members noted prolonged cough or hemoptysis were stigmatized in Vietnam due to their association of TB with death. There was little awareness of TB disease occurring outside of the lungs.
Knowledge of TB transmission was scarce, and responses ranged from airborne to saliva. One respondent mentioned “When I was a kid, I never heard about it, but I knew this one thing, if you work too hard, you know the lack of sleep, and you work too too hard, you might get TB… But I never heard that TB is gonna be the airborne disease; you might inhale the germs from other people; no.”
Few knew of the treatment for TB disease unless they had already been treated themselves or worked in the medical field in some capacity, such as a medical assistant or interpreter. Some older respondents believed that no TB treatment existed, which underscored their belief that TB was deadly and stigmatized. One person described homeopathic treatment of TB stating; “In Vietnam they treat like a remedy; get some kind of veggie and then blend it and make a juice for the person who drink it. In Vietnam, if somebody cough with blood they drink that.”
Overall, it seemed that standardized TB education in Vietnam was rare, and respondents mostly acquired knowledge of TB through knowing someone with the disease, watching movies that had a TB positive character, hearing stigma around chronic coughing, or being diagnosed with the active or latent forms when they later immigrated to the United States. While more recent developments in TB education were recognized such as Vietnamese healthcare podcasts, public health posters and rhyming verses, or the internet, respondents generally agreed that TB is not a frequently discussed subject unless working in healthcare.
Providers should explore TB awareness with Vietnamese patients and provide education accordingly. This is particularly important as in King County, Vietnamese residents constituted 7.3% of the foreign-born population in 2020 (8) and 15% of TB cases in 2024 (9).
Awareness and Testing for LTBI
Most respondents had not heard of latent TB until undergoing their overseas medical examination prior to immigrating to the United States. Ignorance of LTBI was compounded by the fact that those with LTBI remain asymptomatic. However, younger Vietnamese generations might be more aware of TB due to its increasing presence in the media, such as through the internet, podcasts, or Zalo; the most popular, cross-mobile platform in Vietnam for instant messaging, phone or video calls, document sharing, and social media (10).
For latent TB screening, there was a preference for tuberculin skin testing (TST) over a blood test to avoid the higher expense and discomfort of venous blood draw. However, the Quantiferon blood test has become preferred for latent TB screening, and most Vietnamese received the BCG vaccination which will confuse interpretation of a TST result.
In terms of counseling on latent TB, one individual recommended doctors use this wording; “it’s a [bacteria] that is sleeping in your body; it doesn’t harm you now, but when it wakes up it might. And I think that explanation is simple and precise enough to put everyone at ease .”
Respondents were open to latent TB treatment, particularly if the doctor explained the implications well. However, one respondent with experience in healthcare translation advised asking how patients are taking the medicine as side effects may impact adherence; “They didn’t follow instruction from the doctor because they say they take the medicine it made the body too warm, too hot. You hear that a lot from the Vietnamese. So yes, they say they took it but no; I don’t want to say they lie, but they don’t really take as instructed.”
Providers can address this by neutrally and openly asking how patients are taking medications and reinforcing adherence or managing side effects as needed. This is particularly important as in Vietnamese culture, some individuals may automatically smile, nod, and avoid confrontation or answering a question directly out of respect to the physician (11). Additionally, providers may emphasize that taking the medications as prescribed is important to avoid developing drug resistance.
Stigma
Respondents associated TB with certain stereotypes such as people who are poor, hard laborers, or workers in dust-ridden environments like coal mines. Participants mentioned avoiding physical contact or communication with people with active TB or chronic cough; in some cases even towards people with latent TB because “when [Vietnamese] hear TB they only hear the word TB, not ‘latent’.” Reports of abandoning family members at the hospital, isolating them within living quarters, or forcing them to move out because of TB diagnosis were also noted. Fears around TB causing death seemed to underlie this anger and stigma.
Respondents also noted that while Vietnamese may be okay with TB screening for the immigration medical exam, they may still feel shocked if they are screened due to an exposure. “They scared to… They know la foi, the TB, there is not treatment for it, and people has died from it too. The older generation know. So when they are exposed to active TB they don’t like it. So, when they have to come to public health and get tested and take the medicine, they don’t like it.” Normalizing LTBI as common and non-infectious may help reduce stigma of this testing.
TB/HIV Co-Infection
Participants generally did not think of HIV and TB going together. One individual recalled seeing banners about AIDS awareness and prevention back in Vietnam. Indeed, the prevalence of HIV in Vietnam is low. In 2023, 270,000 Vietnamese were living with HIV, which is about 0.3% of the population and of these, 72% were on antiviral treatment (12). Of those individuals with TB, a mere 2.5% were also HIV-positive (13). For perspective, in Sub-Saharan Africa where TB and HIV are predominant, co-infection rates are as high as 54%.(14)
Healthcare in the United States
Size and Composition of the Vietnam Diaspora
The end of the Vietnam War (1955-1975) resulted in mass evacuation of over 175,000 Vietnamese refugees to the U.S. who were escaping Communist persecution (15). This group comprised of Southern military, government, urban educated citizens, many of whom spoke English already, so were more easily able to adjust to living in the U.S.
Continued post-war conflict over border zones with China and Cambodia resulted in another wave of immigration in 1978, known as the “Boat People.” These were rural, working-class citizens who fled by boat, seeking asylum in other countries, and resulting in hundreds of thousands perishing at sea. This group often did not speak English, so had a more difficult time adjusting to life in the U.S (4).
Currently, a third wave of Vietnamese citizens continues to immigrate, with a total of 1.3 million immigrants residing in the U.S. as of 2022 (4,15). Instead of obtaining green cards as refugees or asylum seekers, this group now comprises citizens seeking lawful permanent residence largely through family reunification or employment sponsorship. (15)
For more historical considerations in this community see: https://ethnomed.org/culture/vietnamese/
Insurance Coverage and Access to Care
Respondents reported positive healthcare experiences in the United States, including with providers and insurance. Notably, individuals were impressed by the comprehensive, preventative care and annual wellness exams. Respondents were also pleased with the health costs and insurance here, noting dental and vision coverage were a plus. Indeed, in 2022 only 7% of Vietnamese immigrants were uninsured compared to 18% for all foreign-born immigrants. (15)
“Comparing my life in Vietnam and here, it’s much better, spiritually, mentally, and physically, it’s much better. It’s completely different, so if I want to see the doctor here, I can see the doctor twice a month. The government help me money-wise and help me with the grocery. If I call 911 they going to help me. Everything is good here.” – Vietnamese respondent
Respondents who did not speak English appreciated having a Vietnamese-speaking physician available, but even those that did not reported good experiences using interpreters, both in-person or over the phone. From a quality improvement standpoint, one participant noted difficulty scheduling an appointment, having to rely on someone English-speaking to do it. Creating a clinic intake phone line that streamlines interpretation services, like we have at throughout UW Medicine and Harborview Medical Center might overcome this barrier.
Relevant Historical & Cultural Considerations for TB Care
Colonial history & cultural influences
Practitioners should be aware that Vietnamese patients may make TB care decisions collectively with family and rely on male elders to be the spokesperson. It is also expected that medical practitioners address elders first with a bowed head to show respect. (4,11)
Health insurance and TB coverage in Vietnam Today
In response to reduced international aid in the 1980s following the collapse of the Soviet Union and a shift of financial burden to citizens, the government of Vietnam responded by implementing social health insurance (SHI) in 1992 (16). Although the government has expanded SHI and promotes preventive care at a policy level, many Vietnamese (like our respondents) grew up in a system where healthcare costs were largely paid out-of-pocket, so a visit to the doctor was only considered when very sick. As such, a common theme was that wealth is correlated with quality and accessibility of medical services.
“And we don’t have a like follow-up visit. You have money, you sick, you go to see doctor. Sometime you feel you sick, you just go to the pharmacy and talk to the pharmacy that you have that kind of symptom like a fever or something and the pharmacy just guess what you have and sell you some kind of medicine.”
In Vietnam, annual physical exams and health screenings are still not routine or covered by insurance. This may result in underrepresentation of epidemiologic trends such as the low HIV prevalence noted above. However, beginning in 2026, the Vietnamese national government has set a goal for every citizen to receive a free, annual check-up with age-appropriate health screenings (17).
TB care was previously funded by the public sector through global and domestic donor funding, resulting in a restricted set of covered services. However in 2022, financing for TB care was fully transitioned under SHI, expanding the network of covered TB services and clinics, improving accessibility, and reducing out-of-pocket costs for patients. Of note, drug-resistant TB care continues to rely on donor funding and citizens without SHI continue to pay for TB care out-of-pocket. Given the burden of TB in Vietnam, there is some concern about the sustainability of the SHI TB benefits package. Also, citizens who live in rural, remote locations may still lack access to covered TB care which can be an extraordinary expense (18).
Relevant TB Co-Morbidities / Health Concerns in the Vietnamese Community
Lung and liver cancers, heart disease, and cerebrovascular disease are the largest causes of death among Vietnamese-Americans (VAs). Among comorbidities, diabetes is one of the fastest growing among VAs as well as cigarette smoking, which are both concerningly risk factors for developing active TB (19). TB providers should weigh these comorbidities as risk factors when deciding to treat patients with latent TB. Counseling patients on smoking cessation and healthy lifestyle may be equally important to reduce the risk of developing TB disease and in to improve outcomes in those with active TB.
Resources for TB Providers and Patients from Vietnam
Printable Handouts in Vietnamese language:
Printable Handouts in Vietnamese language:
General: What is TB?
– https://www.cdc.gov/tb/media/pdfs/2024/07/What_You_Need_to_Know_About_TB_Vietnamese.pdf
– https://www.dhs.wisconsin.gov/publications/p42099v.pdf
Contact investigations:
– https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8347.pdf
Latent TB:
Active TB:
– https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8346.pdf
Instructions for collecting sputum:
– https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8345.pdf
Quantiferon blood test:
https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/TUBERCULOSIS/Documents/patiented/qft/QuantiferonVI.pdf
LTBI Treatment Regimens:
– 4mos daily Rifampin: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8365.pdf
– 12weeks of weekly Isoniazid + Rifapentine: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8363.pdf
– 3mos of daily Isoniazid + Rifampin: https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv3711.pdf
– 9mos of Isoniazid
• https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/lv8364.pdf
•https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/TUBERCULOSIS/Pages/factsheets.aspx?wp7087=f:{c:38103,o:{t:2,o:[%22Vietnamese%22]}}
• https://www.cdc.gov/tb/media/pdfs/2024/07/What_You_Need_to_Know_About_TB_Vietnamese.pdf
• https://www.dhs.wisconsin.gov/publications/p42099v.pdf
Youtube Videos
– What is TB? https://www.youtube.com/watch?v=a7IeoF-zYGY&t=1s
Webpages for TB Education in Vietnamese:
– https://chuyenvelao.vn/
– https://www.who.int/vietnam/vi/health-topics/tuberculosis?
Audio Files on TB in Vietnamese:
– What is TB? https://audiopedia.org/Vi%c3%aam_ph%e1%bb%95i_v%c3%a0_b%e1%bb%87nh_lao?mtm_campaign=adp.ax
– Cultural pearls for providers when interacting with Vietnamese patients: https://sntc.medicine.ufl.edu/home/index#/products/183
References
- World Health Organization. Tuberculosis profile: Viet Nam [Internet]. 2025 Apr [cited 2025 Nov 4]. Available from: https://worldhealthorg.shinyapps.io/tb-dashboard-wpr/
- Oishimaya Sen Nag. Languages Spoken In Vietnam. In: WorldAtlas [Internet]. 2017. Available from: https://www.worldatlas.com/articles/languages-spoken-in-vietnam.html
- Oregon Health Authority. Bệnh lao (Tuberculosis hoặc TB Disease). 2020.
- U.S. Department of Health and Human Services. Promoting Cultural Sensitivity: A practical guide for tuberculosis programs that provide services to persons from Vietnam. Atlanta, GA: Centers for Disease Control and Prevention; 2008.
- Nguyen TD, Dang AD, Van Damme P, Nguyen CV, Duong HT, Goossens H, et al. Coverage of the expanded program on immunization in Vietnam: Results from 2 cluster surveys and routine reports. Hum Vaccines Immunother. 2015 Jun 3;11(6):1526–33.
- BCGimmunizationrate-2024-vnm.
- Frick M. Pipeline Report: 2024 Tuberculosis Vaccines. Treatment Action Group; 2024.
- Seattle Office of Immigrant and Refugee Affairs. Seattle’s Immigrants and Refugees Important Data & Statistics. 2023.
- Public Health Seattle & King County. 2024 King County TB Program Summary. 2024.
- Zalo. In: Wikipedia tiếng Việt [Internet]. 2026 [cited 2026 Feb 27]. Available from: https://vi.wikipedia.org/w/index.php?title=Zalo&oldid=74784642
- Southeastern National Tuberculosis Center. Cultural Quick Reference Guide: Vietnam [Internet]. 2023. Available from: https://sntc.medicine.ufl.edu/home/index#/products/183
- Viet Nam | UNAIDS [Internet]. [cited 2025 Dec 12]. Available from: https://www.unaids.org/en/regionscountries/countries/vietnam
- CDC. Global HIV and TB. 2025 [cited 2025 Dec 12]. HIV and TB Overview: Vietnam. Available from: https://www.cdc.gov/global-hiv-tb/php/where-we-work/vietnam.html
- CDC. Global HIV and TB. 2025 [cited 2025 Dec 12]. HIV and TB Overview: South Africa. Available from: https://www.cdc.gov/global-hiv-tb/php/where-we-work/southafrica.html
- Batalova JBJ. migrationpolicy.org. 2023 [cited 2025 Dec 15]. Vietnamese Immigrants in the United States. Available from: https://www.migrationpolicy.org/article/vietnamese-immigrants-united-states
- Le QN, Blizzard L, Si L, Giang LT, Neil AL. The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage. Health Policy OPEN. 2020 Aug 28;1:100011.
- vietnamnews.vn [Internet]. [cited 2025 Dec 15]. Health ministry submits proposed plan for free annual health checks from 2026. Available from: https://vietnamnews.vn/society/1729745/health-ministry-submits-proposed-plan-for-free-annual-health-checks-from-2026.html
- Forse R, Yoshino CA, Nguyen TT, Phan THY, Vo LNQ, Codlin AJ, et al. Towards universal health coverage in Vietnam: a mixed-method case study of enrolling people with tuberculosis into social health insurance. Health Res Policy Syst. 2024 Apr 2;22:40.
- Ta H. Vietnamese and Vietnamese-American Health Statistics, 2003-2019. 2020;(2).