title: Assessing the performance of overseas tuberculosis screening programs: a study among US-bound immigrants in Vietnam.
abstract: BACKGROUND
  Tuberculosis cases in foreign-born persons account for more than 50% of all tuberculosis cases in the United States. The Institute of Medicine has recommended enhancing overseas screening as one measure to support tuberculosis elimination efforts. We assessed the ability of overseas tuberculosis screening (chest radiograph followed by 3 acid-fast bacilli sputum smears for persons with abnormal chest radiographs [suggestive of active tuberculosis]) to detect pulmonary tuberculosis disease among US-bound immigrants with abnormal chest radiographs.
  
  
  METHODS
  During October 1998 to October 1999, 14 098 US immigrant visa applicants were screened overseas in Vietnam. Adult applicants with abnormal chest radiographs were enrolled to assess screening test characteristics among this group using mycobacterial culture as the gold standard for pulmonary tuberculosis disease diagnosis. Risk factors for pulmonary tuberculosis disease were also evaluated.
  
  
  RESULTS
  Among 1179 adult applicants with abnormal chest radiographs, 82 (7.0%) had positive acid-fast bacilli smear results, and 183 (15.5%) had positive Mycobacterium tuberculosis culture results (pulmonary tuberculosis disease). The sensitivity, specificity, and positive and negative predictive values of serial acid-fast bacilli screening among this group were 34.4% (63/183), 98.1% (977/996), 76.8% (63/82), and 89.1% (977/1097), respectively. Risk factors for pulmonary tuberculosis disease included younger age (18-34 years), no history of tuberculosis or treatment, reported symptoms, and cavitation or consolidation on chest radiograph.
  
  
  CONCLUSIONS
  The ability of current overseas screening to detect tuberculosis among immigrants with abnormal chest radiographs is low. Improved diagnostic methods, enhanced screening measures, and postmigration follow-up are essential to control tuberculosis among immigrants and support US and global tuberculosis elimination.
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Maloney
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Fielding
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Warren
authors.initials: W
authors.lastname: Jones
authors.forename: Thi Ngoc Yen
authors.initials: TN
authors.lastname: Nguyen
authors.forename: Quy An
authors.initials: QA
authors.lastname: Dang
authors.forename: Huu Phuoc
authors.initials: HP
authors.lastname: Nguyen
authors.forename: An Trinh
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Thi Cam Nhung
authors.initials: TC
authors.lastname: Duong
authors.forename: Thi Chi Mai
authors.initials: TC
authors.lastname: Vo
authors.forename: M Frank
authors.initials: MF
authors.lastname: Seawright
authors.forename: Thomas
authors.initials: T
authors.lastname: O'Rourke
authors.forename: Xuan Lien
authors.initials: XL
authors.lastname: Truong
authors.forename: Thi Ngoc Lan
authors.initials: TN
authors.lastname: Nguyen
authors.forename: Nancy
authors.initials: N
authors.lastname: Binkin
authors.forename: Martin S
authors.initials: MS
authors.lastname: Cetron
mesh_terms: D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000627:therapeutic use; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D011336:Probability; D017678:Sex Distribution; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014481:United States; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents