Assessing the performance of overseas tuberculosis screening programs: a study among US-bound immigrants in Vietnam.
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.
Maloney
Susan A
SA
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Fielding
Katherine L
KL
Laserson
Kayla F
KF
Jones
Warren
W
Nguyen
Thi Ngoc Yen
TN
Dang
Quy An
QA
Nguyen
Huu Phuoc
HP
Nguyen
An Trinh
AT
Duong
Thi Cam Nhung
TC
Vo
Thi Chi Mai
TC
Seawright
M Frank
MF
O'Rourke
Thomas
T
Truong
Xuan Lien
XL
Nguyen
Thi Ngoc Lan
TN
Binkin
Nancy
N
Cetron
Martin S
MS
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
D000995:Antitubercular Agents