title: Tuberculin Skin Tests versus Interferon-Gamma Release Assays in Tuberculosis Screening among Immigrant Visa Applicants.
abstract: Objective. Use of tuberculin skin tests (TSTs) and interferon gamma release assays (IGRAs) as part of tuberculosis (TB) screening among immigrants from high TB-burden countries has not been fully evaluated. Methods. Prevalence of Mycobacterium tuberculosis infection (MTBI) based on TST, or the QuantiFERON-TB Gold test (QFT-G), was determined among immigrant applicants in Vietnam bound for the United States (US); factors associated with test results and discordance were assessed; predictive values of TST and QFT-G for identifying chest radiographs (CXRs) consistent with TB were calculated. Results. Of 1,246 immigrant visa applicants studied, 57.9% were TST positive, 28.3% were QFT-G positive, and test agreement was 59.4%. Increasing age was associated with positive TST results, positive QFT-G results, TST-positive but QFT-G-negative discordance, and abnormal CXRs consistent with TB. Positive predictive values of TST and QFT-G for an abnormal CXR were 25.9% and 25.6%, respectively. Conclusion. The estimated prevalence of MTBI among US-bound visa applicants in Vietnam based on TST was twice that based on QFT-G, and 14 times higher than a TST-based estimate of MTBI prevalence reported for the general US population in 2000. QFT-G was not better than TST at predicting abnormal CXRs consistent with TB.
authors.affiliation: Northrop Grumman Information Systems Sector, 2800 Century Parkway NE, Atlanta, GA 30345, USA ; Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: Stella O
authors.initials: SO
authors.lastname: Chuke
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Thi Ngoc
authors.initials: NT
authors.lastname: Yen
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA ; Center for Global Health, CDC, Mail Stop D-68, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen Huu
authors.initials: NH
authors.lastname: Phuoc
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen An
authors.initials: NA
authors.lastname: Trinh
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Duong Thi Cam
authors.initials: DT
authors.lastname: Nhung
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Vo Thi Chi
authors.initials: VT
authors.lastname: Mai
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: An Dang
authors.initials: AD
authors.lastname: Qui
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Hoang Hoa
authors.initials: HH
authors.lastname: Hai
authors.affiliation: Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam.
authors.forename: Le Thien Huong
authors.initials: le TH
authors.lastname: Loan
authors.affiliation: International Organization for Migration (IOM), 1B Pham Ngoc Thach District 1, Ho Chi Minh City, Vietnam ; International Organization for Migration (IOM), P.O. Box 55040, Westlands, Nairobi 00200, Kenya.
authors.forename: Warren G
authors.initials: WG
authors.lastname: Jones
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Whitworth
authors.affiliation: Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA ; Department of Family & Community Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU 3E, San Francisco, CA 94143, USA ; Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
authors.forename: J Jina
authors.initials: JJ
authors.lastname: Shah
authors.affiliation: Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Painter
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Mail Stop E-10, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Mazurek
authors.affiliation: Center for Global Health, CDC, Mail Stop D-68, 1600 Clifton Road NE, Atlanta, GA 30333, USA ; Division of Global Migration and Quarantine, CDC, Mail Stop E-03, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Maloney
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