title: USA's expanded overseas tuberculosis screening program: a retrospective study in China.
abstract: BACKGROUND
  To address increasing tuberculosis (TB) incidence in foreign-born populations, immigrant TB screening programs have been implemented in the USA. These programs are modified periodically, the effectiveness of which have been disputed. The aim of this retrospective study was to assess the value of the 2009 Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (CDOT TB TI) in a cohort of the USA permanent-resident applicants from China.
  
  
  METHODS
  Standardized forms were used to collect demographic, clinical, and laboratory data of Chinese individuals screened at the Guangdong International Travel Healthcare Center for permanent residence in the USA between October 08, 2009 and December 31, 2012. Applicants' data were further retrospectively evaluated by three experienced panel physicians and radiologists according to the 1991 Technical Instructions for Tuberculosis Screening and Treatment (TI). TB cases and characteristics identified by the 1991 and expanded 2009 programs were compared.
  
  
  RESULTS
  The CDOT TB TI identified more than twice as many TB cases that required treatment completion before clearance for travel than the 1991 TI (270 vs. 131). In addition, the expanded screening program identified more cases of negative sputum smear but positive culture (181 vs. 44), and more cases of radiography suggestive of inactive (22 vs. 3) and active (248 vs. 128) TB. Specifically, the 1991 TI screening program failed to identify 25/38 (65.79%) cases carrying drug-resistant isolates, and 13/131 (9.92%) would have been inappropriately treated. Moreover, 220/270 (81.48%) of the cases were asymptomatic, which were identified by screening and subsequently treated. Improved chest radiograph and sputum negative conversion occurred in all treated cases.
  
  
  CONCLUSIONS
  CDOT TB TI, a screening program that includes sputum culture and drug susceptibility tests, identifies a greater number of TB cases, likely contributing to the overall decrease in TB prevalence in host (USA) and origin (China) countries.
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. samzjxc@163.com.
authors.forename: Shaojun
authors.initials: S
authors.lastname: Liang
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. zhangjm@gdciq.gov.cn.
authors.forename: Jianming
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Shenzhen Entery-exit Inspection and Quarantine Bureau, 1101 Fuqiang Road, Futian District, Shenzhen, Guangdong, 518045, PR China. hulf@szciq.gov.cn.
authors.forename: Longfei
authors.initials: L
authors.lastname: Hu
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. chenjd@gdciq.gov.cn.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Chen
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. wuj@gdciq.gov.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. huangyx@gdciq.gov.cn.
authors.forename: Yongxin
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. zengy@gdciq.gov.cn.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zeng
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. zhuyf@gdciq.gov.cn.
authors.forename: Yufeng
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. lizh@gdciq.gov.cn.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Li
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. weny@gdciq.gov.cn.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wen
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. liangwy@gdciq.gov.cn.
authors.forename: Wuyi
authors.initials: W
authors.lastname: Liang
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. zhuojx@gdciq.gov.cn.
authors.forename: Jinxue
authors.initials: J
authors.lastname: Zhuo
authors.affiliation: Guangdong International Travel Healthcare Center, 5/F, Eastern Tower, Poly Building, 59 Huali Road, Zhujiang New City, Guangzhou, Guangdong, 510600, PR China. hhtciq@163.com.
authors.forename: Hongtao
authors.initials: H
authors.lastname: He
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000208:ethnology; D023801:Directly Observed Therapy / Q000379:methods*; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents