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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Assessing the performance of overseas tuberculosis screening programs: A study among US-bound immigrants in Vietnam
Archives of Internal Medicine, Volume 166, No. 2, Year 2006
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Description
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. ©2006 American Medical Association. All rights reserved.
Authors & Co-Authors
Maloney, Susan A.
United States, Atlanta
Centers for Disease Control and Prevention
Fielding, Katherine L.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Laserson, Kayla F.
United States, Atlanta
Centers for Disease Control and Prevention
Jones, Warren
Switzerland, Geneva
Organisation Internationale Pour Les Migrations
An, Dangquy
Viet Nam, Ho Chi Minh City
Cho Ray Hospital
O'Rourke, Thomas F.
Switzerland, Geneva
Organisation Internationale Pour Les Migrations
Lien, Truong Xuan
Viet Nam, Ho Chi Minh City
Pasteur Institute in ho Chi Minh City
Lan, Nguyen Thi Ngoc
Viet Nam, Ho Chi Minh City
Pham Ngoc Thach Hospital
Binkin, Nancy J.
Unknown Affiliation
Cetron, Martin S.
United States, Atlanta
Centers for Disease Control and Prevention
Statistics
Citations: 51
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1001/archinte.166.2.234
ISSN:
15383679
Research Areas
Health System And Policy
Study Design
Cohort Study