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.

[1]  S. Oka,et al.  Evaluation of acridinium-ester-labeled DNA probes for identification of Mycobacterium tuberculosis and Mycobacterium avium-Mycobacterium intracellulare complex in culture , 1991, Journal of clinical microbiology.

[2]  T. Petty.  Ending Neglect: The Elimination of Tuberculosis in the United States , 2001 .

[3]  N. M. Burdash,et al.  Evaluation of the Acid-Fast Smear , 1976, Journal of clinical microbiology.

[4]  D. Mitchison,et al.  Quality control in tuberculosis bacteriology. 1. Laboratory studies on isolated positive cultures and the efficiency of direct smear examination. , 1980, Tubercle.

[5]  C. Thornton,et al.  Comparison of the Sodium Dodecyl Sulfate-Sodium Hydroxide Specimen Processing Method with the C18-Carboxypropylbetaine Specimen Processing Method Using the MB/BacT Liquid Culture System , 2003, European Journal of Clinical Microbiology and Infectious Diseases.

[6]  Ellen Jo Baron,et al.  Manual of clinical microbiology , 1975 .

[7]  J. Lewis,et al.  Public health interventions to encourage TB class A/B1/B2 immigrants to present for TB screening. , 1998, American journal of respiratory and critical care medicine.

[8]  E. Peterson,et al.  Comparison of direct and concentrated acid-fast smears to identify specimens culture positive for Mycobacterium spp. , 1999, Journal of clinical microbiology.

[9]  Rapid diagnostic tests for tuberculosis: what is the appropriate use? American Thoracic Society Workshop. , 1997, American journal of respiratory and critical care medicine.

[10]  D. Chin,et al.  Tuberculosis among immigrants and refugees. , 1998, Archives of internal medicine.

[11]  Benjamin A Lipsky,et al.  Factors affecting the clinical value of microscopy for acid-fast bacilli. , 1984, Reviews of infectious diseases.

[12]  S. Benoit,et al.  Tuberculosis among foreign-born persons in the United States. , 2008, JAMA.

[13]  Roger Anderson,et al.  Homeland Security , 2004, Gov. Inf. Q..

[14]  D. Chin,et al.  B notifications and the detection of tuberculosis among foreign-born recent arrivals in California. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[15]  C. Thornton,et al.  Novel Method for Processing Respiratory Specimens for Detection of Mycobacteria by Using C18-Carboxypropylbetaine: Blinded Study , 1998, Journal of Clinical Microbiology.

[16]  Albert Balows,et al.  Manual of Clinical Microbiology, 7th ed. , 2000 .

[17]  N. Binkin,et al.  Tuberculosis among foreign-born persons in Los Angeles County, 1992-1994. , 1996, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[18]  K. Castro,et al.  Overseas screening for tuberculosis in immigrants and refugees to the United States: current status. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  M. Behr,et al.  Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli , 1999, The Lancet.

[20]  N. Binkin,et al.  Tuberculosis prevention among foreign-born persons in Seattle--King County, Washington. , 1997, American journal of respiratory and critical care medicine.

[21]  熊礼宽,et al.  Mycobacterium , 1977, Bacteriological reviews.

[22]  K. Castro,et al.  Long-term risk of tuberculosis among foreign-born persons in the United States. , 1997, JAMA.

[23]  Christopher Dye,et al.  What is the limit to case detection under the DOTS strategy for tuberculosis control? , 2003, Tuberculosis.

[24]  M. Cranfield,et al.  Processing postmortem specimens with C18-carboxypropylbetaine and analysis by PCR to develop an antemortem test for Mycobacterium avium infections in ducks. , 1999, Journal of zoo and wildlife medicine.

[25]  M. Cetron,et al.  Improved Sensitivity of Sputum Smear Microscopy after Processing Specimens with C18-Carboxypropylbetaine To Detect Acid-Fast Bacilli: a Study of United States-Bound Immigrants from Vietnam , 2005, Journal of Clinical Microbiology.

[26]  T. Ficht,et al.  Comparison of C18-Carboxypropylbetaine and Glass Bead DNA Extraction Methods for Detection of Mycobacterium bovisin Bovine Milk Samples and Analysis of Samples by PCR , 1998, Applied and Environmental Microbiology.

[27]  D. Chin,et al.  Differences in contributing factors to tuberculosis incidence in U.S. -born and foreign-born persons. , 1998, American journal of respiratory and critical care medicine.

[28]  R. Elwood,et al.  Tuberculosis screening for immigrants and refugees: diagnostic outcomes in the state of Hawaii. , 1997, American journal of respiratory and critical care medicine.

[29]  L. Thorpe,et al.  Infectious tuberculosis among newly arrived refugees in the United States. , 2004, The New England journal of medicine.

[30]  W. Bishai,et al.  Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. , 2001, JAMA.

[31]  P. Lobue,et al.  Screening of immigrants and refugees for pulmonary tuberculosis in San Diego County, California. , 2004, Chest.

[32]  E. Peterson,et al.  Comparison of Direct and Concentrated Acid-Fast Smears To Identify Specimens Culture Positive forMycobacterium spp , 1999, Journal of Clinical Microbiology.

[33]  T. Tupasi,et al.  Drug-resistant tuberculosis in the Philippines. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[34]  P. Murray,et al.  The acid-fast stain: a specific and predictive test for mycobacterial disease. , 1980, Annals of internal medicine.

[35]  J. Pogoda,et al.  Tuberculosis in the foreign-born population of Tarrant county, Texas by immigration status. , 2001, American journal of respiratory and critical care medicine.