RESUMO
From November 1996 through March 1997, presumptive active pulmonary tuberculosis (TB) was detected in 44 health care workers (HCWs) at a university hospital in Lima, Peru. To further assess the magnitude of the outbreak and determine risk factors for occupational Mycobacterium tuberculosis transmission, we identified HCWs in whom active pulmonary TB was diagnosed from January 1994 through January 1998, calculated rates by year and hospital work area, and conducted a tuberculin skin test (TST) survey. Thirty-six HCWs had confirmed active pulmonary TB. The rate of TB was significantly higher among the 171 HCWs employed in the laboratory than among HCWs employed in all other areas. In multivariate analysis, the only independent risk factor for HCW M. tuberculosis infection in HWCs employed in the laboratory was the use of common staff areas. Very high rates of active pulmonary TB were detected among HCWs at this hospital, and occupational acquisition in the laboratory was associated with HCW-to-HCW transmission.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/transmissão , Adulto , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laboratórios Hospitalares/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mycobacterium tuberculosis/isolamento & purificação , Exposição Ocupacional/estatística & dados numéricos , Peru/epidemiologia , Fatores de Risco , Teste Tuberculínico , Tuberculose Pulmonar/diagnósticoRESUMO
SETTING: The prevalence of substandard anti-tuberculosis drugs is unknown. To maximize the effectiveness of tuberculosis (TB) control efforts, simple, inexpensive drug quality screening methods are needed. DESIGN: Isoniazid (INH) and rifampin (RMP) single- and fixed-dose combination (FDC) formulations were collected from selected TB programs and pharmacies in Colombia, Estonia, India, Latvia, Russia and Vietnam. Samples were screened using a recently developed thin-layer chromatography (TLC) kit. All abnormal samples and a 40% random sample of normal formulations were further analyzed using confirmatory techniques. Samples outside of 85% to 115% of stated content, and/or containing compounds other than the stated drug, were defined as being substandard. RESULTS: Overall, 10% (4/40) of all samples, including 13% (4/30) RMP samples, contained <85% of stated content. More FDCs (5/24, 21%) than single-drug samples (2/16, 13%) were substandard. A comparison of TLC with the confirmatory analysis for RMP analysis showed a sensitivity of 100% (4/4), a specificity of 92% (24/26), a positive predictive value (PPV) of 67% (4/6), and a negative predictive value (NPV) of 100% (24/24). An analysis of INH showed a specificity of 90% (9/10). However, sensitivity, PPV, and NVP could not be determined. CONCLUSION: A substantial number of anti-tuberculosis drugs from several countries, in particular FDCs, were found to be substandard. Such drugs may contribute to the creation of drug-resistant TB. TLC is an effective, convenient, and inexpensive method for the detection of substandard drugs.
Assuntos
Antituberculosos/análise , Cromatografia em Camada Fina/métodos , Isoniazida/análise , Rifampina/análise , Tuberculose/tratamento farmacológico , Antituberculosos/normas , Ásia , Colômbia , Combinação de Medicamentos , Europa Oriental , Humanos , Isoniazida/normas , Valor Preditivo dos Testes , Controle de Qualidade , Padrões de Referência , Rifampina/normas , Sensibilidade e EspecificidadeRESUMO
SETTING: Foreign-born persons in the United States represent a growing proportion of the nation's tuberculosis (TB) cases. OBJECTIVE: To characterize drug resistance patterns in foreign-born TB patients from the three most common birth countries. DESIGN: A descriptive analysis of national TB surveillance data for 1993-1997. TB case reports for foreign-born persons who were at least 15 years old and born either in Mexico (6221), the Philippines (3624), or Vietnam (3351) were included. RESULTS: Among those with no prior history of TB, the proportions with isoniazid-resistant TB and MDR-TB (resistance to at least isoniazid and rifampin) were 9.2% and 1.6% for persons from Mexico, 13.7% and 1.4% for those from the Philippines, and 17.8% and 1.4% for those from Vietnam. Levels of isoniazid resistance and MDR-TB did not change during the 5-year study period. Levels of isoniazid resistance decreased with older age for persons with no prior TB from all three countries; however, rates of MDR-TB did not vary with age. Persons with <1 year of residence in the US were more likely to have MDR-TB; however, duration of residence in the US was not associated with isoniazid resistance. CONCLUSION: Increased drug resistance in younger and more recent arrivals suggests that vigorous efforts to prevent further development of MDR-TB in the three countries are essential.
Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Logísticos , Masculino , México/etnologia , Pessoa de Meia-Idade , Filipinas/etnologia , Vigilância da População , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Vietnã/etnologiaRESUMO
SETTING: Buenaventura, Colombia. OBJECTIVE: To assess whether antituberculosis drug resistance was generated by poor management or community transmission. DESIGN: Treatment-failure and new tuberculosis (TB) patients identified between May 1997 and June 1998 were interviewed and their treatment histories reviewed. Bacteriologic testing, including drug susceptibility profiles (DSP) and DNA fingerprinting by restriction fragment length polymorphism (RFLP), was performed and human immunodeficiency virus (HIV) testing was offered. RESULTS: DSP and RFLP fingerprints were obtained for isolates from 34 of 64 treatment-failure patients; 25 (74%) were resistant to > or = one drug. Fifteen of the 25 patients consented to HIV testing; none were positive. An average of 2.8 major treatment errors per patient was identified. RFLP from the treatment-failure patients revealed 20 unique isolates and six clusters (isolates with identical RFLP); 4/6 clusters contained isolates with different DSP. Analysis of the RFLP from both treatment-failure and new patients revealed that 44/111 (40%) isolates formed 18 clusters. Four of 47 (9%) new patients had multidrug-resistant TB (MDR-TB). Eleven isolates belonged to the Beijing family, related to the MDR strain W. CONCLUSION: Drug resistance in Buenaventura results from both poor management and community transmission. Dependence on DSP to identify TB transmission is inadequate when programmatic mismanagement is common.
Assuntos
Surtos de Doenças , Erros Médicos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/etiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Colômbia/epidemiologia , Impressões Digitais de DNA , Humanos , Polimorfismo de Fragmento de Restrição , Avaliação de Programas e Projetos de Saúde , Falha de Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/genéticaRESUMO
BACKGROUND: Drug resistance threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Mexico. OBJECTIVE: To obtain population-based data on Mycobacterium tuberculosis drug resistance in Mexico. METHODS: To obtain drug resistance data, we conducted a population-based study of TB cases in the states of Baja California, Sinaloa, and Oaxaca, Mexico. We performed cultures and drug susceptibility testing on M tuberculosis isolates from patients with newly diagnosed, smear-positive TB from April 1 to October 31, 1997. RESULTS: Mycobacterium tuberculosis was isolated from 460 (75%) of the 614 patients. Levels of resistance in new and retreatment TB cases to 1 or more of the 3 current first-line drugs used in Mexico (isoniazid, rifampin, and pyrazinamide) were 12.9% and 50.5%, respectively; the corresponding levels of multi-drug-resistant TB were 2.4% and 22.4%. Retreatment cases were significantly more likely than new cases to have isolates resistant to 1 or more of the 3 first-line drugs (relative risk [RR], 3.9; 95% confidence interval [CI], 2.8-5.5), to have isoniazid resistance (RR, 3.6; 95% CI, 2.5-5.2), and to have multi-drug-resistant TB (RR, 9.4; 95% CI, 4.3-20.2). CONCLUSIONS: This population-based study of M tuberculosis demonstrates moderately high levels of drug resistance. Important issues to consider in the national strategy to prevent M tuberculosis resistance in Mexico include consideration of the most appropriate initial therapy in patients with TB, the treatment of patients with multiple drug resistance, and surveillance or periodic surveys of resistance among new TB patients to monitor drug resistance trends.
Assuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , México/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologiaRESUMO
In 1996, 10% of the 20,973 U.S. tuberculosis (TB) cases were among foreign-born (FB) Hispanic persons, with the four states bordering Mexico accounting for 83% of FBH cases. Limited information is available on this population's health care seeking and migration practices and on differences between FB Hispanic patients in border and nonborder areas. Therefore, we conducted interviews and record reviews for all consenting FB Hispanic TB patients from eight counties bordering Mexico (BC; n = 167) and seven urban nonborder counties (NBC; n = 158) in these States during 1995-1997. BC patients had resided in the U.S. longer than NBC patients (17.4 versus 10.8 yr; p < 0.01), had immigrated more often from Mexican border communities (62.4% versus 25.4%; p < 0.01), and had returned to Mexico more often in the past 12 mo (71.5% versus 47.3%; p < 0. 01). TB symptoms were present for >/= 6 mo in 37% of BC and 34% of NBC patients. Binational collaboration is essential for improving TB control in both countries and should extend beyond border areas of Mexico.
Assuntos
Emigração e Imigração , Hispânico ou Latino , Tuberculose Pulmonar/etnologia , Adulto , América Central/etnologia , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Ocupações , Prevalência , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To examine the characteristics of foreign-born people with tuberculosis (TB) in Southern Florida, their contribution to the total number of TB cases, and available data on their HIV status as well as to determine the number of cases detected by the overseas medical screening of immigrants and refugees. METHODS: The authors reviewed TB cases reported by Broward, Dade, and Palm Beach counties in 1995. Case records were matched against the CDC Division of Quarantine database of immigrants and refugees suspected to have TB at the time of visa application overseas. RESULTS: Nearly half (49%) of TB cases in the three counties were among people born outside the United States--34% in Broward County, 58% in Dade County, and 40% in Palm Beach County. A high percentage (26%) were co-infected with HIV. Of those with known date of arrival, 68% had been in the United States for five or more years. Only three cases had been identified by overseas immigrant screening. CONCLUSIONS: A low percentage of TB cases in foreign-born people were identified through the overseas screening system. Controlling TB in South Florida will require efforts targeted toward high risk populations, including people with HIV infection.
Assuntos
Emigração e Imigração , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Adulto , Comorbidade , Feminino , Florida/epidemiologia , Infecções por HIV/etnologia , Humanos , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Tuberculose/etnologia , Índias Ocidentais/etnologiaRESUMO
OBJECTIVES: To describe the epidemiology of foreign-born tuberculosis (TB) cases in Los Angeles County and to evaluate current TB screening and follow-up of immigrants and refugees (I&R) to the USA. DESIGN: Retrospective analysis of the Los Angeles County TB registry between October 1992 and December 1994. We matched all cases who entered the USA during fiscal year 1993 (FY93) with a database from the tracking system of I&R with suspected TB. RESULTS: Foreign-born persons accounted for 64% of all reported TB cases. Half were born in Mexico or Central America. Standardized incidence rates were 3-5 times higher than those of US-born persons for Mexicans and Central Americans, 6-7 times higher for North-east Asians, and 10-15 times higher for South-east Asians. Among foreign-born cases who arrived during FY93, 5% of the Mexicans and Central Americans, 48% of the North-east Asians and 67% of the South-east Asians were registered by the tracking system. CONCLUSION: Mexicans and Central Americans accounted for the majority of cases but had a lower incidence of TB than Asians. The current screening procedures identify a large proportion of cases among recently arrived South-east Asians, but contribute little to the control of TB among Mexicans and Central Americans.
Assuntos
Emigração e Imigração , Tuberculose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Sudeste Asiático/etnologia , América Central/etnologia , Criança , Pré-Escolar , Ásia Oriental/etnologia , Humanos , Incidência , Lactente , Recém-Nascido , Los Angeles/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Refugiados , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Tuberculose/diagnósticoRESUMO
To assess the possible influence of altitude on childhood growth in the United States, we used data collected by the Centers for Disease Control Pediatric Nutrition. Surveillance System from eight mountain states to determine the height and weight status of children aged 5 years or younger enrolled in various public health programs between 1982 and 1984. The mean birth weight, height-for-age, weight-for-age, and weight-for-height indicators were found to decline significantly with increasing altitude, starting at an elevation greater than 1500 m (p less than 0.001, ANOVA). The reduction in growth was observed for all age groups and all birth weight groups studied. Part of the observed reduction in growth could be attributed to the lower birth weight of children born at higher altitude. However, the reduced growth status persisted after controlling for birth weight, suggesting the presence of an extrauterine growth retardation effect related to altitude.
Assuntos
Altitude , Crescimento , Peso ao Nascer , Estatura , Peso Corporal , Pré-Escolar , Coleta de Dados , Humanos , Lactente , Recém-Nascido , Estados UnidosRESUMO
To examine further the differences in birth-weight-specific neonatal mortality rates between ethnic groups, we studied causes of death for infants of white, black, United States-born Hispanic, and Mexican-born Hispanic women using linked California birth-death records from 1981 to 1983. Black infants of low birth weight had considerably lower neonatal mortality rates from respiratory distress syndrome and congenital abnormalities. In the normal birth-weight category, however, black neonatal mortality rates for most conditions were higher than those for whites. The greatest differences between Mexican-born Hispanic and white neonatal mortality rates were seen for other respiratory conditions and trauma/hypoxia/asphyxia. These differences were most marked in the 1500- to 2499-g and greater than or equal to 2500-g birth-weight categories. Attempts to lower the neonatal mortality rate for black infants of normal birth weight may require providers to focus on both broad preventive measures and improved perinatal management. In contrast, improvements in perinatal management among Mexican-born Hispanics may produce improvement in the neonatal mortality rate for this group.
Assuntos
Etnicidade , Mortalidade Infantil , Negro ou Afro-Americano , Peso ao Nascer , California , Hispânico ou Latino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , México/etnologia , Estados Unidos , População BrancaRESUMO
We compared pregnancy outcomes among United States-born and Mexican-born women having Spanish surnames with US-born Whites and Blacks using California's 1981 matched birth-death cohort file. Maternal risk characteristics between US-born Black women and US-born women with Spanish surnames were similar. In contrast, Latino women, regardless of national origin, delivered small proportions of low weight infants as compared to Blacks. Birthweight-specific mortality rates during the fetal and neonatal periods for the offspring of Mexican-born Spanish surname women were generally higher than those for other ethnic groups. Our findings are consistent with the underreporting of postneonatal deaths among Mexican-born Latinos, yet suggest that their relatively low reported infant mortality rates compared to Blacks can be explained by a more favorable birthweight distribution.