RESUMO
Migrant farm workers (MFWs) are considered a high-risk group for tuberculosis. MFW tuberculosis cases reported to the Centers for Disease Control and Prevention represented 1 percent of all reported tuberculosis cases from 1993 to 1997. Most of these cases (70 percent) were reported from Florida, Texas, and California. MFW tuberculosis cases were more likely to be male, foreign-born, or Hispanic and to have a history of alcohol abuse and homelessness than were non-MFWs. Most (79 percent) foreign-born MFWs were from Mexico. HIV status was poorly reported, with results available for only 28 percent of MFW and 33 percent of non-MFW cases. Of the MFWs tested, 28 percent were HIV infected, whereas 34 percent of non-MFWs were HIV infected. Twenty percent of MFWs move or are lost to follow-up before completing therapy; these cases pose a management challenge for the nation's tuberculosis control efforts.
Assuntos
Agricultura , Migrantes/estatística & dados numéricos , Tuberculose/etnologia , Adulto , California/epidemiologia , Florida/epidemiologia , Soropositividade para HIV/complicações , Soropositividade para HIV/epidemiologia , Humanos , Masculino , México/etnologia , Vigilância da População , Fatores de Risco , Texas/epidemiologia , Tuberculose/complicações , Tuberculose/epidemiologia , Recursos HumanosRESUMO
BACKGROUND: Fourteen cases of tuberculosis (TB) in Puerto Rico, diagnosed from April 1993 to April 1995, had the same DNA fingerprint, documenting disease caused by the same strain of Mycobacterium tuberculosis. The 14 cases were retrospectively investigated for epidemiologic links. METHODS: Records were reviewed and staffs of the TB program, hospital/clinic, and AIDS residential facilities were interviewed. RESULTS: Half of the AIDS cases were epidemiologically related, providing evidence of TB transmission in an emergency department, an AIDS inpatient ward, and an AIDS residential facility. DNA fingerprinting allowed detection of M tuberculosis transmission, but contact investigators could have documented it sooner. Factors contributing to transmission included delayed diagnosis, prolonged infectiousness, inadequate discharge planning and infection control procedures, and poor communication between health-care facilities. CONCLUSIONS: The numbers of AIDS residential facilities are increasing and must understand proper monitoring of TB patients and infection control measures that prevent transmissions.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Impressões Digitais de DNA/métodos , DNA Bacteriano/análise , Surtos de Doenças/estatística & dados numéricos , Mycobacterium tuberculosis/genética , Tuberculose/microbiologia , Tuberculose/transmissão , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Análise por Conglomerados , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , DNA Bacteriano/genética , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Controle de Infecções , Masculino , Epidemiologia Molecular , Porto Rico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Inquéritos e Questionários , Tuberculose/epidemiologia , Tuberculose/prevenção & controleAssuntos
Antituberculosos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/transmissão , Idoso , Busca de Comunicante , Florida/epidemiologia , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Porto Rico/epidemiologia , Teste Tuberculínico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Ilhas Virgens Americanas/epidemiologiaRESUMO
OBJECTIVE: To identify factors contributing to a 400% increase in tuberculosis among children in San Diego County, California, from 1985 to 1993. DESIGN: Review of medical records of reported cases in 1989, 1991, and 1993 and their source case. RESULTS: Of 192 children with tuberculosis, the largest increase was observed in children younger than 5 years old, of whom 77.4% were born in the United States, 67.8% had a foreign-born parent, 73.1% came from a non-English-speaking household, and 46.2% were known to visit Mexico. Of 28 source cases, 82.1% were born outside the United States, primarily in Mexico (67.9%). Resistance to at least one first-line antituberculous drug was identified in 27.5% of isolates from children and in 33.3% of isolates from source cases. CONCLUSIONS: The increase in tuberculosis and high level of drug-resistance among children born in the United States may be attributed to transmission outside of the United States or within the United States from household contacts born in countries in which tuberculosis is highly endemic.
Assuntos
Tuberculose/epidemiologia , Adolescente , Adulto , África/etnologia , Sudeste Asiático/etnologia , California/epidemiologia , América Central/etnologia , Criança , Pré-Escolar , Busca de Comunicante , Doenças Endêmicas , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , México/etnologia , Tuberculose/etnologia , Tuberculose/prevenção & controleRESUMO
OBJECTIVE: To determine the extent of transmission of Mycobacterium tuberculosis to pediatric patients exposed to a pediatrician with smear- and culture-positive pulmonary tuberculosis (TB). METHODS: Clinic billing and hospital admission records were used to identify patients seen during the pediatrician's infectious period. Patients were notified of the potential exposure and were offered screening. RESULTS: A total of 1416 pediatric patients were identified as exposed. Of the 606 who completed screening, 12 (2%) had a skin test result > or = 10 mm, 2 (0.3 had a result 5 to 9 mm, and 592 (98%) had a negative test result (0 to 4 mm). No active TB cases were identified. Of the 14 children with a skin test result > or = 5 mm, 7 were U.S.-born and had no other risk for a positive skin test. The remaining seven had either been exposed to another person with infections TB or were from countries with a high prevalence of TB. CONCLUSION: We found evidence of limited transmission of Mycobacterium tuberculosis in the outpatient pediatric setting. Despite extensive resources dedication, only 43% of exposed children completed screening. In similar situations decision should balance the responsibility to protect children exposed to Mycobacterium tuberculosis with other public health priorities and available resources.
Assuntos
Transmissão de Doença Infecciosa do Profissional para o Paciente , Pediatria , Tuberculose Pulmonar/transmissão , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mycobacterium tuberculosis , Teste TuberculínicoRESUMO
OBJECTIVE: Between November 1994 and April 1995, more than 3300 students in 49 schools in two countries in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students. METHODS: Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as >/=10 mm induration, and a converter was an individual with an increase in reaction size of >/=10 mm in the past 2 years. RESULTS: The rates of positive skin tests were 0.8 percent, 0.3 percent, 9.9 percent, 1.1 percent and 0.7 percent among US-born student exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for student expose to driver 3 and the only secondary case identified among students was exposed to driver 3. The DNA fingerprinting patterns of isolates from drivers 3 and 4 matched. CONCLUSION: There was no clear evidence of transmission of M tuberculosis to students from driver 1, 2, 4, or 5. However, evidence suggests the driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures(AU)
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Pulmonar/transmissão , Busca de Comunicante , Impressões Digitais de DNA , Haiti/etnologia , Mycobacterium tuberculosis/isolamento & purificação , New York , Instituições Acadêmicas , Estudantes , Meios de Transporte , Trinidad e Tobago/etnologia , Teste Tuberculínico , Estados Unidos/etnologiaRESUMO
OBJECTIVE: Between November 1994 and April 1995, more than 3300 students in 49 schools in two counties in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students. METHODS: Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as >/=10 mm induration, and a converter was an individual with an increase in reaction size of >/=10 mm in the past 2 years. RESULTS: The rates of positive skin tests were 0.8%, 0.3%, 9.9%, 1.1%, and 0.7% among US-born students exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for students exposed to driver 3, and the only secondary case identified among students was exposed to driver 3. The DNA fingerprint patterns of isolates from drivers 3 and 4 matched. CONCLUSION: There was no clear evidence of transmission of M tuberculosis to students from drivers 1, 2, 4, or 5. However, evidence suggests that driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures.
Assuntos
Tuberculose Pulmonar/transmissão , Adolescente , Adulto , Criança , Pré-Escolar , Busca de Comunicante , Impressões Digitais de DNA , Feminino , Haiti/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , New York , Instituições Acadêmicas , Estudantes , Meios de Transporte , Trinidad e Tobago/etnologia , Teste Tuberculínico , Estados Unidos/etnologiaRESUMO
Completeness of tuberculosis case reporting in Puerto Rico was assessed. Cases diagnosed among hospitalized, tuberculosis, and human immunodeficiency virus clinic patients during 1992 were retrospectively reviewed. Hospital discharge diagnoses, pharmacy listings of patients receiving anti-tuberculous medications, laboratory and acquired immunodeficiency syndrome registry data were used for case finding in selected hospitals and clinics. Identified cases were matched to the health department TB case registry to determine previous reporting through routine surveillance. Records of unreported cases were reviewed to verify tuberculosis diagnoses. Of 159 patients with tuberculosis, 31 (19.5%) were unreported. A case was defined according to the Centers for Disease Control and Prevention definition. Unreported cases were less likely than previously reported cases to have specimens that were culture positive for M. tuberculosis, 14 of 31 (45.2%) compared with 111 of 128 (86.7%). Excluding the laboratory, tuberculosis diagnoses in acquired immunodeficiency syndrome registry patients had the highest predictive value of finding tuberculosis (94.1%), followed by tuberculosis clinic records (71.7%), and pharmacy listings (45.6%). Tuberculosis discharge diagnoses, however, yielded the largest number of unreported cases (14). Health care providers should be educated regarding the importance of promptly reporting all suspected TB cases regardless of results of laboratory testing.