Tuberculosis among Families of Children with Suspected Tuberculosis and Employees at a Children's Hospital

Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas TX 77030, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 02/2011; 32(2):188-90. DOI: 10.1086/657940
Source: PubMed


Children with tuberculosis are rarely contagious, but their caregivers may be. Only 7 (12%) of 59 children were potentially contagious, and 10 (17%) were accompanied by contagious adults. Screening caregivers was more cost-effective than performing employee contact investigations, with one-sixteenth the cost ($5,470 vs $88,323) and requiring screening of 35 times fewer persons.

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    • "However, in this sample, we found HCWs who had a history of working in pediatric wards had an increased incidence of TB. Transmission of TB from family members or visitors to pediatric patients, HCWs, and visitors to pediatric wards has been reported [26–31]. In this setting with high TB incidence, it is possible that undiagnosed family members or visitors who spend extended periods of time in pediatric wards may expose HCWs to TB. HCWs working in pediatric wards may perceive themselves at low risk for TB and not adhere to infection control measures. "
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    ABSTRACT: Background Tuberculosis (TB) is an occupational hazard for health care workers (HCWs) who are at greater risk of developing TB than the general population. The objective of this study was to compare the difference in TB incidence among HCWs with versus without a history of working in TB wards, to estimate the incidence of TB among HCWs, and to identify risk factors for TB disease in HCWs. Methods A retrospective cohort study (January 2006 to December 2010) was conducted in three district hospitals in KwaZulu-Natal, South Africa. Data were abstracted via chart review from occupational health medical records. Bivariate and multivariate analyses were performed using a Poisson multilevel mixed model. Results Of 1,313 (92%) medical charts reviewed with data on location of work documented, 112 (9%) cases of TB were identified. Among HCWs with TB 14 (13%) had multidrug-resistant TB. Thirty-six (32%) were cured, 33 (29%) completed treatment, and 13 (12%) died. An increased incidence of TB was reported for HCWs with a history of working in TB wards (incidence rate ratio [IRR] 2.03, 95% CI 1.11-3.71), pediatric wards (IRR 1.82 95% CI 1.07-3.10), outpatient departments (IRR 2.08 95% CI 1.23-3.52), and stores/workshop (IRR 2.38 95% CI 1.06-5.34) compared with those without such a history. HCWs living with HIV had a greater incidence of TB (IRR 3.2, 95% CI 1.54-6.66) than HIV-negative HCWs. TB incidence among HCWs was approximately two-fold greater than that of the general population over the study period. Conclusions HCWs working in a TB ward had an increased incidence of TB. However, a greater incidence of TB was also found in HCWs working in other wards including pediatric wards, outpatient departments and stores. We also identified a greater incidence of TB among HCWs than the general population. These findings further support the need for improved infection control measures not only in TB or drug-resistant TB wards or areas perceived to be at high-risk but also throughout hospitals to protect HCWs. Additionally, it is recommended for occupational health services to routinely screen HCWs for TB and provide HCWs with access to care for TB and HIV.
    BMC Public Health 08/2014; 14(1):891. DOI:10.1186/1471-2458-14-891 · 2.26 Impact Factor
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    ABSTRACT: Tuberculosis (TB) infection control recommendations in healthcare settings were developed to decrease nosocomial transmission from adults. In the absence of pediatric-specific guidelines, these infection control recommendations have been incorporated, in almost unmodified format, for childhood TB. We will review the evidence concerning the contagiousness of TB in children, scenarios in which transmission is more likely, review United States national recommendations, and consider the family unit, as opposed to the patient, to be the transmission unit for childhood TB.
    Tuberculosis (Edinburgh, Scotland) 11/2011; 91 Suppl 1:S11-5. DOI:10.1016/ · 2.71 Impact Factor
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    ABSTRACT: Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines. We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB. After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2–4.4%, I2=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9–1.8%, I2=95.9%), and latent TB infection was 51.5% (95% CI 47.1–55.8%, I2=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1–4.5%, I2=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8–12.6%, I2=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1–1.8%, I2=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2–32.4%, I2=99.5%). There was substantial heterogeneity among published studies. Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.
    European Respiratory Journal 08/2012; 41(1). DOI:10.1183/09031936.00070812 · 7.64 Impact Factor
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