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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Mary Reichler, MD, Division of TB Elimination, Centers for Disease Control, 1600 Clifton Road, Mailstop E-10, Atlanta, GA 30333, 404-639-5350, mrr3@cdc.gov
Background. To identify recently infected individuals and place them on therapy, contact investigations are routinely conducted by health departments throughout the US for all cases of active pulmonary tuberculosis (TB). Methods. To evaluate contact investigations and outcomes, health department records were reviewed for all contacts of 349 culture-positie pulmonary TB patients reported from five study areas in the US. Results. A total of 3,823 contacts were identified for 349 patients with active pulmonary TB. Of the TB patients, 48(14%) had no contacts identified. Of the contacts, 55% completed screening, 27% had an initial but no post-exposure tuberculin skin test, 12% were not screened, and 6% had a history of prior TB or prior (+) tuberculin skin test. Of 2,095 contacts who completed screening, 68% had (-) skin test results, 24% initial positive results with no prior test results available, 7% documented skin test conversions, and 1% active TB at the time of investigation. Of contacts with positive skin tests, treatment of latent TB infection was recommended for 71%; among these, 45% were documented to have completed a 6-month course of therapy. Several factors associated with TB patient infectiousness, contact susceptibility to infection, contact risk of progression to active TB, and amount of contact exposrue to the TB patient were not routinely recorded in health department records. Investigation outcomes are published in JAMA 2002;287:991-995 and Southern Medical Journal 2002;95:414-420. Conclusions. Improvement is needed in the multi-step contact investigation process to ensure that persons exposed to active pulmonary TB patients are identified and appropriately screened, and that recent contacts with latent TB infection complete a full course of treatment.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.