Epidemiologic basis of tuberculosis control

BACKGROUND—The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated.
METHODS—A subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of the British Thoracic Society to revise the guidelines published in 1994 by the JTC, including representatives of the Royal College of Nursing, Public Health Medicine Environmental Group, and Medical Society for Study of Venereal Diseases. In preparing the revised guidelines the authors took account of new published evidence and graded the strength of evidence for their recommendations. The guidelines have been approved by the JTC and the Standards of Care Committee of the British Thoracic Society.
RECOMMENDATIONS—Tuberculosis services in each district should have staffing and resources to fulfil both the control and prevention recommendations in this document and to ensure adequate treatment monitoring. Notification of tuberculosis is required for surveillance and to initiate contact tracing (where appropriate). The following areas are discussed and recommendations made where appropriate: (1) public health law in relation to tuberculosis; (2) the organisational requirements for tuberculosis services; (3) measures for control of tuberculosis in hospitals, including segregation of patients; (4) the requirements for health care worker protection, including HIV infected health care workers; (5) measures for control of tuberculosis in prisons; (6) protection for other groups with potential exposure to tuberculosis; (7) awareness of the high rates of tuberculosis in the homeless together with local plans for detection and action; (8) detailed advice on contact tracing; (9) contact tracing required for close contacts of bovine tuberculosis; (10) management of tuberculosis in schools; (11) screening of new immigrants and how this should be performed; (12) outbreak contingency investigation; and (13) BCG vaccination and the management of positive reactors found in the schools programme.

/pdf/control-and-prevention-of-tuberculosis-in-the-united-kingdom-3su0zton1v.pdf

Control and prevention of tuberculosis in the United Kingdom:Code of Practice 2000

Physician groups are concerned that legislation requiring physicians to report illegal immigrants to immigration authorities will delay curative care. In particular, patients with tuberculosis may delay seeking care for infectious symptoms and spread the disease. We surveyed 313 consecutive patients with active tuberculosis from 95 different facilities to examine the relationship of immigration-related variables, symptoms, and delay in seeking care. Most patients (71%) sought care for symptoms rather than as a result of the efforts of public health personnel to screen high-risk groups or to trace contacts of infectious persons. At least 20% of respondents lacked legal documents allowing them to reside in the United States. Few (6%) feared that going to a physician might lead to trouble with immigration authorities. Those who did were almost 4 times as likely to delay seeking care for more than 2 months, a period of time likely to result in disease transmission. Patients potentially exposed an average of 10 domestic and workplace contacts during the course of the delay. Any legislation that increases undocumented immigrants' fear that health care professionals will report them to immigration authorities may exacerbate the current tuberculosis epidemic.

Does Fear of Immigration Authorities Deter Tuberculosis Patients from Seeking Care

Illness semantics and international health: the weak lungs/TB complex in the Philippines.

Ongoing transmission and re-infection, primarily in congregate settings, is a key factor fueling the global multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) epidemic, especially in association with the human immunodeficiency virus Even as efforts to broadly implement conventional TB transmission control measures begin, current strategies may be incompletely effective under the overcrowded conditions extant in high-burden, resource-limited settings Longstanding evidence suggesting that TB patients on effective therapy rapidly become non-infectious and that unsuspected, untreated TB cases account for the most transmission makes a strong case for the implementation of rapid point-of-care diagnostics coupled with fully supervised effective treatment Among the most important decisions affecting transmission, the choice of an MDR-TB treatment model that includes community-based treatment may offer important advantages over hospital or clinic-based care, not only in cost and effectiveness, but also in transmission control In the community, too, rapid identification of infectious cases, especially drug-resistant cases, followed by effective, fully supervised treatment, is critical to stopping transmission Among the conventional interventions available, we present a simple triage and separation strategy, point out that separation is intimately linked to the design and engineering of clinical space and call attention to the pros and cons of natural ventilation, simple mechanical ventilation systems, germicidal ultraviolet air disinfection, fit-tested respirators on health care workers and short-term use of masks on patients before treatment is initiated

https://www.ghdonline.org/uploads/Turning_off_the_spigot_IUATLD_2010.pdf

Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings

Drs. Richard Riley and Allan Moodie have provided valuable information on the "Infectivity of Patients with Pulmonary Tuberculosis in Inner City Homes" in the REVIEW (1974, 110, 810) . I would hope that one of the modifications of the continuing study will be the inclusion of a skin test at approximately 10 weeks in order to document more exactly the time of infection. The large interval between the 6th and the 20th week following the first test might have been too long. Another possibility should be considered to ex· plain the absence of late conversions in contacts of patients treated at home. The observation is also consistent with the hypothesis that all of the suscePtible contacts had already been infected by the time the index case was identified, leaving only those with heightened natm·al resistance at risk of subsequent infection. I believe that both factors, loss of infectivity after initiation of chemotherapy and previous infection of the more susceptible contacts, were operative.

Infectivity of patients with pulmonary tuberculosis in inner city homes.

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Infectivity of patients with pulmonary tuberculosis in inner city homes.