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Grohs E, Short M, Griffin G, Sheets A, Tegarden T, Schaffzin J, Huang FS. Nosocomial exposure of health care workers to a visitor with active pulmonary tuberculosis in a pediatric intensive care unit: A contact investigation. Am J Infect Control 2023; 51:1189-1191. [PMID: 37059123 DOI: 10.1016/j.ajic.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
Visitors with active tuberculosis (TB) can lead to uncontrolled introductions in health care settings, even in facilities with robust TB control programs. We report a pediatric case of TB meningitis who had an adult visitor with active pulmonary TB. We identified 96 contacts from the index case. One high-risk contact had a positive follow-up TB test with no clinical symptoms. TB control programs should incorporate the risk of TB exposure from adult visitors, especially in pediatric settings.
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Affiliation(s)
- Emily Grohs
- Infection Prevention & Control Program, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH.
| | - Matt Short
- Infection Prevention & Control Program, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Gladys Griffin
- Infection Prevention & Control Program, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Anna Sheets
- Employee Health, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Taryn Tegarden
- Employee Health, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Joshua Schaffzin
- Infection Prevention & Control Program, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH; Division of Infectious Diseases, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Felicia Scaggs Huang
- Infection Prevention & Control Program, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH; Division of Infectious Diseases, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH.
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2
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Starke JR, Erkens C, Ritz N, Kitai I. Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings. Pathogens 2022; 11:pathogens11020158. [PMID: 35215101 PMCID: PMC8877840 DOI: 10.3390/pathogens11020158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/22/2023] Open
Abstract
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.
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Affiliation(s)
- Jeffrey R. Starke
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-832-824-4330
| | - Connie Erkens
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands;
| | - Nicole Ritz
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children’s Hospital, University of Basel, 4031 Basel, Switzerland
| | - Ian Kitai
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada;
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3
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Martinez L, Lo NC, Cords O, Hill PC, Khan P, Hatherill M, Mandalakas A, Kay A, Croda J, Horsburgh CR, Zar HJ, Andrews JR. Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies. THE LANCET RESPIRATORY MEDICINE 2019; 7:544-552. [PMID: 31078497 DOI: 10.1016/s2213-2600(19)30137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - Palwasha Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Anna Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alexander Kay
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; The Baylor Children's Foundation, Mbabane, Swaziland
| | - Julio Croda
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil; Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - C Robert Horsburgh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South Africa Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Darby J, Falco C. Infection Control and the Need for Family-/Child-Centered Care. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2019. [PMCID: PMC7122132 DOI: 10.1007/978-3-319-98122-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient- and family-centered care (FCC) has become central to the delivery of medical care over the last 20 years and has been shown to improve patient outcomes. Infection control practices have the potential to greatly influence family centeredness and care providers, and hospital personnel must consider the potential impacts of isolation and the use of personal protective equipment (PPE). Approaching infection control with the perspective of FCC requires balancing patient safety and overall patient well-being. In this chapter, authors consider infection control and the benefits of FCC, family and sibling visitation, the use of playrooms, animals in healthcare settings including animal-assisted interventions, the potential adverse effects of infection control practices, and strategies to mitigate these impacts.
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Sfeir M, Simon MS, Banach D. Isolation Precautions for Visitors to Healthcare Settings. INFECTION PREVENTION 2018. [PMCID: PMC7123668 DOI: 10.1007/978-3-319-60980-5_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Visitors may be involved in infection transmission within healthcare settings; however, there is currently limited published data on this subject. This chapter describes situations in which visitor-associated infection transmission occurred and highlights the potential role of visitors in the transmission of pathogenic organisms that can lead to outbreaks in healthcare settings. Infection prevention measures, including isolation precautions and visitor restriction, may be utilized and potentially adapted in order to protect patients and their visitors as well as healthcare personnel. The practical and ethical challenges regarding the use of isolation precautions among visitors to healthcare facilities are discussed.
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Siegel JD, Guzman-Cottrill JA. Pediatric Healthcare Epidemiology. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152479 DOI: 10.1016/b978-0-323-40181-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
One million children develop tuberculosis disease each year, and 210,000 die from complications of tuberculosis. Childhood tuberculosis is very different from adult tuberculosis in epidemiology, clinical and radiographic presentation, and treatment. This review highlights the many unique features of childhood tuberculosis, with special emphasis on very young children and adolescents, who are most likely to develop disease after infection has occurred.
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Kulak S, Stein REK. Toy Age-Labeling: An Overview for Pediatricians of How Toys Receive Their Age Safety and Developmental Designations. Pediatrics 2016; 138:peds.2015-1803. [PMID: 27273747 DOI: 10.1542/peds.2015-1803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/24/2022] Open
Abstract
Injuries related to toys continue to cause significant childhood morbidity and mortality, despite considerable government regulation of the toy industry. Recent controversy related to toys that contain strong magnets demonstrate the dangers they pose to children. The pediatric community is often unaware of how toys receive their developmental and safety labeling and the degree to which age-labeling on toys can be discretionary. Toy labeling has 2 basic manifestations. The first, safety labeling for hazards like small parts, balloons, or small balls that may present a choking risk, is mandatory. The second, "developmental" age-labeling, describes the age of the children for which the toy is intended, and sometimes has discretionary components. This article provides a review of the regulations governing toy age-safety standards and how they are reflected on toy packaging to help pediatric practitioners apply safety advice across settings and patient characteristics. We review the existing age-labeling regulations and processes and discuss the major areas where children remain vulnerable despite labeling. Finally, we list some recommendations for counseling parents about toy safety.
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Affiliation(s)
- Shuli Kulak
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Ruth E K Stein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Yuen CM, Amanullah F, Dharmadhikari A, Nardell EA, Seddon JA, Vasilyeva I, Zhao Y, Keshavjee S, Becerra MC. Turning off the tap: stopping tuberculosis transmission through active case-finding and prompt effective treatment. Lancet 2015; 386:2334-43. [PMID: 26515675 PMCID: PMC7138065 DOI: 10.1016/s0140-6736(15)00322-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To halt the global tuberculosis epidemic, transmission must be stopped to prevent new infections and new cases. Identification of individuals with tuberculosis and prompt initiation of effective treatment to rapidly render them non-infectious is crucial to this task. However, in settings of high tuberculosis burden, active case-finding is often not implemented, resulting in long delays in diagnosis and treatment. A range of strategies to find cases and ensure prompt and correct treatment have been shown to be effective in high tuberculosis-burden settings. The population-level effect of targeted active case-finding on reducing tuberculosis incidence has been shown by studies and projected by mathematical modelling. The inclusion of targeted active case-finding in a comprehensive epidemic-control strategy for tuberculosis should contribute substantially to a decrease in tuberculosis incidence.
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Affiliation(s)
| | | | | | | | | | | | - Yanlin Zhao
- Chinese Centre for Disease Control and Prevention, Beijing, China
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Vecchio AL, Bocchino M, Lancella L, Gabiano C, Garazzino S, Scotto R, Raffaldi I, Assante LR, Villani A, Esposito S, Guarino A. Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis: Systematic Review and Proposed Recommendations for Pediatric Patients Living in Developed Countries. [Corrected]. Medicine (Baltimore) 2015; 94:e2045. [PMID: 26683914 PMCID: PMC5058886 DOI: 10.1097/md.0000000000002045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tuberculosis (TB) is a re-emerging health problem in developed countries. This paper is part of large guidelines on the global management of TB in children, by a group of scientific societies. It describes the indications to hospitalization of children with suspected or diagnosed TB, the isolation measures, hospital discharge, and re-admission into the community. Using the Consensus Conference method, relevant publications in English were identified by means of a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Available data on indications to hospitalization were mainly indirect and largely derived from observational studies. They include: (1) host-related risk factors, the main being age <12 months, immune deficiencies, and malnutrition; (2) TB-related clinical conditions that resemble those of pneumonia but also include drug-resistance; and (3) social and logistic conditions. The latter are based on opinion and depend on local conditions. Analysis of the literature showed that patients hospitalized with suspected pulmonary TB should be put in precautionary respiratory isolation regardless of their age while they await diagnosis. The general conditions for re-admission into the community are at least 14 days of effective treatment and negative microscopic tests of 3 consecutive samples in previously microscopically positive patients. This is the first paper that provides indications to hospitalization of children with TB. Most recommendations are generally applicable in all developed countries. Some might need an adaptation to local setting, epidemiological, parameters, and availability of specific health-care facilities.
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Affiliation(s)
- Andrea Lo Vecchio
- From the Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy (ALV, RS, AG); Pneumology Unit, Federico II University of Naples, Naples, Italy (MB, LRA); Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy (LL, AV); Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy (CG, SG, IR); and Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (SE)
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Dramowski A, Cotton MF, Whitelaw A. Utilization of paediatric isolation facilities in a TB-endemic setting. Antimicrob Resist Infect Control 2015; 4:36. [PMID: 26396738 PMCID: PMC4578346 DOI: 10.1186/s13756-015-0078-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/07/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction In hospital settings, patient isolation is used to limit transmission of certain pathogens (e.g. M. tuberculosis [TB], antibiotic-resistant bacteria and viruses causing respiratory and enteric infection). Data is lacking on utilization of paediatric isolation facilities in low-resource, TB-endemic settings. Methods Prospective weekday observation of 18 paediatric isolation rooms at Tygerberg Children’s Hospital, Cape Town, South Africa, was conducted between 1 May 2014 and 31 October 2014 documenting: occupancy rate; indication for isolation; duration of isolation; application of transmission-based precautions and infection prevention (IPC) behaviour of personnel. Potential under-utilization of isolation rooms was determined by cross-referencing isolation room occupancy with laboratory isolates of antibiotic-resistant bacteria, M. tuberculosis and selected viral pathogens. Results Six percent (335/5906) of hospitalized children were isolated: 78 % (260/335) for IPC purposes. Most IPC-isolated patients had community-acquired infections (213/260; 82 %), including tuberculosis (130/260; 50 %) and suspected viral infections (75/260; 29 %). Children (median age 17 months [IQR 6–50]) spent 4 days (IQR 2–8) in isolation. Isolation occupancy was 66 % (2172/3294 occupied bed days), but varied significantly by month. Laboratory data identified an additional 135 patients warranting isolation with 2054 extra bed-days required. Forty patients with 171 patient days of inappropriate isolation were identified. During 1223 weekday visits to IPC-isolated patient rooms: alcohol-based handrub was available (89 %); transmission-based precautions were appropriately implemented (71 %); and personal protective equipment was provided (74 %). Of 358 observed interactions between paediatric staff and isolated patients, hand hygiene compliance was 65 % and adherence to transmission-based precautions was 58 %. Conclusion Patients isolated for TB (under airborne precautions) accounted for more than half of all isolation episodes. Missed opportunities for patient isolation were common but could be reduced by implementation of syndromic isolation. Demand for isolation facilities was seasonal, with projected demand exceeding available isolation beds over winter months.
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Andrew Whitelaw
- Department of Medical Microbiology, Stellenbosch University and the National Health Laboratory Service (NHLS), Cape Town, South Africa
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13
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Schepisi MS, Sotgiu G, Contini S, Puro V, Ippolito G, Girardi E. Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis. PLoS One 2015; 10:e0121639. [PMID: 25835507 PMCID: PMC4383623 DOI: 10.1371/journal.pone.0121639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/11/2015] [Indexed: 11/18/2022] Open
Abstract
Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04-0.21) for infants, 0.38% (95% CI 0.01-1.60) for children, 0.09% (95% CI 0.02-0.22) for adults and 0.00% (95% CI 0.00-0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 - 2.02) for infants, 0.9% (95% CI 0.40-1.60) for children, 4.32% (95% CI 1.43-8.67) for adults and 2.62% (95% CI 1.05-4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.
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Affiliation(s)
- Monica Sañé Schepisi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
- * E-mail:
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Silvia Contini
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Vincenzo Puro
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Enrico Girardi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
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Cruz AT, Medina D, Whaley EM, Ware KM, Koy TH, Starke JR. Tuberculosis among Families of Children with Suspected Tuberculosis and Employees at a Children's Hospital. Infect Control Hosp Epidemiol 2015; 32:188-90. [DOI: 10.1086/657940] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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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Tudor C, Van der Walt M, Margot B, Dorman SE, Pan WK, Yenokyan G, Farley JE. Tuberculosis among health care workers in KwaZulu-Natal, South Africa: a retrospective cohort analysis. BMC Public Health 2014; 14:891. [PMID: 25174848 PMCID: PMC4161912 DOI: 10.1186/1471-2458-14-891] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Carrie Tudor
- />Fogarty Global Health Post-doctoral Fellow, University of North Carolina, Chapel Hill, 211 W. Sierra Circle, San Marcos, TX 78666 USA
| | | | - Bruce Margot
- />KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Susan E Dorman
- />Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - William K Pan
- />Duke University Nicholas School of Environment and Duke Global Health Institute, Durham, NC USA
| | - Gayane Yenokyan
- />Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Jason E Farley
- />Johns Hopkins University School of Nursing, Baltimore, Maryland USA
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Abstract
Many clinicians regard tuberculosis as an adult pulmonary disease, but tuberculosis (TB) is a major cause of disease, both pulmonary and extrapulmonary, and death in young children from TB-endemic countries, especially in areas affected by poverty, social disruption, and human immunodeficiency virus (HIV) infection. This article reviews the disease burden and the natural history of disease in children with TB. It also provides guidance regarding the diagnosis, treatment, and prevention of TB in children.
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Affiliation(s)
- Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) and The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales 2145, Australia
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa
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Wallace RM, Stanek D, Griese S, Krulak D, Vora NM, Pacha L, Kan V, Said M, Williams C, Burgess TH, Clausen SS, Austin C, Gabel J, Lehman M, Finelli LN, Selvaggi G, Joyce P, Gordin F, Benator D, Bettano A, Cersovsky S, Blackmore C, Jones SV, Buchanan BD, Fernandez AI, Dinelli D, Agnes K, Clark A, Gill J, Irmler M, Blythe D, Mitchell K, Whitman TJ, Zapor MJ, Zorich S, Witkop C, Jenkins P, Mora P, Droller D, Turner S, Dunn L, Williams P, Richards C, Ewing G, Chapman K, Corbitt C, Girimont T, Franka R, Recuenco S, Blanton JD, Feldman KA. A large-scale, rapid public health response to rabies in an organ recipient and the previously undiagnosed organ donor. Zoonoses Public Health 2014; 61:560-70. [PMID: 24673934 DOI: 10.1111/zph.12105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Indexed: 11/29/2022]
Abstract
This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.
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Affiliation(s)
- R M Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology (DHCPP), Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Schaaf HS, Seddon JA. Epidemiology and management of childhood multidrug-resistant tuberculosis. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/cpr.12.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Carlos M Perez-Velez
- Grupo Tuberculosis Valle-Colorado and Clínica León XIII, IPS Universidad de Antioquia, Medellín, Colombia
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Siegel JD. Pediatric Infection Prevention and Control. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7151971 DOI: 10.1016/b978-1-4377-2702-9.00101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Stein RA. Super-spreaders in infectious diseases. Int J Infect Dis 2011; 15:e510-3. [PMID: 21737332 PMCID: PMC7110524 DOI: 10.1016/j.ijid.2010.06.020] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 04/05/2010] [Accepted: 06/16/2010] [Indexed: 12/15/2022] Open
Abstract
Early studies that explored host–pathogen interactions assumed that infected individuals within a population have equal chances of transmitting the infection to others. Subsequently, in what became known as the 20/80 rule, a small percentage of individuals within any population was observed to control most transmission events. This empirical rule was shown to govern inter-individual transmission dynamics for many pathogens in several species, and individuals who infect disproportionately more secondary contacts, as compared to most others, became known as super-spreaders. Studies conducted in the wake of the severe acute respiratory syndrome (SARS) pandemic revealed that, in the absence of super-spreading events, most individuals infect few, if any, secondary contacts. The analysis of SARS transmission, and reports from other outbreaks, unveil a complex scenario in which super-spreading events are shaped by multiple factors, including co-infection with another pathogen, immune suppression, changes in airflow dynamics, delayed hospital admission, misdiagnosis, and inter-hospital transfers. Predicting and identifying super-spreaders open significant medical and public health challenges, and represent important facets of infectious disease management and pandemic preparedness plans.
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Affiliation(s)
- Richard A Stein
- Department of Molecular Biology, Princeton University, One Washington Road, LTL320, Princeton, NJ 08544, USA.
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Abstract
OBJECTIVES The objectives were to describe emergency department (ED) presentations of children with tuberculosis (TB) disease and assess the utility in children of TB screening tools developed for adults. METHODS Children at most 18 years old with confirmed or probable TB seen at the Children's TB Clinic from 2005 to 2009 who were initially evaluated in the ED for symptoms compatible with TB in the preceding month were included. TB was classified as microbiologically confirmed disease or probable TB disease, as defined by the World Health Organization. RESULTS Sixty children (29 with confirmed TB and 31 with probable TB) were identified after presentation to the ED, representing 35% of all children diagnosed with TB at the two hospitals during this interval. Eighty-eight percent were previously healthy. Fifty-five percent were Hispanic, 30% were black or African American, 12% were Asian, and 3% were white. Forty-four (73%) had intrathoracic disease (37 pulmonary parenchymal or pleural disease, four miliary disease, two endobronchial, one pericarditis). Sixteen (27%) had extrathoracic disease (eight meningitis, five cervical lymphadenopathy, two gastrointestinal, one interstitial keratitis), 11 of whom also had abnormal chest radiographs, including all eight children with TB meningitis. Most (76.7%) were diagnosed at the time of their first ED visit or during their first hospital admission, 12% after their second ED visit, 10% after their third ED visit, and one patient after six ED visits to various facilities. In 33 case (55%), the diagnosis was suspected in the ED because of epidemiologic risk factors (15), radiographic evaluation (11), or symptoms (7). Hemoptysis (12%) and night sweats (10%) were uncommon. Neither cavitary lesions (seen in two children) nor apical lesions (seen in 42%) predominated. The five screening tools validated for adults with pulmonary disease were 77% to 98% sensitive in identifying children with intrathoracic TB and 50% to 100% sensitive for extrathoracic TB. CONCLUSIONS The point of entry to health care for many children with TB is the ED. The more protean manifestations of TB in children can decrease the utility of screening tools developed to identify adults with TB. While TB in adults often is a microbiologic diagnosis, childhood TB often is an epidemiologic diagnosis. Therefore, questioning caregivers about TB risk factors in the family may identify a higher percentage of children with possible TB.
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Affiliation(s)
- Andrea T Cruz
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Zinder SM, Basler RSW, Foley J, Scarlata C, Vasily DB. National athletic trainers' association position statement: skin diseases. J Athl Train 2011; 45:411-28. [PMID: 20617918 DOI: 10.4085/1062-6050-45.4.411] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To present recommendations for the prevention, education, and management of skin infections in athletes. BACKGROUND Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Close quarters combined with general poor hygiene practices make athletes particularly vulnerable to contracting skin diseases. An understanding of basic prophylactic measures, clinical features, and swift management of common skin diseases is essential for certified athletic trainers to aid in preventing the spread of infectious agents. RECOMMENDATIONS These guidelines are intended to provide relevant information on skin infections and to give specific recommendations for certified athletic trainers and others participating in athletic health care.
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Abstract
WHO estimated that of 9.4 million cases of tuberculosis (TB) worldwide in 2008, 440,000 (3.6%) had multidrug-resistant (MDR)-TB. Childhood TB is estimated at 10-15% of the total burden, but little is known about the burden of MDR-TB in children. Children in close contact with MDR-TB cases are likely to become infected with the same resistant strains and are vulnerable to develop disease. Although MDR-TB is a microbiological diagnosis, children should be treated empirically according to the drug susceptibility result of the likely source case, as often cultures cannot be obtained from the child. MDR-TB treatment in children is guided by the same principles, using the same second-line drugs as in adults, with careful monitoring for adverse effects. Co-infection with HIV poses particular challenges and requires early initiation of antiretroviral therapy. Preventive therapy for high-risk MDR-TB contacts is necessary, but no consensus guidance exists on how best to manage these cases. Pragmatic and effective Infection control measures are essential to limit the spread of MDR-TB.
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HealthCare–Associated Infections in the Nursery. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN 2011:1126-1143. [PMCID: PMC7152384 DOI: 10.1016/b978-1-4160-6400-8.00035-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
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Outside the box and into thick air: implementation of an exterior mobile pediatric emergency response team for North American H1N1 (swine) influenza virus in Houston, Texas. Ann Emerg Med 2009; 55:23-31. [PMID: 19837479 PMCID: PMC7124240 DOI: 10.1016/j.annemergmed.2009.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 07/28/2009] [Accepted: 08/04/2009] [Indexed: 11/28/2022]
Abstract
Study objective We describe the implementation of a mobile pediatric emergency response team for mildly ill children with influenza-like illnesses during the H1N1 swine influenza outbreak. Methods This was a descriptive quality improvement study conducted in the Texas Children's Hospital (Houston, TX) pediatric emergency department (ED), covered, open-air parking lot from May 1, 2009, to May 7, 2009. Children aged 18 years or younger were screened for viral respiratory symptoms and sent to designated areas of the ED according to level of acuity, possibility of influenza-like illness, and the anticipated need for laboratory evaluation. Results The mobile pediatric emergency response team experienced 18% of the total ED volume, or a median of 48 patients daily, peaking at 83 patients treated on May 3, 2009. Although few children had positive rapid influenza assay results and the morbidity of disease in the community appeared to be minimal for the majority of children, anxiety about pandemic influenza drove a large number of ED visits, necessitating an increase in surge capacity. Surge capacity was augmented both through utilization of existing institutional resources and by creating a novel area in which to treat patients with potential airborne pathogens. Infection control procedures and patient safety were also maximized through patient cohorting and adaptation of social distancing measures to the ED setting. Conclusion The mobile pediatric emergency response team and screening and triage algorithms were able to safely and effectively identify a group of low-acuity patients who could be rapidly evaluated and discharged, alleviating ED volume and potentially preventing transmission of H1N1 influenza.
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Aziz AM. Pandemic influenza: implications for infection control in hospital. ACTA ACUST UNITED AC 2008; 17:1020, 1022-6. [DOI: 10.12968/bjon.2008.17.16.31067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Siegel JD, Grossman L. Pediatric Infection Prevention and Control. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASE 2008. [PMCID: PMC7315330 DOI: 10.1016/b978-0-7020-3468-8.50008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65-164. [PMID: 18068815 PMCID: PMC7119119 DOI: 10.1016/j.ajic.2007.10.007] [Citation(s) in RCA: 1630] [Impact Index Per Article: 95.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Infections Acquired in the Nursery: Epidemiology and Control. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2006:1179-1205. [PMCID: PMC7150280 DOI: 10.1016/b0-72-160537-0/50037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
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American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States. Am J Respir Crit Care Med 2005; 172:1169-227. [PMID: 16249321 DOI: 10.1164/rccm.2508001] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During 1993-2003, incidence of tuberculosis (TB) in the United States decreased 44% and is now occurring at a historic low level (14,874 cases in 2003). The Advisory Council for the Elimination of Tuberculosis has called for a renewed commitment to eliminating TB in the United States, and the Institute of Medicine has published a detailed plan for achieving that goal. In this statement, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) propose recommendations to improve the control and prevention of TB in the United States and to progress toward its elimination. This statement is one in a series issued periodically by the sponsoring organizations to guide the diagnosis, treatment, control, and prevention of TB. This statement supersedes the previous statement by ATS and CDC, which was also supported by IDSA and the American Academy of Pediatrics (AAP). This statement was drafted, after an evidence-based review of the subject, by a panel of representatives of the three sponsoring organizations. AAP, the National Tuberculosis Controllers Association, and the Canadian Thoracic Society were also represented on the panel. This statement integrates recent scientific advances with current epidemiologic data, other recent guidelines from this series, and other sources into a coherent and practical approach to the control of TB in the United States. Although drafted to apply to TB-control activities in the United States, this statement might be of use in other countries in which persons with TB generally have access to medical and public health services and resources necessary to make a precise diagnosis of the disease; achieve curative medical treatment; and otherwise provide substantial science-based protection of the population against TB. This statement is aimed at all persons who advocate, plan, and work at controlling and preventing TB in the United States, including persons who formulate public health policy and make decisions about allocation of resources for disease control and health maintenance and directors and staff members of state, county, and local public health agencies throughout the United States charged with control of TB. The audience also includes the full range of medical practitioners, organizations, and institutions involved in the health care of persons in the United States who are at risk for TB.
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Abstract
The epidemiology of pediatric tuberculosis (TB) is shaped by risk factors such as age, race, immigration, poverty, overcrowding, and HIV/AIDS. Once infected, young children are at increased risk of TB disease and progression to extrapulmonary disease. Primary disease and its complications are more common in children than in adults, leading to differences in clinical and radiographic manifestations. Difficulties in diagnosing children stem from the low yield of mycobacteriology cultures and the subsequent reliance on clinical case definitions. Inadequately treated TB infection and TB disease in children today is the future source of disease in adults.
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Affiliation(s)
- Kristina Feja
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH4West, New York, NY 10032, USA
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Abstract
PURPOSE OF REVIEW Nosocomial infections (NI) constitute a significant public health problem and contribute to prolonged hospitalization, additional healthcare costs, and excess morbidity and mortality. Immunocompromised patients, including HIV-infected individuals, are at increased risk for NI, and 15-18.3% of them are represented by lower respiratory tract infections. Nosocomial pulmonary infections (NPI) appear to be more common in patients with acquired immunodeficiency syndrome (AIDS), as a result of the degree of immunosuppression, prior use of antibiotics, and exposure to invasive procedures. RECENT FINDINGS This article reviews the epidemiologic and clinical evidences and reports on the occurrence of NPI in HIV-infected inpatients. SUMMARY Although underestimated, NI occur commonly in HIV-infected patients, and among them nosocomial pneumonia, including tuberculosis and bacterial pneumonia, are associated with significant morbidity and mortality. The improvement of antiretroviral therapeutic options in developed countries has resulted in a decreased hospitalization rate of HIV-infected individuals. Healthcare delivery in the in- and outpatient setting represents a potential for infections, including lower respiratory tract ones, according to the degree of immunosuppression and the intensity of invasive procedures. To minimize the risk of acquisition of healthcare associated low respiratory tract infections, adherence of healthcare workers to common infection practices, specific respiratory precautions, and early identification of persons who have tuberculosis or are at high risk for active tuberculosis, should be strengthened.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Cross Infection/diagnosis
- Cross Infection/drug therapy
- Cross Infection/epidemiology
- Female
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Humans
- Incidence
- Italy/epidemiology
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/epidemiology
- Male
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Survival Analysis
- Treatment Outcome
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
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Affiliation(s)
- Nicola Petrosillo
- National Institute for Infectious Disease L. Spallanzani, IRCCS, Rome, Italy.
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Matlow A, Robb M, Goldman C. Infection control and paediatric tuberculosis: A practical guide for the practicing paediatrician. Paediatr Child Health 2003; 8:624-6. [PMID: 20019856 PMCID: PMC2795276 DOI: 10.1093/pch/8.10.624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tuberculosis (TB) in children requires close attention to infection control to prevent transmission to other patients and health care workers. Although many children with TB are not infectious, appropriate airborne precautions must be maintained until conditions that increase the risk of transmission have been ruled out and accompanying adults, who may also be infectious, have been screened. Concurrent strategies to prevent TB transmission should be implemented, including administrative, engineering and personal protective measures. The most important measure is maintaining a high clinical index of suspicion for TB in patients with compatible symptoms and epidemiological risk factors. Comprehensive tuberculin skin test programmes and the use of N 95 masks can reduce the risk of transmission within health care settings. Current standards of practice should be followed to prevent transmission from patients with active TB disease.
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Affiliation(s)
- Anne Matlow
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children
- Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario; and the Department of Medicine and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario
| | - Maryanne Robb
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children
| | - Carol Goldman
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children
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Ijaz K, Castro KG. Pediatric tuberculosis: all in the family? Infect Control Hosp Epidemiol 2002; 23:562-3. [PMID: 12400882 DOI: 10.1086/501970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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