European shortage of purified protein derivative and its impact on tuberculosis screening practices

SETTING

In June 2014, we became aware that shortages of purified protein derivative (PPD), the test substance used for the tuberculin skin test (TST), had occurred in several European health care institutions providing care for children with tuberculosis (TB).

OBJECTIVE

To establish the extent of the shortage, a survey was performed.

DESIGN

Survey conducted over a 1-month period (June-July 2014) among members of the Paediatric Tuberculosis Network European Trials Group (ptbnet).

RESULTS

Thirty-five physicians from 23 European countries contributed data. The most commonly used PPD product was RT23 (Statens Serum Institut; n = 22, 63%). Twenty-one (60%) participants reported that their institution was experiencing a PPD shortage. The majority (n = 17, 81%) of those reporting a shortage were using RT23. Thirteen (37%) participants reported changes in screening practices resulting from the shortage, including sourcing PPD from alternative manufacturers, restricting remaining supplies to patients at greatest risk or replacing TST by an interferon-gamma release assay.

CONCLUSIONS

The data show that a PPD shortage occurred in 2014, affecting multiple European countries. The shortage resulted in changes in TB screening capabilities and practices, potentially compromising both patient care as well as public health efforts. Appropriate actions to prevent future PPD shortages should be explored urgently by public health agencies and key stakeholders.

High risk of tuberculosis in health care workers in Romania

SETTING

The main university hospital in Iasi, Romania.

OBJECTIVE

To assess whether health care workers (HCWs) have a higher risk of acquiring tuberculosis (TB) than the general population, and if TB incidence varies between departments, to develop adequate infection control measures.

DESIGN

All records of TB cases among HCWs were reviewed by cross-checking laboratory and medical records (retrospectively, 1971--1996; prospectively 1997--2003, following the implementation of the first World Health Organization pilot project in Romania). Annual TB incidence rates among HCWs were calculated and compared with those of the general population; relative and attributable risk with 95% confidence intervals (CI) were calculated.

RESULTS

Fifty TB cases were diagnosed in HCWs; 42% were nurses, 24% ancillary staff, 12% physicians, 10% laboratory staff, 10% administrative staff and 2% radiology technicians. The mean incidence of TB in Romania during the study period was 96.8 per 100,000 persons/year (95%CI 83.5-110.1); the mean incidence among HCWs was 942.8/100,000 persons/year (95%CI 726.3-1159.3, P < 0.001); comparing the two previous absolute risks, the mean relative risk was 11 (95%CI 8-14) and the attributable risk 846.

CONCLUSION

TB is a major occupational hazard in Iasi, Romania, where a great potential exists for further development of an effective infection control plan.

[The efficacy of the intensive, short-duration chemotherapy of patients with cavitary pulmonary tuberculosis]

This study was carried out on 100 cases of cavitary pulmonary tuberculosis in patients eliminating tuberculosis bacilli, as noted at microscopic study. The treatment included four drugs (RHSZ) in 95 case, and 3 drugs in the remaining patients. All the treatments were tailored to individual needs. The duration of chemotherapy was of 6 months in 62 cases. It was prolonged to 9 months in 33 cases and to 12 months in 5 cases. In 81 patients the drugs were applied regularly. The results have demonstrated that at 6 months negative cultures were obtained in 98 patients although the excavations were closed in only 55 cases. At 9 months all the patients were negative but excavations were closed in only 71. Suppression of elimination of bacilli was achieved in 99 of the cases at 12 months, but the excavations were closed in only 92 of the patients. Ninety-nine patients were investigated after 2.5-3.0 years. Five of them were again positive, 94.5% were negative and the excavations were closed in 91.9%. The importance of the cavitary score is discussed with regard to the risk of renewed positivity, and an association is recommended of surgical collapsing and exeresis at the right time.