Incidence of tuberculosis among drug addicts in Amsterdam methadone programmes

The objective was to determine the tuberculosis incidence andrelated factors among drug users in 3 methadone maintenanceprogrammes in Amsterdam to see whether the present screeningprocedures are adequate. The study population was selected fromthe Central Methadone Register (CMR). Cases were identifiedduring hospitalization and during routine screening of ambulatorymethadone clients. The data were generated by the drug and tuberculosisdepartments of the Amsterdam Municipal Health Service (MHS).From 5,044 clients, 43 new cases were identified. The incidenceof tuberculosis was 386 per 100,000 person years (py) and increasedwith age and period of registration with the CMR. After correctionfor age, sex and period of registration, the incidence amongclients of general practitioners (GP) was the lowest. The incidenceamong the general MHS clients is 9 times this and in the MHSprogramme for prostitutes and illegal foreigners 27 times higherthan in the GP population. The increased risk for drug userstreated at the MHS indicates lifestyle as a risk factor; MHSclients are more involved in the drugscene than GP clients.On the basis of this study, periodic screening limited to clientsof the MHS would seem to be adequate for the present.