Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control

BACKGROUND: Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. METHODS: Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. RESULTS: Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. CONCLUSIONS: PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.     

A survey of tuberculosis prevalence in Hanoi, Vietnam.

OBJECTIVE: To assess the prevalence of tuberculosis (TB) in Hanoi, Vietnam, in 2003/2004. METHODS: A random selection was carried out involving 11624 subjects from 20 communes within the city. RESULTS: On chest X-ray examination, 317 subjects (2.73%) showed abnormal lung opacity, of which 17 were sputum smear-positive, two concentrated smear-positive and three culture-positive, all with active TB. The prevalence of sputum smear-positive pulmonary TB was 146 per 100000 in persons aged >or=15 years (95%CI 65-228). CONCLUSION: This is the first large-scale assessment of the prevalence of TB in Hanoi. The prevalence rate was higher than expected, suggesting that a significant number of patients with active TB, particularly females, remain undiagnosed, thus representing a continuing potential source of transmission in the community.     

Three-fold reduction in the prevalence of tuberculosis over 25 years in Indonesia.

BACKGROUND: Tuberculosis (TB) remains the principal cause of death from a curable infectious disease. Indonesia is estimated to have the third highest case load worldwide, but TB prevalence has not been measured for 25 years. METHODS: In 2004, 20000 households were selected in all 30 provinces. All adults (aged >/=15 years) in every household were screened for symptoms of pulmonary tuberculosis (PTB). Among those with symptoms, TB was diagnosed by sputum smear microscopy and sputum culture. RESULTS: Eighty adults were positive on at least two sputum smears (104 per 100000 population, 95%CI 66-142). Prevalence was lower in Central Indonesia (Java-Bali, 59/100000) than in the Western (Sumatra, 160/100000) or Eastern regions (189/100000), but the estimated 225000 prevalent cases were distributed evenly among the three regions. The national per capita prevalence in 2004 was lower than in 1979-1982 by a factor of three (3.1, 95%CI 1.2-4.9), and the total number of cases was lower by a factor of two. CONCLUSIONS: Although the 2004 national survey may have underestimated the prevalence of smear-positive TB in Indonesia, there is strong evidence that it fell markedly between 1979-1982 and 2004.     

An evaluation of symptom and chest radiographic screening in tuberculosis prevalence surveys.

SETTING: A tuberculosis (TB) prevalence survey was performed in 2002 in two urban communities in Cape Town, South Africa. The population was 36,334 in 2001, and the TB notification rate was 341 per 100,000 population for new smear-positive TB in 2002. OBJECTIVE: To evaluate the relative contributions of symptom and chest radiographic (CXR) screening in the detection of subjects with smear- and/or culture-positive TB in prevalence surveys. DESIGN: Information on symptoms, CXR abnormalities, sputum smear and culture was gathered from a random cluster sample of 1170 adults (aged > or = 15 years). Smear and/or culture-positive TB was used as the gold standard. RESULTS: Of 1170 adults, 29 had bacteriologically positive TB (smear- and/or culture-positive). The presence of any abnormalities on CXR had the highest sensitivity for detecting subjects with bacteriologically positive TB (0.97, 95%CI 0.90-1.00). Specificity for any abnormalities on CXR was 0.67 (95%CI 0.64-0.70). The specificity of any of five TB-related symptoms was 0.68 (95%CI 0.65-0.71). Individual symptoms had low sensitivities, ranging from 0.10 for fever to 0.54 for cough of > or = 2 weeks. CONCLUSION: In this TB prevalence survey, CXR screening, but not symptom screening, was a sensitive alternative to sputum examination of all participants.     

A baseline survey of the prevalence of tuberculosis in a community in south India at the commencement of a DOTS programme.

OBJECTIVE: To determine the baseline prevalence of culture-positive and smear-positive tuberculosis and the annual risk of tuberculous infection (ARTI) in a community in south India where DOTS is being implemented. METHODS: Using cluster sampling, 50 rural panchayats (villages) and three urban units in Tiruvallur district were selected randomly. All adults aged > or = 15 years underwent symptom and radiographic examination, and those with abnormal shadows and/or chest symptoms had sputum smear and culture examination. In another cluster sample of 73 villages and three urban units, all children aged < 10 years were tuberculin tested. RESULTS: The prevalence of culture-positive and smear-positive tuberculosis was respectively 605 and 323/100,000. Both increased appreciably with age, and were substantially higher in males than in females at all ages; the overall male:female ratio was 5.5 for culture-positive and 6.5 for smear-positive tuberculosis. The ARTI in children aged under 10 years was 1.6%, and was unaffected by sex. Over three decades there was an overall decline of 1.8% per annum in the prevalence of culture-positive and 2.1% for smear-positive tuberculosis. CONCLUSION: Tuberculosis is a major problem in this rural community in south India, with a prevalence of 605/100,000 for culture-positive tuberculosis and 323/100,000 for smear-positive tuberculosis.     

Additional risk of developing TB for household members with a TB case at home at intake: a 15-year study.

OBJECTIVE: To assess the additional risk to household contacts from an infectious case of tuberculosis (TB) at home in a rural community in south India. METHODS: In all, 3506 contacts of smear-positive (S+C+) and 2910 contacts of smear-negative TB cases (S-C+) and 246 845 persons with no TB case at home were followed for 15 years, with a repeat survey every 2.5 years consisting of radiographic and sputum examination, selective follow-up of high-risk individuals and passive surveillance. If a case developed during follow-up, all household members were subsequently considered as contacts. Cox's proportional hazards model (multivariate) was employed to compare incidences. RESULTS: The annual incidence of culture-positive TB was respectively 526 and 271 per 100000 population for contacts of smear-positive and smear-negative patients, and 198/100000 in non-contacts. The adjusted hazard rate was 3.4 for contacts of smear-positive patients (95% CI 3.0-3.9) and 1.7 for contacts of smear-negative patients (95% CI 1.4-2.0) as compared to non-contacts. Of 3942 incident cases, 337 (8.5%) came from households with a TB case. CONCLUSION: Although family contacts had a significantly higher incidence, their contribution to total new caseload was meagre. Contact chemoprophylaxis as a public health measure would therefore have limited impact on community TB incidence.     

Tuberculosis epidemiology in India: a review.

High prevalence and incidence of disease and a high rate of transmission of infection characterise the tuberculosis (TB) situation in India. Disease surveys conducted in different parts of the country since the 1950s have reported prevalences of smear-positive pulmonary TB (PTB) of 0.6-7.6 per 1000 population, culture-positive TB of 1.7-9.8 and culture and/or smear-positive TB of 1.8-12.7. The incidence of smear-positive PTB has been observed in the range of 1.0-1.6/1000 and that of culture-positive PTB 1.0-2.5/1000 in the limited number of studies carried out. The annual risk of tuberculous infection (ARTI) had been estimated at 1-2% for most of the tuberculin surveys carried out in different areas over different time periods. During a nationwide study in 2000-2003, the average ARTI in the country was estimated at 1.5%. An increasing trend has been observed in human immunodeficiency virus (HIV) seropositivity among TB cases, which has been found to vary between 0.4% and 28.8% in different studies conducted mostly at tertiary health care centres. The proportion of new cases with multidrug resistance (MDR) was relatively low, at 0.5-5.3%. However, the proportion of MDR cases among previously treated cases varied between 8% and 67%.     

新疆世行贷款/英国政府赠款中国结核病控制项目(2002—2009年)实施效果分析

目的分析新疆世行贷款/英国赠款中国结核病控制项目的实施效果,提出新疆自治区结核病控制工作可持续发展建议,为制定2011—2020结核病规划提供科学依据。方法根据项目终期评估调查表,收集分析全区96个县市2002—2009年相关资料,汇总分析。结果通过项目的实施,全面推行了现代结核病控制策略(DOTS),积极发现和治愈传染性肺结核。(1)实现了肺结核病人的高发现率。涂阳肺结核病人的登记率逐年提高,从2002年的52.03/10万提高至2005年的89.38/10万,2002—2009年累计完成项目涂阳病人发现指标的110%。(2)98%以上的传染性肺结核落实了免费治疗和管理,初治涂阳病人治愈率达到94.7%,治疗成功率为96.3%。复治涂阳病人治愈率达到91.4%,治疗成功率为94.7%。(3)2002—2009年项目执行期间,累计免费治疗涂阳肺结核病人78 782例,共计为全区广大农牧民节约医药费用6亿多元。结论世行贷款结核病控制项目实施促进了结核病规划目标实现,达到了高发现率高治愈率的控制目标,取得了显著社会效益和经济效益。     

全国活动性肺结核报告发病率变动趋势及预测研究

目的 研究全国2009—2018年活动性肺结核报告发病率的变动趋势,并对2019—2022年报告发病率及终止结核病流行状况进行预测。方法 收集全国2009—2020年活动性肺结核报告发病率监测资料,应用Mann-Kendall趋势检验研究全国2009—2018年活动性肺结核报告发病率的变动趋势,并应用灰色模型GM(1,1)对全国活动性肺结核报告发病率进行预测。结果 全国活动性肺结核报告发病率从2009年的81.09/10万下降到2018年的59.27/10万,10年间下降了26.91%,10年间年均递降率为3.42%,总体呈下降趋势(Mann-Kendall趋势检验,Z=-3.940,P<0.001)。灰色模型GM(1,1)拟合结果显示,预测值和实测值平均相对误差为0.8255%,后验差比值C=0.097,小误差概率值P=1,说明拟合精度为优,可以用于外推预测。应用灰色模型GM(1,1)预测全国2019—2022年活动性肺结核报告发病率结果为56.7673/10万、55.1394/10万、53.5581/10万、52.0222/10万。如结核病防控策略维持不变,按照年均递降率为3.42%计算,到2030年全国活动性肺结核报告发病率为39.04/10万,到2035年为32.80/10万。结论 2009—2018年全国活动性肺结核报告发病率总体呈下降趋势,如结核病防控策略维持不变,实现世界卫生组织终止结核病流行策略难度很大。     

Survival and relapse rate of tuberculosis patients who successfully completed treatment in Vietnam.

SETTING: Reported tuberculosis (TB) cure rates are high in Vietnam with the 8-month short-course chemotherapy regimen. However, long-term treatment outcomes are unknown. OBJECTIVE: To assess survival and relapse rates among patients successfully treated for new smear-positive pulmonary tuberculosis (PTB). METHODS: A cohort of patients treated in 32 randomly selected districts in northern Vietnam were followed up 12-24 months after reported cure or treatment success for survival and bacteriologically confirmed relapse. Measurements included sputum smear examination, culture and interview for recent treatment history. RESULTS: Of 304 patients included in the study, no information was available for 31 (10%) and 19 (6%) had died. Bacteriology results were available for 244 (80%). The median interval between treatment completion and follow-up was 19 months. Relapse was recorded in 21/244 (8.6%, 95%CI 5.4-13), including 9 (4%) with positive sputum smears, 3 (1%) with negative smears but positive culture and 9 (4%) who had started TB retreatment. Four of 12 culture-positive relapse cases (33%) had multidrug-resistant strains. If the definition of relapse was extended to include death, reportedly due to TB, the relapse proportion was 26/263 (9.9%, 95%CI 6.6-14). CONCLUSION: A substantial proportion of patients (15%) had died or relapsed after being successfully treated for TB in northern Vietnam.     

The national tuberculosis drug resistance survey in Cambodia, 2000-2001.

SETTING: Cambodia has a high incidence of tuberculosis (TB). Hospital-based DOTS was predominant throughout the country from 1994 to 2002. OBJECTIVES: To determine the prevalence of resistance to four major anti-tuberculosis drugs, isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and streptomycin (SM), among new cases as a baseline before a new National Tuberculosis Programme strategy with decentralised ambulatory DOTS was widely implemented. DESIGN: A cluster sampling of TB diagnostic centres with probability proportional to the number of new cases in a diagnostic centre in 1999 was used. Intake of cases took place from October 2000 to April 2001. RESULTS: From 734 isolates collected, drug susceptibility test results were obtained for 638 new cases. The prevalence of resistance to any of four drugs was 10.1% (95%CI 7.7-13). Resistance to INH was 6.1% (95%CI 4.3-8.4) and resistance to RMP 0.6% (95%CI 0.2-1.6). No multidrug-resistant (MDR) case was found among the new cases (95%CI 0.0-0.6). Three of 96 previously treated cases had MDR (3.1%, 95%CI 1.0-9.0). CONCLUSION: The first survey indicates that the current prevalence of MDR is low. It is necessary to track resistance trends when restructuring a DOTS-based programme.     

Tuberculosis in east timorese refugees: implications for health care needs in East Timor.

SETTING: East Timorese refugees evacuated to Darwin, Australia, September 1999. OBJECTIVE: Presentation of the process and results of tuberculosis (TB) screening in a previously unscreened refugee population. DESIGN: Screening for TB by clinical examination (all persons) and chest X-ray (CXR) (persons over 12 years of age and those of any age with respiratory symptoms) and sputum microscopy and mycobacterial culture (abnormal CXR). RESULTS: Seventy-six patients were diagnosed with TB (38 culture-positive for Mycobacterium tuberculosis, including 11 sputum smear-positive). Of 89 positive mycobacterial cultures, 51 were non-tuberculous mycobacteria (NTM). Of the M. tuberculosis isolates, 82.2% were fully sensitive, 17.2% were resistant to isoniazid and 8.6% were resistant to isoniazid and streptomycin. Fifty-three consecutively diagnosed patients with TB were HIV-negative. The TB burden in this population was very high (point prevalence of 542/100,000 for smear-positive and 2,060/100,000 for culture-positive cases). Rates of culture for NTM were also high. Information from this study assisted the implementation of a National TB Control Programme for East Timor in February 2000. CONCLUSION: The challenges for public health authorities in East Timor to provide a successful TB control programme are enormous. The apparently low prevalence of drug resistance and HIV co-infection in the population is encouraging.     

The first-three year report of the Tuberculosis Control Project, Lumbini, Rupandehi

The Tuberculosis Control Project, Lumbini, Rupandehi (TCPLR) is a bilateral cooperative venture between two NGO's, the Nepal Anti-Tuberculosis Association (NATA) and the Japan Anti-Tuberculosis Association (JATA), which consists of planning and implementing pilot tuberculosis control activities in Lumbini, Rupandehi district in Nepal, aiming at achieving high cure rate of newly detected smear-positive pulmonary tuberculosis patients before introducing DOTS strategies. Between December 1993 and July 1996, 349 tuberculosis (TB) cases were enrolled in the TCPLR. The categories of cases were as follows: 138 cases (40%) of new smear-positive pulmonary TB [new Sm(+) PTB], and 54 cases (15%) of smear positive pulmonary TB other than new Sm(+) PTB [other Sm(+) PTB] including such cases as continued treatment and relapse, 106 cases (30%) of new smear-negative TB [new Sm(-) TB], and 51 cases (15%) of other smear-negative TB other than New Sm(-) PTB [other Sm(-) TB]. The number and proportion of new Sm(+) PTB cases enrolled in the project have been increasing [6 cases (23%) for the first year, 102 cases (54%) for the third year] although the proportion is still low (40% overall). The regimens of chemotherapy in the initial intensive and the continuation phases of treatment according to the categories of TB were as follows: New Sm(+) PTB; 2HRZE(S)/6HE, other Sm(+) PTB; 2HRZES/1HRZE/5HRE, and Sm(-) TB; 2HRZ/6HE. The proportion of cases treated by the appropriate regimen of chemotherapy has increased. The cohort analysis of the treatment outcome of the cases enrolled in the project showed the following. The proportion of cured cases plus smear-unconfirmed cases completing treatment among new Sm(+) PTB was 74% overall, however, the proportion of defaulters increased in the third year. The proportion of cured cases plus smear-unconfirmed cases completing treatment among other Sm(+) PTB cases was 66% overall, which is slightly lower than that of new Sm(+) PTB cases, however, the difference was not so marked. The proportion of treatment completed cases among smear-negative pulmonary TB cases was 77% overall, however, proportion of defaulters increased in the third year. The treatment outcome in this report was obtained before the adoption of DOTS strategies: However, it showed that cure and treatment completion rates were comparable to those obtained in the SEARO countries which adopt DOTS strategies. The treatment outcome could be improved after the introduction of DOTS strategies in 1997.     

2002—2007年安徽省肺结核病人发现及治疗转归分析

目的评价2002—2007全省肺结核病人发现及治疗效果。方法利用各结核病项目执行单位的月报表、季报表、网络专报督导及检查资料进行分析。结果2002—2007年全省发现活动性肺结核病人分别为9158、30279、41157、54869、50878、47628例,其中新发涂阳肺结核病人分别为2743、5846、12751、28329、28840、27836例,新涂阳登记率分别为10万人口中4.3、9.2、19.9、44.2、44.8和42.8,2002—2006年新发涂阳肺结核病人治愈百分率分别为82.8、82.8、89.3、91.4 和91.7。结论全面实施DOTS策略后,病人的发现率、治愈率都有了较大的提高。     

Excess mortality and tuberculosis among individuals with prolonged cough: a population-based study from Vietnam.

SETTING: A demographic surveillance site in north-west Vietnam. OBJECTIVES: To compare notification rates of sputum smear-positive tuberculosis (TB) and mortality rates between the general population and individuals with prolonged cough. DESIGN: A cohort study of 559 prolonged cough cases in a total population of 35,832, observed over 2.5 years. Outcome measures were sputum smear-positive TB and death. RESULTS: The age-standardised smear-positive TB notification rate among cough cases (553/100,000 person-years [py], 95%CI 268-1143) was significantly higher than in the general population (50/100,000 py, 95%CI 43-57), with a relative risk of 11.06 (95%CI 8.28-14.77). Among those who had a chest X-ray suggestive of TB but negative sputum smears prior to the study start, the rate was 6542/100,000 py (95%CI 2906-12,511). The cough cohort had a 2.61 (95%CI 2.38-2.87) times higher risk of dying than the general population. CONCLUSIONS: Individuals with prolonged cough in this study run a significantly increased risk of developing infectious TB and of dying. We recommend further evaluations of improved follow-up systems aimed at identifying and treating sputum smear-negative TB cases before they convert to an infectious stage.     

The 1997 Nationwide Tuberculosis Prevalence Survey in the Philippines.

SETTING: The Philippines is a developing country where tuberculosis (TB) remains a significant public health problem. OBJECTIVE: To determine the prevalence of TB as a basis for setting the targets of the National Tuberculosis Control Program. STUDY POPULATION AND METHODS: A multi-stage cluster survey of a random sample of 21960 subjects from 36 clusters nationwide was undertaken from 2 April to 31 July 1997. BCG scar verification and tuberculin testing was performed for subjects aged 2 months and over, and chest radiography screening was done on subjects 10 years and older. Sputum samples were collected from individuals who were initially assessed to have abnormal chest radiographs to determine the prevalence of bacillary tuberculosis. Acid-fast smear by modified Kinyoun's technique and culture on L?wenstein Jensen were done to demonstrate Mycobacterium tuberculosis. RESULTS: The prevalence of active pulmonary TB was 42/1000 population. The prevalence of culture-positive and smear-positive cases was 8.1 and 3.1/1000, respectively. The prevalence was similar in urban and rural areas. CONCLUSION: Morbidity from TB remains high. Allowing for methodological differences from the survey in 1981-1983, the prevalence of active pulmonary TB was unchanged. There was only a minimal decrease, of 37% for smear-positive cases and 25% for culture-positive cases, in the 14-year interval.     

Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB.

SETTING: Zomba Central Hospital, Malawi. OBJECTIVES: To determine the outcome of all adult patients who were registered for tuberculosis (TB) treatment 7 years previously according to initial human immunodeficiency virus (HIV) status and type of TB. DESIGN: A retrospective cohort study of adult patients registered for TB treatment between July and December 1995. Follow-up at patients' homes was performed at the end of treatment, at 32 months and at 84 months (7 years) from the time of TB registration. FINDINGS: Eight hundred and twenty-seven TB patients were registered: 793 had concordant HIV test results, of whom 612 (77%) were HIV-positive. At 7 years, 136 (17%) patients were alive, 539 (65%) had died and 152 (18%) were lost to follow-up. The death rate for all TB patients was 23.7 per 100 person-years of observation. HIV-positive patients had higher death rates than HIV-negative patients (hazard ratio [HR] 2.2, 95% confidence interval [95%CI] 1.7-2.8). Death rates in smear-negative pulmonary TB patients (HR 2.1, 95%CI 1.7-2.6) and in patients with extra-pulmonary TB (HR 1.7, 95% CI 1.3-2.0) were higher than in patients with smear-positive PTB. CONCLUSIONS: There was a high mortality rate in TB patients during and after anti-tuberculosis treatment. Adjunctive treatments to reduce death rates are urgently needed.     

佛山市结核病控制项目1O年效果分析(1992-2001年)

目的　分析广东省佛山市结核病控制项目10年的效果以及取得成效的原因。方法 收集、分析1992-2001年佛山市实施世界银行贷款结核病控制项目资料。结果 1992-2001年共接诊可疑肺结核症状者40470例,发现活动性肺结核病人8652例。其中涂阳肺结核病人5005例,新发涂阳4320例,复治涂阳病人685例;新发涂阳登记率由1993年的7.47/10万上升至2001年的30.30/10万;初治涂阳治愈率由1993年的73.5%上升至2001年的99.4%;复治涂阳治愈率由1993年的60.8%上升至2001年的91.4%。结论 10年来,佛山市的结核病控制项目实行免费检查治疗、归口管理和执行DOTS策略,实现了“高发现率”和“高治愈率”的目标,结核病控制水平整体提高,为实施新项目提供宝贵的经验,促进佛山市结核病控制工作的可持续发展。     

High prevalence of drug-resistant tuberculosis, Republic of Lithuania, 2002.

BACKGROUND: Nations of the former Soviet Union have the world's highest reported levels of resistance to anti-tuberculosis drugs. We conducted the first national survey of anti-tuberculosis drug resistance in the Republic of Lithuania. METHODS: We tested Mycobacterium tuberculosis isolates from all incident culture-positive pulmonary TB patients registered in 2002. New patients were those treated for <1 month with any first-line anti-tuberculosis drug (isoniazid [INH], rifampin [RMP], ethambutol, or streptomycin); previously treated patients were those treated for > or =1 month. RESULTS: Of 1163 isolates, 475 (41%) were resistant to at least one first-line drug, and 263 (23%) were resistant to at least INH and RMP (MDR); this included 76/818 (9.3%) from new patients and 187/345 (54%) from previously treated patients. Of 52 MDR isolates randomly selected for extended testing at an international reference laboratory, 27 (51%, 95%CI 38-66) had resistance to pyrazinamide, 21 (40%, 95%CI 27-55) to kanamycin, and 9 (17%, 95%CI 8-30) to ofloxacin. CONCLUSIONS: The prevalence of MDR-TB in Lithuania is among the world's highest. Among MDR-TB isolates, aminoglycoside and fluoroquinolone resistance were common. To combat drug-resistant TB, Lithuania has implemented the WHO global TB control strategy (DOTS), and is developing an MDR-TB treatment program (DOTS-Plus).     

High tuberculosis prevalence in a psychiatric hospital in Vietnam.

Little is known about tuberculosis (TB) prevalence in psychiatric hospitals in Vietnam, but prevalence may be higher than in the general population. We assessed the TB prevalence among in-patients of a psychiatric hospital in 2005 in Danang City, Vietnam. Of 300 in-patients, 70 had an abnormal X-ray or prolonged cough, and underwent sputum smear examinations. The prevalence of smear-positive TB was 0.33% (1/300, 95%CI 0.008-1.9). Twenty-three (7.7%) patients had X-ray lesions suggesting active TB and 22 (7.3%) had a history of TB treatment. TB prevalence was high in this psychiatric hospital, and TB infection control needs strengthening.