Factors associated with tuberculin reactivity in two general hospitals in Mexico.

OBJECTIVE: To identify risk factors associated with tuberculin reactivity in healthcare workers (HCWs). DESIGN: Cross-sectional survey of tuberculin reactivity (2 TU of purified protein derivative (PPD) RT23, using the Mantoux two-step test). SETTING: Two general hospitals located in a region with a high prevalence of tuberculosis and high bacille Calmette-Guerin (BCG) coverage. PARTICIPANTS: Volunteer sample of HCWs. RESULTS: 605 HCWs were recruited: 71.2% female; mean age, 36.4 (standard deviation [SD], 8.2) years; 48.9% nurses, 10.4% physicians, 26.8% administrative personnel; mean time of employment, 10.9 (SD, 6.7) years. PPD reactivity (> or =10 mm) was found in 390 (64.5%). Multivariate analysis revealed an association of tuberculin reactivity with occupational exposure in the hospital: participation in autopsies (odds ratio [OR], 9.3; 95% confidence interval [CI95], 2.1-40.5; P=.003.), more than 1 year of employment (OR, 2.4; CI95, 1.1-5.0; P=.02), work in the emergency or radiology departments (OR, 2.0; CI95, 1.03-3.81; P=.04), being physicians or nurses (OR, 1.5; CI95, 1.04-2.11; P=.03), age (OR, 1.04; CI95, 1.02-1.07 per year of age; P<.001), and BCG scar (OR, 2.1; CI95, 1.2-3.4; P=.005). CONCLUSIONS: Although the studied population has a high baseline prevalence of tuberculosis infection and high coverage of BCG vaccination, nosocomial risk factors associated with PPD reactivity were identified as professional risks; strict early preventive measures must be implemented accordingly.     

Risk of tuberculosis in correctional healthcare workers

OBJECTIVE: The objective of this study was to determine the prevalence, incidence, and risk factors for occupational infection with tuberculosis among healthcare workers employed in correctional facilities. METHODS: The authors conducted a self-administered survey, clinical interview, and tuberculin skin testing. RESULTS: The overall tuberculin skin test point prevalence rate was 17.7%, the reactivity rate was 2.2%, and the annual incidence was 1.3%. At the multivariate level, after controlling for bacille Calmette-Guérin vaccination, only origin of birth remained significantly associated with prevalence of tuberculosis infection. CONCLUSIONS: Although the prevalence of tuberculin reactivity was high in this population, the risk factors were predominantly demographic rather than occupational. Nevertheless, continued vigilance to control occupational exposure to this and other respiratory pathogens is warranted, given the potential for future outbreaks of tuberculosis, as well as other known and emerging airborne pathogens.     

Tuberculin reactivity among California Hispanic migrant farm workers

We conducted a cross-sectional study of tuberculin reactivity among residents of two northern California migrant-farm-worker housing centers. Participants completed a brief health questionnaire and were offered tuberculin skin testing with radiologic and medical follow-up. Four hundred and sixty-nine persons (estimated participation rate: 70%) completed questionnaires. All but one were Hispanic. Two hundred and ninety-six (63%) participants completed tuberculin skin testing and 49 (16.6%) showed reactivity (≥10 mm induration at 48–72 hours). Increased prevalence was seen for the 15–39-year age group (vs. persons younger than 15: OR 2.59; 95% CI 0.79–8.47), former smokers (vs. never smokers: OR 3.11; 95 %CI 1.20–8.09), and persons born outside the U.S. (OR 2.09; 95% CI 0.66–6.61). Prophylaxis with isoniazid was recommended for 23 persons; nine (39%) completed therapy. No cases of active tuberculosis were found. Prevalence of tuberculin reactivity in this population is lower than reported among Hispanic farm workers in the eastern and midwestern U.S. Higher prevalence may obtain among California farm workers not included in the study population, including homeless, single, and highly mobile persons. Public-health efforts in this population should focus on ever-smokers, young adults, and persons born outside the U.S. Am. J. Ind. Med. 32:600–605, 1997. © 1997 Wiley-Liss, Inc.     

Screening and treatment of latent tuberculosis among healthcare workers at low, moderate, and high risk for tuberculosis exposure: a cost-effectiveness analysis.

OBJECTIVE: To evaluate cost-effective screening and treatment strategies for healthcare workers (HCWs) at risk for tuberculosis exposure. DESIGN: A Markov model was developed to track three hypothetical cohorts of HCWs at low, moderate, and high risk for tuberculosis exposure. For those found to be tuberculin reactors at entry, the choice was for isoniazid treatment or no treatment. For those without tuberculin reactivity, the choice of screening intervals was 6 months, 1 year, 2 years, or 5 years. Outcomes measured were tuberculosis cases, death, life expectancy, and cost. Assumptions were derived from published data and analyses. RESULTS: Treatment of initial reactors with isoniazid in all three risk groups was associated with a net savings of $14,800 to $15,700 for each tuberculosis case prevented. For those without evidence of infection at entry, the most cost-effective screening interval was 1 year for high-risk groups, 2 years for moderate-risk groups, and 5 years for low-risk groups, with a net savings $0.20 to $26 per HCW per year. Screening at a more frequent interval was still cost-effective. CONCLUSIONS: For HCWs found to be tuberculin reactors, treatment of their latent infection is to their benefit and is associated with a net cost-savings. Regular tuberculin screening of HCWs can be cost-effective or result in a net cost-savings. Each institution could use its own skin test surveillance data to create an optimum screening program for its employees. However, for most HCWs, a 1-year screening interval would be a cost-effective and safe choice.     

Results and significance of a baseline tuberculin skin test programme among health care workers in a hospital setting

BACKGROUND: Due to the resurgence of tuberculosis (Tb), health care workers (HCW) are considered at increased risk for Latent Tuberculosis Infection (LTI). According to the national guidelines health care facilities are required both to perform tuberculin skin tests (TsT) on all employees with potential occupational exposure to Tb and to analyze the results obtained. However, only a limited number of studies can be found in the literature reporting data of Tb prevalence in Italian hospitals. OBJECTIVES: The aim of this study was to determine the prevalence of and the relative risks for positive TsT among employees of the Hospital of Cuneo. METHODS: After informed consent, a questionnaire and a TsT according to the Mantoux technique were administered to the 2368 employees of the hospital exposed to occupational risk for Tb. The variables considered for the univariate and multivariate analysis included several anthropometric, occupational and clinical factors RESULTS: 274 of the 2210 employees who completed the screening programme had positive TsT (12.4%). Only one subject had been treated for active Tb. Factors significantly associated with a positive TsT were duration of employment (odds ratio [OR]:4.90, CI: 2.25-10.66, for length of employment 10-17 years; and OR: 8.77, CI: 3.53-21.81, for length >17 years; p < 0.001); working in a Tb high-risk occupational setting (OR 4.26, CI: 1.90-9.57for level of "limited" risk and OR: 5.68, CI: 2.47-13.07 for level of "medium" risk; p < 0.001); belonging to nurse or assistant nurse job categories (OR: 2.80, CI: 1.09-7.19; p < 0.05); history of active or latent Tb infection (OR: 11.54, CI: 5.54-24.06; p < 0.001); birth in a foreign country (OR: 4.40, CI: 1.30-14.85; p = 0.01); and BCG immunization (OR: 2.51, CI: 1.68-3.75; p < 0.001). Seventeen subjects had a positive reaction after a two-step test (0.8%). Boosting occurred among elderly employees (mean age: 48, 3 +/- 8.0 yrs), with long duration of employment (22, 2 +/- 10.5 yrs), vaccinated with BCG (17/17). CONCLUSIONS: Our data suggest that a baseline survey based on TsT is useful to assess the prevalence of and risk factors for TLI in a health care setting. The high rate of participation in the survey (93.3%) was probably due to the training and awareness efforts aimed specifically at exposed HCW.     

Smoking by French general practitioners: behaviour, attitudes and practice

INTRODUCTION: This paper examines smoking prevalence, sociodemographic factors and the medical practice of French general practitioners. METHOD: Data from the 1998 cross-sectional national survey of 2,073 GPs. The questionnaire was administered by telephone. A response rate of 67% was attained. Instrumentation included questions about medical practice, sociodemographic characteristics, and health behaviour. Bivariate and multiple logistic regression (MLR) analyses were conducted. RESULTS: Almost one-third (32.1%) of physicians were current smokers. A significantly higher proportion of male (33.9%) were smokers compared to women (25.4%, p<0.001) and men were more likely to be former smokers (49.1% versus 31.7%). Two-thirds of physicians reported recommending nicotine replacement therapy to their patients. MLR shown that former smokers were more likely (OR = 1.51, 95% CI, 1.24-1.83) to indicate that their help in getting patients to quit was not effective compared to smokers. Also, physicians who were 'dissatisfied' with the profession were more likely (OR = 0.75, 95% CI, 0.60-0.92) to report their help as not effective than those who were 'satisfied'. CONCLUSION: These data support the need for greater professional participation in reducing smoking among general practitioners in France and greater education concerning the vital role of physicians in promoting cessation among the general population. KEY POINTS: This study examines smoking habits among French GP's, intervention practices, and opinions about their ability to help patients quit smoking. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women.     

Screening of TB contacts by tuberculin skin tests in a low-incidence community by BCG vaccination

A 36-year-old man, an unemployed waiter, a regular patron of two bars living in a Czech city suffered for about a year from disorders caused probably by tuberculosis (TB). When hospitalised, diabetes mellitus and extensive lung TB were diagnosed. TB was found also at the post mortem examination when the patient died one week later. Screening of his contacts by tuberculin skin tests (2TU RT23 W. Tw.80) provided data for analyzing the usefulness of tuberculin tests for monitoring of propagation of TB infection among BCG vaccinated population with high TB prevalence in the A statistically significant difference was found in tuberculin reactivity between 543 contacts and 232 individuals who had not reported contact with, the patient. A skin reaction of 12 mm and more was found in 55.6% contacts while only in 2.6% of those included in the second group. The high tuberculin reactivity was proved in the individuals exposed to massive TB infection. Neither BCG vaccination, nor possible previous contact with TB in the past seemed to influence the actual tuberculin reactivity in the group of non-contacts. Furthermore, it is indicative of the fact that unknown TB sources are rare among the Czech population. The high tuberculin reactivity is suggestive of a fresh infection and justifies the tuberculin testing and the application of chemoprophylaxis.     

A European risk model for hepatitis among health care workers

Hepatitis B (HBV) is the most important occupational hazardfacing workers in the hearth care and related environments.It is a serious, but underestimated, occupational hazard amongsuch personnel, who are at a 2 to 10 times greater risk of infectionthan the general population. In the light of recent changesin legislation concerning hepatitis B, we have designed a riskmodel for health care workers (HCW) in Western Europe to estimatethe number of cases of HBV infection in this group. An annualattack rate was derived, based on data from the literature andfrom hearth registers. The number of HCW exposed to HBV infectionwas calculated from official registers, taking into accountthe prevalence and incidence of HBV infection and vaccinationcoverage. Even with the present vaccination coverage of 40%among traditional HCW and 25% among allied HCW, we estimatethat 16,500 cases of HBV infection occur in these groups annually(i.e. over 40 per day). Approximately 5,800 workers will developacute symptoms and 990 will become carriers, of whom 240 willdie due to liver cirrhosis and/or primary hepatocellular cancer.If no further vaccinations are made, the number of infectionswill rise to approximately 24,000 each per year. An increasein vaccination coverage would greatly decrease these numbers.The amendments to the Biological Agents at Work EC Directive(EC90/679/EEC) were formally adopted on 12 October 1993. SinceApril 1994, a specific code of practice on vaccination shouldhave been in place in the national legislation of each memberstate. This represents an important step in achieving consensuson a preventive policy In Western Europe. It is equally importantthat the legislation obliges employers to identify and vacdnate(free of charge) those workers at risk of infection from hepatitisB.     

Is tuberculin skin testing useful to diagnose latent tuberculosis in BCG-vaccinated children?

BACKGROUND: The tuberculin skin test (TST) is the most commonly used tool to detect infection with Mycobacterium tuberculosis. We sought to determine whether tuberculin skin testing is useful to detect latent infection by M. tuberculosis in a population that was vaccinated with the Bacille Calmette Guérin (BCG) vaccine. METHODS: We performed a cross-sectional study during October 2000-February 2001, enrolling first and sixth graders from a random, stratified sample of public elementary schools in Orizaba, Veracruz, Mexico. We assessed the relationship between sociodemographic and epidemiological information, BCG scars, and TST reactivity. RESULTS: There were 858 children enrolled in the study with a completed questionnaire and TST result. The prevalence of a positive TST result (> or =10 mm) was 12.4%. Controlling for BCG scar, age, and other characteristics, close contact with pulmonary tuberculosis patients (odds ratio 6.56, 95% confidence interval 2.05-21.07, P = 0.001) was independently associated with TST reactivity. CONCLUSIONS: TST results helped identify children in a BCG-vaccinated population who had recent exposure to persons with pulmonary tuberculosis, were probably infected with M. tuberculosis, and could benefit from treatment for their latent tuberculosis infection.     

Prevalence of tuberculosis and HIV infections among participants in an intravenous drug user risk-control program]

BACKGROUND: To determine the prevalence of tuberculosis and HIV infection in addition to the related factors among a population of participants in the risk control program in the town of Lleida. METHODS: The sample was comprised of the newly-enrolled participants in the program in April-June 1996, among whom a questionnaire was handed out for collecting the data concerning the variables involved: age, gender, results of the tuberculin test, BCG vaccination, knowledge of the serology regarding HIV, former imprisonment and number of years having used heroin. The prevalence of the tuberculosis and HIV infection was calculated to a 95% confidence interval (CI). The relating of these two variables to all other variables in the study was determined by means of the odds ratio (OR) and its 95% CI. RESULTS: One hundred and fifty (150) patients were seen, 45 of whom were newly enrolled participants. Eighty percent (80%) were males, averaging 31.1 years of age. The prevalence of this dual infection was 8.9% (95% CI 2.8-22.1). The prevalence of the tuberculosis infection was 27.3% (95% CI 12.4-43.0), being higher among former prison inmates (OR = 3.4; 95% CI 0.5-27.4). The prevalence of the HIV infection was 36.1% (95% CI 21.3-53.8), being greater among those who had been using heroin for longer than 11 years (OR = 7.3; 95% CI 1.0-65.9). CONCLUSIONS: Former imprisonment is the main risk factor for tuberculosis infection. The number of years of heroin use are related to the HIV infection, especially when longer than 11 years. The risk control programs in our country should carry out activities aimed at monitoring tuberculosis and HIV infection.     

Tuberculin reactivity in adults after 50 years of universal bacille Calmette-Guerin vaccination in Taiwan

We aimed to assess whether tuberculin reactivity in adults is affected by bacille Calmette-Guerin (BCG) vaccination after 50 years of universal BCG vaccination with 80-95% coverage. A community-based study on tuberculin reactivity in 619 participants was conducted in February 2000 in Keelung city, Taiwan. Information on BCG vaccination policies and annual risk of infection (ARI) in the underlying population was extracted from consecutive national prevalence surveys relating to the period 1952-1997. Compared with the expected ARI estimate, the standardized morbidity ratio of positive tuberculin response for vaccination in infancy was 2.2 (95% CI 0.3-15.5) for those aged <10 years. The corresponding figures for older age groups ranged from 3.6 (95% CI 2.2-5.9) for those aged 10-12 years to 0.7 (95% CI 0.5-0.9) for those aged 57-67 years. This suggests that the effect of BCG vaccination on positive tuberculin response in adults aged >30 years is probably negligible irrespective of age at vaccination or revaccination and that the tuberculin skin test can be used to diagnose TB in control programmes in countries with moderate or high incidence of TB.     

A survey of latent tuberculosis infection among laboratory healthcare workers in New York City.

OBJECTIVE: To determine the prevalence of positive tuberculin skin tests (TSTs), incidence of TST conversion, risk factors for positive TSTs, and history of active TB among HCWs in microbiology laboratories in New York City. DESIGN: Two-year survey from May 1999 to June 2001. SETTING: Nineteen microbiology laboratories. RESULTS: During the first year, interviews were conducted with 345 laboratory HCWs (mean, 18 HCWs per site; range, 2 to 51) to assess the prevalence of positive TSTs, but 3 (1%) could not recall their result and were excluded from further analyses. The mean age of the remaining 342 HCWs was 48 years; 68% (n = 233) were female, 54% (n = 183) received bacille Calmette-Guerin (BCG) vaccination, and 71% (n = 244) were foreign born. The prevalence of a positive TST was 57% (n = 196), but only 20% (n = 39) of the HCWs received isoniazid. The incidence of TST conversion in the second year of the study was 1% (1 of 108). Multivariate analysis identified age (odds ratio [OR] per year, 1.05; 95% confidence interval [CI95], 1.02-1.08), foreign birth (OR, 3.80; CI95, 1.98-7.28), BCG immunization (OR, 4.89; CI95, 2.72-8.80), and employment in a mycobacteriology laboratory (OR, 2.14; CI95, 1.25-3.68) as risk factors for a positive TST. Only one HCW had been treated for active TB. CONCLUSIONS: The prevalence of positive TSTs was high among laboratory HCWs, but the TST conversion rate was low. Higher rates of treatment for latent TB infection are desirable.     

Tuberculosis transmission in a renal dialysis center--Nevada, 2003

Among persons with chronic renal failure, infection with Mycobacterium tuberculosis is more likely to progress to tuberculosis (TB). Chronic renal failure is an immunocompromising condition associated with cutaneous anergy, which can result in a false-negative tuberculin skin test (TST) result. In 2003, a health-care worker (HCW) (i.e., a hemodialysis technician) in an outpatient renal dialysis center in Nevada became ill with pulmonary TB, exposing more than 400 patients and other employees. The HCW had a previous positive TST result but never received treatment for TB infection. This report summarizes the results of a contact investigation, which suggested that the HCW had transmitted M. tuberculosis to 29 patients and 13 employees. The findings underscore the need for TB screening and treatment of TB infection for all HCWs and patients at high risk.     

Assessing the health of future physicians: an opportunity for preventive education

INTRODUCTION: Research shows that physicians who model prevention are more likely to encourage preventive behaviors in their patients. Therefore, understanding the health of medical students ought to provide insight into the development of health promotion programs that influence the way these future physicians practice medicine. A university-based General Clinical Research Center (GCRC) provides a venue well suited to the health assessment and education of medical students. This research explores the utility of a GCRC in a program measuring the prevalence of clinical risk factors and related health behaviors in first-year medical students. METHODS: A 6-year cross-sectional study of first-year medical students measured clinical and behavioral variables associated with metabolic syndrome. Statistical testing was used to determine the prevalence of risk factors and the influence of gender in these variables. RESULTS: This group of medical students displayed better health indicators than did the general young adult population; however a small proportion of medical students exhibited early risk factors for chronic disease. There were significant gender differences in mean values for clinical risk factors, with males displaying higher cardiovascular risk overall. Males and females demonstrated significant differences in dietary intake and exercise programs. DISCUSSION: A GCRC can be used to provide a health assessment of medical students. Moreover, some students may benefit from health promotion programs incorporated into medical school curricula. This study provides a foundation for further research on the health of future physicians and the development of health promotion programs for this population. It also begins to explore the use of a GCRC as a teaching resource for medical students.     

Results of five-year systematic screening for latent tuberculosis infection in healthcare workers in Portugal

Introduction  

The risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group. The prevalence of latent tuberculosis infection (LTBI) in HCWs in Portugal using the tuberculin skin test (TST) and the interferon-γ release assays (IGRA) was analyzed over a five-year period.     

Screening for tuberculosis infection using whole-blood interferon-gamma and Mantoux testing among Japanese healthcare workers.

OBJECTIVE: To examine the hypothesis that results of the QuantiFERON-TB Gold assay (QFT-G), a whole-blood test for detection of tuberculosis infection, are more significantly related to known risk factors for tuberculosis infection in healthcare workers (HCWs) who have received bacille Calmette-Guerin vaccine than are results of the Mantoux tuberculin skin test (TST). DESIGN: All HCWs (approximately 510) from a 370-bed general hospital in Tokyo where patients with and patients without tuberculosis are treated were invited to participate in the study. All study participants completed a questionnaire about their Mycobacterium tuberculosis infection risk factors as HCWs at the general hospital. They were then tested for LTBI by means of the QFT-G, followed by the TST. Statistical analyses were performed to compare results of each test with M. tuberculosis infection risk factors (age, length of employment in the healthcare industry, history of working with tuberculosis-positive patients in a tuberculosis ward or in the outpatient department of the hospital's tuberculosis clinic for more than 1 year, chest radiograph evidence of healed tuberculosis, history of performing bronchoscope procedures, and job classification), and for TST-positive HCWs, to compare the QFT-G result with the TST induration diameter. RESULTS: A total of 332 HCWs (95% of whom had been vaccinated with BCG) participated in the study, and 33 had positive QFT-G results, suggesting a prevalence of LTBI of 9.9%. Of 304 HCWs who underwent TST, 283 (93.1%) had an induration diameter of 10 mm or more. Multiple logistic regression analysis revealed that positive QFT-G results were significantly associated with age and with a history of working in a tuberculosis ward or an outpatient department of a tuberculosis clinic. TST results were not correlated with any of the tuberculosis infection risk factors we evaluated. CONCLUSIONS: Positive QFT-G results were closely associated with the presence of risk factors for LTBI in a hospital setting, suggesting that the QFT-G can detect LTBI in a population composed predominantly of BCG vaccinees. Because most HCWs worldwide have been vaccinated with BCG, the QFT-G offers a significant improvement over the TST in tuberculosis screening programs and minimizes unwarranted use of tuberculosis prophylaxis.     

Influenza vaccination in German health care workers: effects and findings after two rounds of a nationwide awareness campaign

In Germany, despite longstanding recommendations for influenza vaccination, uptake among health care workers (HCW) is poor. We conducted and evaluated a 2-year nationwide campaign to increase influenza vaccination rates among German HCW. The campaign was tailored to the results of a baseline survey and included the distribution of information material to all German hospitals (n approximately 2000) and engagement of stakeholders, such as professional HCW associations. Human and financial resources consisted of one full-time public health scientist (2 months) and approximately USD 45,000 to produce and distribute materials. We evaluated the intervention in a survey among a systematic sample of HCW in a sample of selected 20 hospitals. HCW were stratified by profession and asked to self-administer a questionnaire inquiring about self-perceived risk for influenza, belief of effectiveness of the vaccine, and influenza vaccination before the starting season (2003/2004) as well as the previous two seasons (2001/2002, 2002/2003). Three hundred and ninety-six of 800 (50%) HCW who were addressed in the evaluated hospitals participated in the evaluation survey. The overall influenza vaccination rate among respondents increased from 21% (2001/2002) to 26% (2003/2004), which was mostly due to a significant increase among physicians (2001/2002: 21%; 2003/2004: 31%; nurses: 20% and 22%, respectively). Significantly more physicians than nurses felt at increased risk for influenza and believed that the vaccine is very effective. Increased uptake among physicians (compared to nurses) was likely due to physicians' higher awareness of their risk and trust in the vaccine. In the future it may be necessary to address nurses differently than physicians. We conclude that a national campaign with very limited resources is feasible and capable of achieving measurable results in a short time frame.     

Prevalence and prediction of chlamydial cervical infection in a rural area: an UPRNet project

BACKGROUND. Though many studies have described the prevalence of genital Chlamydia trachomatis infections in urban and suburban populations, no data on a rural general practice population have been published. Knowledge of the prevalence of infection is necessary to develop screening strategies. METHODS. The Upper Peninsula Research Network (UPRNet) is a rural primary care research group composed of five family practice offices. Cervical cultures for C trachomatis were taken on all women under the age of 36 years who presented to UPRNet physicians for a pelvic examination for any reason between August 15 and November 10, 1989. Demographic and clinical variables were analyzed for correlation with infection, and the best predictors of infection were identified by logistic regression. Previously published screening protocols were then tested on our data to develop the best predictive model for our rural population. RESULTS. C trachomatis was cultured from 25 (4.7%, 95% CI 2.9% to 6.5%) of 530 consecutive women. Infection was significantly more common among younger and single women, women with a new sex partner, and women with mucopurulent cervical discharge or increased cervical friability. No symptoms were predictive of an increased risk of infection. Based on the clinical presentation alone, the physicians correctly predicted only 28% of the infections. Using a modified Rosenthal protocol, we would have identified 80% of the infections while testing only 31% of the women. The protocols of Magder and Handsfield and their respective colleagues performed reasonably well, too. Other published screening protocols were less useful. CONCLUSIONS. The prevalence of C trachomatis cervical infection in our rural primary care office population is relatively low. In rural primary care we recommend testing all high-risk women using a modification of Rosenthal's protocol instead of relying on symptoms or clinical suspicion.     

Determining the prevalence of tuberculosis infection in populations with non-specific tuberculin sensitivity

In tropical countries, where there is generally a high prevalence of non-specific sensitivity, the tuberculin test is inadequate for detecting tuberculosis infection. A method is proposed by which the prevalence of infection in the population can be determined under such circumstances thus making possible meaningful epidemiological surveillance of the disease. This method compares levels of tuberculin sensitivity in individuals before and after BCG vaccination. If BCG vaccination fails to produce an increase in tuberculin sensitivity, the individual must have been infected with human or bovine tubercle bacilli.     

Prevalence of hepatitis A among drug users in north-eastern Italy. Is vaccination necessary in low prevalence areas?

BACKGROUND: The authors report on the prevalence of, and risk factors for, hepatitis A virus (HAV) in a group of drug users in Italy. METHODS: 404 heroin users were recruited and compared with a control group of 107 subjects in the general population. RESULTS: Drug users born in north-eastern Italy have a prevalence of anti-HAV similar to the control group. A much higher prevalence was found in drug users born in southern Italy. CONCLUSION: The similar prevalence of anti-HAV in drug users born in north-eastern Italy and in the general population, suggests that their lifestyle does not involve a substantial additional risk of HAV. The much higher prevalence found in drug users born in southern Italy is more likely to be related to infection during infancy.