Skip to main content Accessibility help
×
Home

Factors Associated With Tuberculin Reactivity in Two General Hospitals in Mexico

  • María de Lourdes García-García (a1), Aida Jiménez-Corona (a1), María Eugenia Jiménez-Corona (a1), Leticia Ferreyra-Reyes (a1), Kenneth Martínez (a2), Blanca Rivera-Chavira (a3), María Elena Martínez-Tapia (a4), Emilio Valenzuela-Miramontes (a5), Manuel Palacios-Martínez (a1), Luis Juárez-Sandino (a1) and José Luis Valdespino-Gómez (a1) (a5)...

Abstract

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-Guérin (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 (≥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.

Copyright

Corresponding author

Instituto Nacional de Salud Público, Ave Universidad No. 655, Col Sta Ma Ahuacatitlán, Cuernavaca CP 62508, México

References

Hide All
1. Coronado, VG, Beck-Sague, CM, Hutton, MD, Davis, BJ, Nicholas, P, Villarreal, C, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital epidemiological and restriction fragment length polymorphism analysis. J Infect Dis 1993;168:10521055.
2. Beck-Sague, C, Dooley, SW, Hutton, MD, Otten, J, Breeden, A, Crawford, JT, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections: factors in transmission to staff and HIV-infected patients. JAMA 1992;268:12801286.
3. Aita, J, Barrera, L, Reniero, A, Lopez, B, Biglione, J, Weisburd, G, et al. Hospital transmission of multidrug-resistant Mycobacterium tuberculosis in Rosario, Argentina. Medicina (B Aires) 1996;56:4850.
4. Harries, AD, Kamenya, A, Namarika, D, Msolomba, IW, Salaniponi, FM, Nyangulu, DS, et al. Delays in diagnosis and treatment of smear-positive tuberculosis and the incidence of tuberculosis in hospital nurses in Blantyre, Malawi. Trans R Soc Trop Med Hyg 1997;91:1517.
5. Ritacco, V, Di Lonardo, M, Reneiro, A, Ambroggi, M, Barrera, L, Dambrosi, A, et al. Nosocomial spread of human immunodeficiency virus-related multidrug-resistant tuberculosis in Buenos Aires. J Infect Dis 1997;176:637642.
6. Wilkinson, D, Crump, J, Pillay, M, Sturm, AW. Nosocomial transmission of tuberculosis in Africa documented by restriction fragment length polymorphism. Trans R Soc Trop Med Hyg 1997;91:318.
7. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:9298.
8. Sepkowitz, KA. AIDS, tuberculosis and the health care worker. Clin Infect Dis 1995;20:232242.
9. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):1132.
10. Maloney, SA, Pearson, ML, Gordon, MT, Del Castillo, R, Boyle, JF, Jarvis, WR. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and healthcare workers. Ann Intern Med 1995;122:9095.
11. Ponce-de-Leon, S. The needs of developing countries and the resources required. J Hosp Infect 1991;18(suppl A):S376S381.
12. Harries, AD, Maher, D, Nunn, P. Practical and affordable measures for the protection of health care workers from tuberculosis in low-income countries. Bull World Health Organ 1997;75:477489.
13. Direction General de Epidemiologia. Sistema national de information epidemiologica. Epidemiologia, Sistema Vnico de Informatión 1999;15:78.
14. Latin American Demographic Center. Latin America Population Projections Calendar Year 1950-2000. Demographic Bulletin 1991;48:186.
15. Garcia-Garcia, ML, Valdespino, JL. Tuberculosis. In: Valdespino, JL, Velasco, O, Escobar, A, eds. Enfermedades Tropicales en México. Diagnóstico, Tratamiento y Distributión Geográfica. México, D.F.: Secretaria de Salud; 1994:215225.
16. Magis-Rodríguez, C, Bravo-Garcia, E, Anaya-López, L, Uribe-Zúñiga, P. La situatión del SIDA en México a finales de 1998. SIDA-ETS 1998;4:143155.
17. Garcia-Garcia, ML, Jimenez-Corona, A, Ferreyra-Reyes, L, Rivera-Chavira, B, Martinez-Tapia, ME, et al. Triage of tuberculosis patients: a low cost intervention for prevention of tuberculosis transmission in hospitals. Int J Tuberc Lung Dis 1999;9(suppl 1):S171.
18. Secretaría de Salud. Norma Oficial para el Control y Prevención de la Tuberculosis en la Atención Primaria a la Salud. Norma No. NOM-006-SSAA2-1993. Official Gazette. 1995;496:2029.
19. Arnadottir, T, Rieder, HL, Trebucq, A, Waaler, HT. Guidelines for conducting tuberculin skin test surveys in high prevalence countries. Tuber Lung Dis 1996;77(suppl 1):119.
20. Sokal, JE. Measurement of delayed skin-test responses. N Engl J Med 1975;293:501502.
21. Hosmer, DW Jr Lemeshow, S. Applied Logistic Regression. New York, NY: Wiley Interscience; 1989:82175.
22. Hennekens, CH, Buring, J, Mayrent, SL. Epidemiology in Medicine. Boston, MA: Little, Brown and Co; 1986:8790.
23. Molina-Gamboa, J, Fivera-Morales, I, Ponce-de-Leon-Rosales, S. Prevalence of tuberculin reactivity among healthcare workers from a Mexican hospital. Infect Control Hosp Epidemiol 1994;15:319320.
24. Cardenas-Ayala, VM, Bernal-Perez, J, Cabrera-Coello, L, Stetler, HC, Pineda-Salgado, J, Guerrero-Reyes, P. Tuberculosis surveys in Guerrero and new estimates of the magnitude of tuberculosis infection in Mexico [in Spanish]. Salud Publico Mex 1989;31:7381.
25. Haas, DW, Milton, S, Kreiswirth, BN, Brinsko, VL, Bifani, PJ, Schaffner, W. Nosocomial transmission of a drug-sensitive W-variant Mycobacterium tuberculosis strain among patients with acquired immunodeficiency syndrome in Tennessee. Infect Control Hosp Epidemiol 1998;19:635639.
26. Kantor, HS, Poblete, R, Pusateri, SL. Nosocomial transmission of tuberculosis from unsuspected disease. Am J Med 1988;84:833838.
27. Ktsanes, VK, Williams, WL, Boudreaux, W. The cumulative risk of tuberculin skin test conversion for five years of hospital employment. Am J Public Health 1986;76:6567.
28. Behrman, AJ, Shofer, FS. Tuberculosis exposure and control in an urban emergency department. Ann Emerg Med 1998;31:370375.
29. Ostrosky-Zeichner, L, Rangel-Frausto, S, Garcia-Romero, E, Vászquez, A, Ibarra, MJ, Ponce de León-Rosales, S. Tuberculosis in health personnel: importance of surveillance and control programs [in Spanish]. Salud Publico Mex 2000;42:4852.
30. Ponce de Leon, S, Rangel-Frausto, MS, Elias-Lopez, JI, Romero-Olivera, C, Huertas-Jimenez, M. Nosocomial infections: secular trends of a control program in Mexico [in Spanish]. Salud Publico Mex 1999;41(suppl 1):S5S11.
31. Bailey, TC, Fraser, VJ, Spitznagel, EL, Dunagan, WC. Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital. Ann Intern Med 1995;122:580585.
32. Menzies, R, Vissandjee, B, Rocher, I, St Germain, Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med 1994;120:190198.
33. Miret-Cuadras, P, Pina-Gutierrez, JM, Juncosa, S. Tuberculin reactivity in Bacillus Calmette-Guerin vaccinated subjects. Tuber Lung Dis 1996;77:5258.
34. Garcia-Garcia, ML, Valdespino-Gomez, JL, Garcia Sancho, C, Mayar-Maya, ME, Palacios-Martinez, M, Balandrano-Campos, S, et al. Underestimation of Mycobacterium tuberculosis infection in HIV-infected subjects using reactivity to tuberculin and anergy panel. Int J Epidemiol 2000;29:369375.
35. Granich, R, Binkin, N, Jarvis, W, Simone, P, Rieder, H, Espinal, M, et al. Guidelines for the prevention of tuberculosis in health-care facilities in resource-limited settings. (WHO/CDS/TB/99.269). Geneva, Switzerland: World Health Organization; 1999.

Factors Associated With Tuberculin Reactivity in Two General Hospitals in Mexico

  • María de Lourdes García-García (a1), Aida Jiménez-Corona (a1), María Eugenia Jiménez-Corona (a1), Leticia Ferreyra-Reyes (a1), Kenneth Martínez (a2), Blanca Rivera-Chavira (a3), María Elena Martínez-Tapia (a4), Emilio Valenzuela-Miramontes (a5), Manuel Palacios-Martínez (a1), Luis Juárez-Sandino (a1) and José Luis Valdespino-Gómez (a1) (a5)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed