Article    Table of Contents                    Full Text of this article Free    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Stead, W. W.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Management of Health Care Workers after Inadvertent Exposure to Tuberculosis: A Guide for the Use of Preventive Therapy

William W. Stead

15 June 1995 | Volume 122 Issue 12 | Pages 906-912

Objective: To quantify the protection of previously infected persons from developing tuberculosis after intense exposure.

Setting: 6 hospitals and 22 nursing homes in which heavy tuberculosis exposure had occurred.

Measurements: Results of tuberculin skin tests before and after exposure and the development of tuberculosis among known reactors, both converters and nonconverters.

Intervention: All converters were given preventive therapy with isoniazid as soon as they could be identified. Nonconverters and previously known reactors were not treated.

Results: In 6 hospital outbreaks, largely aborted by prompt preventive therapy, 98 of 336 nonreactors (29%) showed skin test conversion, and, before therapy could be started, 19 (19% [95% CI, 12% to 29%]) had developed tuberculosis. No tuberculosis developed among the 238 nonconverters (0% [CI, 0% to 1.5%]) or the 76 known reactors who were not treated (0% [CI, 0.5% to 2%]). Tuberculosis developed in 5 of 209 known reactors (2.4% [CI, 0.8% to 5.5%]) in 22 nursing homes with heavy exposure, little more than 10 of 921 known reactors (1.1% [CI, 0.5% to 2%]) in 76 homes where there was no exposure (P = 0.17).

Conclusions: Healthy persons who remain nonreactive to tuberculin after heavy exposure have escaped infection and require no chemotherapy. However, if exposure is discovered immediately, it is wise to start preventive therapy in particularly heavily exposed nonreactors and discontinue it if the skin test result is still negative at 3 months. Persons who react after exposure fall into three groups: 1) converters, in whom the risk for tuberculosis warrants preventive chemotherapy, regardless of age; 2) reactors with no preexposure test results, who should be treated as converters; and 3) previously known reactors, in whom the risk for tuberculosis generally is too slight to warrant therapy. However, those who are younger than age 35 years, have human immunodeficiency virus infection, are receiving cancer chemotherapy or long-term corticosteroid therapy, or are otherwise immunocompromised should be considered for preventive therapy, regardless of the exposure.

Author and Article Information

From the Arkansas Department of Health, Little Rock, Arkansas.
Requests for Reprints: William W. Stead, MD, Tuberculosis Program, Arkansas Department of Health, 4815 West Markham Street, Little Rock, AK 72205.
Acknowledgments: The author thanks the public health nurses of the Arkansas Department of Health and the Directors of Nursing of 230 Arkansas nursing homes for their help in efforts at tuberculosis control. Their carefully kept database made it possible to assess the effect of heavy exposure on elderly tuberculin reactors. The author also thanks Dr. Noreen A. Hynes for helping to organize the presentation of data and statistical analyses; Dr. Eugene Stead for his assistance in presenting the material in a form better suited for practicing physicians; Jack T. Crawford, PhD, for resurrecting three of the original cultures 7 years after an outbreak was recorded and M. Donald Cave, PhD, for doing restriction fragment-length polymorphism fingerprinting on these cultures; Drs. J. P. Lofgren and John W. Senner for their help in the early analysis of data; Dr. Joseph H. Bates for his many suggestions; and Christopher Murphy for his patience with the many revisions of the tables and figure.

Related articles in Annals:

Brief Communications
The Risk for Transmission of Mycobacterium tuberculosis at the Bedside and during Autopsy
Gary L. Templeton, Lee Ann Illing, Lanne Young, Donald Cave, William W. Stead, AND Joseph H. Bates

Annals 1995 122: 922-925. [ABSTRACT][Full Text]  

Perspectives
Fixed-Dose Combinations of Antituberculous Medications To Prevent Drug Resistance
Thomas Moulding, Asim K. Dutt, AND Lee B. Reichman

Annals 1995 122: 951-954. [ABSTRACT][Full Text]  

Editorials
Tuberculosis: Yesterday, Today, and Tomorrow
John A. Sbarbaro

Annals 1995 122: 955-956. [Full Text]  

This article has been cited by other articles:

				G. de Vries, M. M. G. G. Sebek, and C. S. B. Lambregts-van Weezenbeek Healthcare workers with tuberculosis infected during work Eur. Respir. J., December 1, 2006; 28(6): 1216 - 1221. [Abstract] [Full Text] [PDF]

				J. Walrath, L. Zukowski, A. Krywiak, and R. F. Silver Resident Th1-Like Effector Memory Cells in Pulmonary Recall Responses to Mycobacterium tuberculosis Am. J. Respir. Cell Mol. Biol., July 1, 2005; 33(1): 48 - 55. [Abstract] [Full Text] [PDF]

				R. F. Silver, L. Zukowski, S. Kotake, Q. Li, F. Pozuelo, A. Krywiak, and R. Larkin Recruitment of Antigen-Specific Th1-Like Responses to the Human Lung following Bronchoscopic Segmental Challenge with Purified Protein Derivative of Mycobacterium tuberculosis Am. J. Respir. Cell Mol. Biol., July 1, 2003; 29(1): 117 - 123. [Abstract] [Full Text] [PDF]

				S. J. Shukla, D. K. Warren, K. F. Woeltje, C. A. Gruber, and V. J. Fraser Factors Associated With the Treatment of Latent Tuberculosis Infection Among Health-Care Workers at a Midwestern Teaching Hospital Chest, November 1, 2002; 122(5): 1609 - 1614. [Abstract] [Full Text] [PDF]

				R. Vankayalapati, B. Wizel, D. L. Lakey, Y. Zhang, K. A. Coffee, D. E. Griffith, and P. F. Barnes T Cells Enhance Production of IL-18 by Monocytes in Response to an Intracellular Pathogen J. Immunol., June 1, 2001; 166(11): 6749 - 6753. [Abstract] [Full Text] [PDF]

				K. J. Brill, Q. Li, R. Larkin, D. H. Canaday, D. R. Kaplan, W. H. Boom, and R. F. Silver Human Natural Killer Cells Mediate Killing of Intracellular Mycobacterium tuberculosis H37Rv via Granule-Independent Mechanisms Infect. Immun., March 1, 2001; 69(3): 1755 - 1765. [Abstract] [Full Text] [PDF]

				D. N. Rose Benefits of Screening for Latent Mycobacterium tuberculosis Infection Arch Intern Med, May 22, 2000; 160(10): 1513 - 1521. [Abstract] [Full Text] [PDF]

				S. V. GOLDBERG, J. S. DUCHIN, T. SHIELDS, and C. M. NOLAN Four-Month, Four-Drug Preventive Therapy for Inactive Pulmonary Tuberculosis Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 508 - 512. [Abstract] [Full Text]

				N. W. SCHLUGER and W. N. ROM The Host Immune Response to Tuberculosis Am. J. Respir. Crit. Care Med., March 1, 1998; 157(3): 679 - 691. [Full Text] [PDF]

				R. F. Silver, Q. Li, W. H. Boom, and J. J. Ellner Lymphocyte-Dependent Inhibition of Growth of Virulent Mycobacterium tuberculosis H37Rv Within Human Monocytes: Requirement for CD4+ T Cells in Purified Protein Derivative-Positive, But Not in Purified Protein Derivative-Negative Subjects J. Immunol., March 1, 1998; 160(5): 2408 - 2417. [Abstract] [Full Text] [PDF]