Search

From November 1996 through March 1997, presumptive active pulmonary tuberculosis (TB) was detected in 44 health care workers (HCWs) at a university hospital in Lima, Peru. To further assess the magnitude of the outbreak and determine risk factors for occupational Mycobacterium tuberculosis transmission, we identified HCWs in whom active pulmonary TB was diagnosed from January 1994 through January 1998, calculated rates by year and hospital work area, and conducted a tuberculin skin test (TST) survey. Thirty-six HCWs had confirmed active pulmonary TB. The rate of TB was significantly higher among the 171 HCWs employed in the laboratory than among HCWs employed in all other areas. In multivariate analysis, the only independent risk factor for HCW M. tuberculosis infection in HWCs employed in the laboratory was the use of common staff areas. Very high rates of active pulmonary TB were detected among HCWs at this hospital, and occupational acquisition in the laboratory was associated with HCW-to-HCW transmission.

Little is known about the clinical outcomes of patients with primary multidrug-resistant (MDR) tuberculosis. Clinical outcomes among 46 patients in Estonia with primary MDR tuberculosis and 46 patients with pansusceptible tuberculosis were compared. Patients with MDR tuberculosis were more likely than those with pansensitive tuberculosis to have treatment failure (odds ratio, 8.9; 95% confidence interval [CI], 3.0-26.3) after adjusting for medical problems and weeks of effective treatment, often with second-line drugs. Ten patients (22%) with MDR tuberculosis and 2 (4%) with susceptible tuberculosis died of tuberculosis (P=.03). MDR tuberculosis (hazard ratio [HR], 7.8; 95% CI, 1.6-37.4), number of medical problems (HR, 2.5; 95% CI, 1.5-4.4), and male sex (HR, 5.8; 95% CI, 1.1-29.6) were associated with death due to tuberculosis in multivariable analysis. Human immunodeficiency virus test results were negative for all 55 patients tested. These findings underscore the urgent need for increased attention to prevention and treatment of MDR tuberculosis globally.

The number of reported cases of tuberculosis (TB) in foreign-born persons in the United States during 1995 was 8,042, 36% of the national total. The overseas screening of immigrants and refugee visa applicants, which relies on a chest radiograph and smear microscopy, is designed to identify future U.S. residents who have active TB or who are at high risk for TB. In this commentary, we summarize current policies and review retrospective evaluations of the screening system currently in place. The system appears to detect most persons who have active TB at the time of screening. However, active TB is actually diagnosed in < 15% of persons who are identified by screening as having suspected TB and who are evaluated in the United States. To improve the system, more sensitive and specific techniques as well as improved means of data transmission to state and local health departments are needed.

We identified 1699 liveborn twin pairs, discordant for sex. In this study, which essentially controls for gestational age, race, and maternal risk factors among males and females, there was no significant sex difference (108 male deaths and 103 female deaths) in neonatal mortality (p greater than 0.50). However, there was a sex difference in intrauterine growth, since 53% of the males, but only 42% of the females had birthweights greater than 2499 grams (p = 0.0002). A differential growth pattern can bias birthweight-specific assessments of survival. Such a bias may have been responsible for our finding that low-birthweight white females had better survival than did males in that category, since there was no such sex difference found among white twins born prematurely (greater than 36 weeks gestation). Therefore, we recommend that accurate assessments of sex differences in neonatal survival should be on the basis of gestational age, controlling for race and maternal risk factors.

A nutritional survey in the Tihama region of Yemen allowed an analysis of the relationship between infant feeding practices and the growth of children 3-23 months of age. The survey was conducted in 1979 on a representative sample of 364 preschool children 3-23 months of age. After adjustment for demographic and socioeconomic factors, breast feeding was found to be associated with higher weight-for-length and weight-for-age. The strongest beneficial effect of breast feeding on weight-for-length was seen at 3-6 months, a weaker effect at 7-12 months, and essentially no effect over 12 months of age. A higher weight-for-age was seen in breast-fed infants 3-6 months of age only. Introducing other foods was associated with higher weight-for-length only in children 13-23 months of age. Neither breast feeding nor introducing other foods was associated with length-for-age. Infant feeding practices appear to be associated with weight gain, but not linear growth in Yemeni infants.

Part of the slow decline in the postneonatal mortality rate and the rapid decline in the neonatal mortality rate during the 1970s may have been due to a postponement of some neonatal deaths into the postneonatal period. The authors hypothesized that any such postponement should be accompanied by a lack of decline, or even an increase, in late neonatal and postneonatal mortality rates among low birth weight babies and babies dying of conditions originating in the perinatal period. To examine this theory, the authors used vital records data to compare infant mortality rates in Massachusetts during 1970-1972 with rates during 1978-1980. Log-linear hazard models were used to calculate death rates, while controlling for changes in maternal age, race, education, and prior reproductive history. The authors found that babies of birth weight under 1,500 g had no decline in late neonatal mortality rates and babies of birth weight under 2,500 g had no decline in postneonatal mortality rates. Babies of birth weight 500-999 g had an increased postneonatal mortality rate (rate ratio = 2.4; 95% confidence limits = 1.0-5.4). These unimproved or increased death rates were due in part to conditions originating in the perinatal period. The authors conclude that, although infant mortality rates have declined, this postponement was real, and that efforts to monitor infant mortality will benefit from its routine quantification.