Impact of Choice of Test for Latent Tuberculosis Infection on Treatment Acceptance and Completion

Objective: The aim of this study is to assess whether choice of test for tuberculosis (TB) infection affects decisions to accept and complete treatment among contacts to TB cases. Methods: Retrospective study is conducted in which TB contacts, ⩾15 years old during 2005 and 2009, were tested for infection with either a tuberculin skin test (TST) or an interferon-gamma release assay test, the QuantiFERON-TB Gold In-Tube (QFT-GIT). Results: Of 658 persons with valid test results, 185 (28%) had positive results, including 128 of 406 (32%) who had TST and 57 of 252 (23%) who received QFT-GIT. Treatment acceptance was 43 of 57 (75%) among QFT-GIT-positive and 97 of 128 (76%) among TST-positive persons (risk ratio [RR] = 1.0, 95% confidence interval [CI], 0.83-1.2). Treatment completion was 56% among QFT-GIT-positive (32 of 57) and 59% (75 of 128) among TST-positive persons (RR = 0.96, 95% CI, 0.73-1.26). Discussion: Our study showed no difference in proportions of TB contacts ⩾15 years old with positive TST results who accepted or completed LTBI treatment compared with those with positive QFT-GIT results. Future studies should include high-risk persons with no known TB exposure, who constitute the main reservoir for TB cases in the United States

Investigation of hepatitis B virus and human immunodeficiency virus transmission among severely mentally ill residents at a long term care facility.

BACKGROUND: A high prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections have been reported among persons with severe mental illness. In October, 2009, the Cook County Department of Public Health (CCDPH) initiated an investigation following notification of a cluster of HBV infections among mentally ill residents at a long term care facility (LTCF). METHODS: LTCF staff were interviewed and resident medical records were reviewed. Residents were offered testing for HBV, HCV, and HIV. Serum specimens from residents diagnosed with HBV or HIV infection were sent to the Centers for Disease Control and Prevention (CDC) for analysis. RESULTS: Eleven newly diagnosed HBV infections were identified among mentally ill residents at the LTCF. Of these 11 infections, 4 serum specimens were available for complete HBV genome sequencing; all 4 genomes were found to be closely related. Four newly diagnosed HIV infections were identified within this same population. Upon molecular analysis, 2 of 4 HIV sequences from these new infections were found to be nearly identical and formed a tight phylogenetic cluster. CONCLUSIONS: HBV and HIV transmission was identified among mentally ill residents of this LTCF. Continued efforts are needed to prevent bloodborne pathogen transmission among mentally ill residents in LTCFs

Phylogenetic relationship of the complete HBV genomic sequences of 4 long term care facility (LTCF) A residents with newly diagnosed HBV infection and representative HBV genotype A (n = 29) and D (n = 6) strains.

<p>Representative HBV genotype A and D strains were retrieved from GenBank and CDC's sequence database. The 4 LTCF A residents are shown by the solid boxes.</p

Phylogenetic relationship of the HIV sequences of 6 LTCF A residents with HIV infection (4 newly diagnosed), 23 reference US subtype B sequences, and one reference subtype C sequence (the outgroup).

<p>The 6 LTCF A residents are shown by the solid boxes. The tree was derived from a nucleotide alignment of the 1497-bp <i>pro-pol</i> region. Trees were inferred from 3 different phylogenetic analysis methods (neighbor-joining, maximum likelihood, and Bayesian inference) which independently showed that 2 sequences (COB 2 and COB 3) consistently cluster together with high bootstrap/statistical support (99/100/1.0 respectively). These two sequences show a pairwise nucleotide identity of 99.3%.</p