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Free Content Outcomes of contact investigation among homeless persons with infectious tuberculosis

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SETTING: Homelessness is an important risk factor for tuberculosis (TB). Health departments often fail to identify contacts for homeless TB cases, but little else is known about the outcome of contact investigations for these cases.

OBJECTIVE: To describe the outcomes of identification, tuberculin skin testing (TST), clinical evaluation and treatment for contacts of infectious homeless TB cases.

DESIGN: Retrospective multicenter review of data of contact investigations conducted in 1996 by five health departments in the United States.

RESULTS: Twenty-seven (8%) of 349 TB cases were homeless. Failure to identify contacts occurred in six (50%) of 12 cases residing in shelters vs. one (7%) of 15 non-shelter cases. Of 479 contacts identified, 297 (62%) were fully evaluated, 97 (20%) had only initial testing, and 85 (18%) were not evaluated. Of the 394 evaluated contacts, 13 (3%) had a prior positive TST. Of the remaining 381 contacts, six (1.6%) had active TB and 67 (17.6%) were TST-positive. Only 27 (44%) of 61 contacts completed treatment for latent TB infection.

CONCLUSION: Despite the failure to identify contacts for some cases, contact investigations for homeless TB cases identified large numbers of contacts for whom evaluation and treatment were often not completed. Prospective studies with more complete documentation are needed to improve contact investigations for homeless TB cases.
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Keywords: contact investigation; homelessness; transmission; tuberculosis

Document Type: Regular Paper

Affiliations: 1: TB Clinic, Denver Health and Hospital, Denver, Colorado, USA 2: National Center for HIV, STD and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 3: TB Clinic, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA 4: TB Clinic, Mississippi State Department of Public Health, Jackson, Mississippi, USA 5: TB Clinic, New Jersey Department of Health and Senior Services, Trenton, New Jersey, USA 6: TB Clinic, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA

Publication date: 2003-12-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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