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Free Content Impact of a 14-year screening programme on tuberculosis transmission among the homeless in Paris

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Abstract:

OBJECTIVE: To evaluate the impact of an active case-finding programme on tuberculosis (TB) transmission in homeless shelters in Paris, France.

DESIGN: Between 1994 and 1997, an active case-finding programme was implemented in homeless shelters using a mobile radiological screening unit, and continued from 1997 to 2007. During these periods, the strains isolated from TB cases diagnosed in the homeless were genotyped by restriction fragment length polymorphism analysis using the insertion sequence IS6110 as a probe.

RESULTS: Between 1994 and 2007, 313 new TB cases were diagnosed among the homeless population: 179 through the programme among shelter users, and 134 among homeless people not using shelters. Half of the strains were clustered in 35 distinct patterns (2–48 cases/cluster). The clustering of TB cases steadily decreased in shelters during the 13 years of the survey, from 14.3 to 2.7 related cases per year (P < 0.01) and from 75% to 30% of related cases among all TB cases (P < 0.01). In contrast, there was only a slight trend towards a decrease in homeless people not using shelters.

CONCLUSION: Active case finding in homeless shelters resulted in a decrease in case clustering, mainly in shelter users. Genotyping contributed to confirming the positive impact of the intervention.

Keywords: DNA fingerprinting; active case-finding programme; homeless; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0241

Affiliations: 1: Laboratoire de Bactériologie–Hygiène, Université Pierre et Marie Curie, Paris, France; Laboratoire de Bactériologie–Hygiène, Hôpital Pitié–Salpêtrière, Assistance publique–Hôpitaux de Paris, Paris, France; Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France 2: Direction de l'Action Sociale de l'Enfance et de la Santé, Paris, France 3: Laboratoire de Bactériologie–Hygiène, Université Pierre et Marie Curie, Paris, France; Laboratoire de Bactériologie–Hygiène, Hôpital Pitié–Salpêtrière, Assistance publique–Hôpitaux de Paris, Paris, France; Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France

Publication date: May 1, 2012

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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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