Introduction A key component of TB control is to identify potential transmission incidents following exposure to active cases. Appropriate risk stratification and screening of contacts can pre-emptively identify TB infections, and reinforce education and prevention messages. We report the use of a dedicated TB Nurse role to pro-actively manage incidents within a metropolitan TB network.
Methods Data on potential TB transmission incidents within the TB Network (TBN) were collected. Incidents were defined as a reported significant contact between an index case (pulmonary TB diagnosed by culture/molecular testing) and individuals outside the household setting referred to the local Public Health Unit. Incident management followed local guidelines.
Results Between 1.6.17 and 20.7.18, the TBN screening lead managed 148 incidents. 43.2% were in a healthcare setting (67.2% In-patient, 20.3% Emergency Dept, 10.9% Nursing Home and 1.6% GP surgery). The remainder were in the community: 14.2% educational establishments; 12.8% places of work; 3.4% hostels/homeless shelters and 16.9% other venues e.g. pubs, restaurants, shops, religious centres. 9.5% related to airline travel and were not assessed by our service. Following specialist risk assessment, 45.9% of our incidents required further management. 2450 non-household contacts were identified: 1344 were screened, 763 ‘inform and advise’ letters were sent, and in 343 investigation is on-going. A median of 12 (IQR: 5–20) contacts were screened per incident. 64 LTBI cases and two with active TB were identified. A median of 4.1% (IQR: 3.9–5.2) of screened contacts had latent TB infection (LTBI) across a range of settings (figure 1). 46 (71.9%) of the LTBI cases started treatment. In 2016–17, of 1389 non-incident close contacts screened in our network, 258 (18.6%) were diagnosed with LTBI, and 42 (3%) active TB.
Conclusion The large number of healthcare-related events, which are mostly in a hospital setting, following systematic non-household TB incident investigation is a concern. This highlights the need for on-going healthcare worker education regarding TB transmission and infection control. The yield of new LTBI cases in schools, colleges and places of work provides the opportunity for a ‘teachable moment’ in community settings which can be facilitated by the TBN screening lead.
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