Skin-Test Screening and Tuberculosis Transmission among the Homeless1

Abstract

We describe the implementation of a mandatory tuberculosis (TB) screening program that uses symptom screening and tuberculin skin testing in homeless shelters. We used the results of DNA fingerprinting of Mycobacterium tuberculosis isolates to evaluate the effect of the program on TB incidence and transmission. After the program was implemented, the proportion of cases among homeless persons detected by screening activities increased, and the estimated TB incidence decreased from 510 to 121 cases per 100,000 population per year. Recent transmission, defined by DNA fingerprinting analysis as clustered patterns occurring within 2 years, decreased from 49% to 14% (p=0.03). Our results suggest that the shelter-based screening program decreased the incidence of TB by decreasing its transmission among the homeless.

Pre-employment screening of latent tuberculosis infection among healthcare workers using tuberculin skin test and QuantiFERON-TB Gold test at a tertiary care hospital in Saudi Arabia

“…Yet, TST is the only test for which the risk of developing active TB in persons with a positive result has been well defined [7][8][9]. Recently, interferon gamma release assays (IGRAs) have been increasingly used for LTBI screening.…”

Homelessness and the Response to Emerging Infectious Disease Outbreaks: Lessons from SARS

“…Previous studies of outbreaks among homeless people have focused on infections such as tuberculosis and seasonal influenza. [6][7][8][9][10] The goal of outbreak response management is to mitigate the effects of the infectious disease on the affected and prevent its spread to others. International guidelines provide a roadmap for risk assessment, surveillance, and mobilization of services in response to an outbreak in the general population.…”

Trends in Tuberculosis/Human Immunodeficiency Virus Comorbidity, United States, 1993-2004

“…A number of communities have implemented more intense TB screening programs among the homeless. 31 However, the relatively stable TB/HIV comorbidity rate among homeless persons may be attributable to the difficulty in providing HIV testing and care and LTBI treatment to this population.…”