Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111269

T. Scott Troppy, MPH¹, Lisa Covington, RN, MPH¹, Sandra Montrond, RN, BSN¹, Claudia Martorell, MD, MPH², James Dickinson, BS¹, Julia E. Gunn, RN, MPH¹, and M. Anita Barry, MD, MPH¹. (1) Communicable Disease Control Division, Boston Public Health Commission, 1010 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, 617-686-2542, scott_troppy@hotmail.com, (2) Communicable Disease Control Division/TB, Boston Public Health Commission, 1010 Massachusetts Avenue, 2nd Floor, Boston, MA 02118

Background: Most tuberculosis disease (TB) in the United States results from reactivation of latent infection. In Boston, 77% of TB cases from 2000-2003 have been in foreign-born persons. We report on a cluster of TB spanning 14 years in a foreign-born family.

Methods:Two members of a family were diagnosed with TB in 2004. We reviewed medical records to obtain information on demographics, treatment, and outcomes in the two cases and their extended family members. A bicultural/bilingual public health nurse obtained detailed information on the family structure as part of the contact investigation. TB isolates were submitted for DNA fingerprinting.

Results:The family consisted of 15 members in 3 separate households. A non-family household contact diagnosed with pulmonary TB (smear+) in 1990 was the index case. The 1990 contact investigation identified 11 family members with LTBI. Of the 3 who did not complete preventive therapy, 2 developed TB disease (1999, 2004). Three additional cases occurred in 1990 (3 month old), 2000 (33 year old), and 2004 (31 year old). All contact investigations were hampered by immigration issues, frequent travel, multiple name changes, availability of appropriate bicultural/bilingual staff and an understanding of the family structure. DNA fingerprinting results are identical for the 1999 and 2004 isolates; the 2000 isolate differs by only one band.

Conclusion: Despite intense public health efforts, linguistic, cultural, and immigration concerns hampered successful TB control. Definitions of family need to include alternative and expanded structures. As TB cases in foreign-born persons increase, addressing these challenges will be critical.

Learning Objectives:

• Identify challenges to the delivery of TB services to foreign-born families.
• Discuss interventions to improve TB treatment outcomes among the foreign-born.

Keywords: Tuberculosis, Cultural Competency

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.