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

Abstract #111924

Geoffrey R. Swain, MD, MPH¹, Paul Biedrzycki, MPH, MBA¹, Angela M. Hagy, MSPH¹, Irmine Reitl, RN, MSN², David Campbell, BS RS¹, Douglas Gieryn, BS, RS³, and Frederick A. Radmer, MPH¹. (1) City of Milwaukee Health Department, 841 N. Broadway, 3rd Floor, Milwaukee, WI 53202-3653, 414-286-8172, gswain@milwaukee.gov, (2) TB Control Clinic, City of Milwaukee Health Department, 3200 N. 36th Street, Room 304, Milwaukee, WI 53216-3716, (3) Winnebago County Health Department, 725 Butler Avenue, PO Box 68, Winnebago, WI 54985-0068

Investigation of TB cases in certain settings can be particularly challenging for LPHAs from the perspective of environmental and epidemiologic assessment, follow-up, and risk communication. The City of Milwaukee Health Department (MHD) conducted an extensive investigation and intervention associated with a case of active tuberculosis (TB) in a faculty member at a local university.

MHD's case investigation revealed that re-activation of prior TB in the faculty member resulted in unanticipated risk for significant student exposure. A comprehensive joint environmental assessment involved examination of air handling system efficacy and air-exchange rates. Case-contact exposure assessment considered symptom presence, duration of contact, and physical proximity to the index case. Based on both assessment outcomes, an on-site clinic was established by the MHD and university Student Health Services to provide counseling and skin testing for students, employees and faculty identified as being at risk for TB exposure.

Exposed students (n=104) had skin test positivity rates of 21-44% (well above the 2-3% expected). Skin test positivity among faculty and employees was less than 4%. There was no evidence of secondary transmission, and no additional active cases were identified or epidemiologically linked to the index case. Case-contact counseling, follow-up skin testing, radiographic examination and prophylactic therapy were offered to all at-risk individuals. Appropriate and timely risk communication for students, parents and the media was essential to assuring an effective response in this particular setting.

LPHAs should carefully consider the environmental context and other influences that may substantially affect the follow-up of TB case contacts.

Learning Objectives:

• -Describe LPHA case-contact investigative methods employed in context of scenario
• -Describe environmental factors influencing tuberculosis exposure in context of scenario
• -Describe LPHA response measures in context of scenario
• -Describe risk communication strategy and delivery in context of scenario

Keywords: Tuberculosis, Environment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation