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

Abstract #122088

Rana Jawad Asghar, MD, MPH¹, David E. Patlan, BA², Joseph Abellard, MD², Nitin Kapur, BA³, Mark Miner, BA⁴, Jamal Spurlock, BA², Juanita Morris Ford, BA², Halsey D. Rhodes, BS⁵, David Beall, PhD⁵, Michael Fraser, BA¹, Solages Anthony, MD², Emma B. Simmonds, MD², Dolly Katz, PhD¹, and John Oeltmann, PhD¹. (1) Division of Tuberculosis Elimination / NCHSTP (CDC), 1600 Clifton Road, Atlanta, GA 30329, 404-639-5313, bvv9@cdc.gov, (2) Miami-Dade County Health Department, 1350 NW 14 Street, Miami, FL 33125, (3) Office of Minority Health, CDC, 1600 Clifton Road, Atlanta, GA 30329, (4) Maryland Department of Health and Mental Hygiene, 201 W Preston St., Baltimore, MD 21201, (5) Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL 32399

Background: Illicit drug users present challenges to tuberculosis (TB) control. Named contacts (persons named by the TB patient) are the focus of TB contact investigations and receive high priority for screening. Between January 2004 and May 2005, eighteen isoniazid-resistant TB cases with matching spoligotypes were identified in Miami. An investigation began in July 2005 to identify contacts to these patients. Methods: We reviewed medical records and interviewed patients to find named contacts and locations. Observed contacts were those who were not named, but were encountered at the same crack house frequented by patients. Contacts were evaluated for latent TB infection with a tuberculosis skin test (TST). Results: All 18 case-patients had pulmonary TB, 15 (83%) had positive sputum smears for acid-fast bacilli. Twelve (67%) reported crack use and 14 (82%) illicit drug use. We evaluated 187 contacts. Of these, 91 (49%) were named, 16 (8%) were screened at a church named by a patient, 61 (33%) were screened at a dialysis center named by a patient and 19 (10%) were observed contacts. Compared to named contacts, individuals at named locations (dialysis center, church) had no elevated risk of a positive TST result (RR 1.1 CI 0.4-3.0 & RR: 1.4 CI 0.3-6.1 respectively). Compared to named contacts, observed contacts were eight times as likely to have positive TST results (RR 7.8 CI 3.8-16.1). Conclusions: Among illicit drug users, traditional name-based contact investigations may yield relatively low-priority contacts and miss high-priority contacts that can be identified by observing who attends common locations.

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