Journal Article

Nursing and Community Rates of <i>Mycobacterium tuberculosis</i> Infection among Students in Harare, Zimbabwe

Elizabeth L. Corbett, Joyce Muzangwa, Kathryn Chaka, Ethel Dauya, Yin Bun Cheung, Shungu S. Munyati, Andrew Reid, James Hakim, Steven Chandiwana, Peter R. Mason, Anthony E. Butterworth and Stan Houston

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 3, pages 317-323
Published in print February 2007 | ISSN: 1058-4838
Published online February 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/509926
Nursing and Community Rates of Mycobacterium tuberculosis Infection among Students in Harare, Zimbabwe

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Background.African hospitals have experienced major increases in admissions for tuberculosis, but they are ill-equipped to prevent institutional transmission. We compared institutional rates and community rates of tuberculin skin test (TST) conversion in Harare, Zimbabwe

Methods.We conducted a cohort study of TST conversion 6, 12, and 18 months into training among 159 nursing and 195 polytechnic school students in Harare. Students had negative TST results (induration diameter, ≤9 mm) with 2-step testing at the start of training.

Results.Nursing students experienced 19.3 TST conversions (increase in induration diameter, ⩾10 mm) per 100 person-years (95% confidence interval [CI], 14.2–26.2 conversions per 100 person-years), and polytechnic school students experienced 6.0 (95% CI, 3.5–10.4) conversions per 100 person-years. The rate of difference was 13.2 conversions (95% CI, 6.5–20.0) per 100 person-years. With a more stringent definition of conversion (increase in the induration diameter of ⩾10 mm to at least 15 mm), which is likely to increase specificity but decrease sensitivity, conversion rates were 12.5 and 2.8 conversions per 100 person-years in nursing and polytechnic school students, respectively (rate difference, 9.7 conversions per 100 person-years; 95% CI, 4.5–14.8 conversions per 100 person-years). Nursing students reportedly nursed 20,868 inpatients with tuberculosis during 315 person-years of training.

Conclusions.Both groups had high TST conversion rates, but the extremely high rates among nursing students imply high occupational exposure to Mycobacterium tuberculosis. Intense exposure to inpatients with tuberculosis was reported during training. Better prevention, surveillance, and management of institutional M. tuberculosis transmission need to be supported as part of the international response to the severe human immunodeficiency virus infection epidemic and health care worker crisis in Africa.

Journal Article.  3642 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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