Abstract
Background: The homeless are at very high risk of suffering tuberculosis (TB). The aims of this study were to determine the prevalence and risk factors for tuberculosis infection and disease among the homeless in Barcelona and to evaluate the roles of case finding and contact investigation. Methods: Observational prevalence study carried out between 1997 and 1998. Participants: 447 homeless patients (394 men and 53 women) were evaluated before admission to shelters and free-meal services. At the same time, 48 co-residents with smear-positive TB patients in 2 long-term shelters were evaluated too. A chest X-ray and Tuberculin Skin Test were performed on all subjects. Sputum smears were processed by the Ziehl–Neelsen and Löwenstein–Jensen procedures in patients with radiographic findings consistent with pulmonary TB. Results: Of the 447 homeless examined, 335 (75%) were infected with Mycobacterium tuberculosis. Active pulmonary TB was diagnosed in five persons (1.11%), and 62 (13.8%) had radiographic evidence of inactive pulmonary TB. Tuberculosis infection was associated with age and smoking, but not with sex or alcohol abuse. No significant differences in infection rates were found between the main group and 48 homeless co-residents of smear-positive subjects. Only 16.9% of the homeless with active TB in Barcelona in the same period were diagnosed through active case-finding, the remainder being mainly detected in hospitals (69.8%) and other several centres (13.3%). Conclusions: Homeless individuals have a very high risk of TB infection and disease and contact investigation requires specific methods for them. Programmes of screening and supervised treatment should be ensured in this group.
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References
Centres for Disease Control. Prevention and control of tuberculosis among homeless persons. Recommendations of the advisory Council for the Elimination of Tuberculosis. MMWR 1992; 41/No RR-5.
Zolopa AR, Hahn J, Gorter R, et al. HIV and tuberculosis infection in San Francisco's homeless adults. JAMA 1994; 272: 455–461.
Frieden TR, Woodley CL, Crawford JT, Lew D, Doodley SM. The molecular epidemiology of tuberculosis in New York City: The importance of nosocomial transmission and laboratory error. Tubercle and Lung Dis 1996; 77: 407–413.
Buskin S, Gale J, Weis N, Nolan Ch. Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990. American Journal of Public Health 1994; 84(11): 1750–1756.
Altisent R, Cordoba R, Martín-Moros JM. Criterios operativos para la definición del alcoholismo. Med Clin (Barc) 1992; 99: 584–588.
American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990; 142: 725–735.
Grupo de trabajo sobre tuberculosis. Consenso nacional para el control de la tuberculosis en España. Med Clin (Barc) 1992; 98: 24–31.
Centers for Disease Control. Tuberculosis among homeless shelter residents. JAMA 1992; 267: 483–484.
Schluger NW, Huberman R, Holzman R, Rom WN, Cohen DI. Screening for infection and disease as a tuberculosis control measure among indigents in New York City, 1994–1997. Int J Tuberc Lung Dis 1999; 3: 281–286.
Diez M for the MPTR Study Group. Incidence of tuberculosis in Spain: Preliminary results from the Multicenter Project for TB Research (MPTR). Int J Tuberc Lung Dis 1998; 2(Suppl 2): 200–201.
Martin V, Gonzalez P, Caylà JA, et al. Case-finding of pulmonary tuberculosis on admission to a penitentiary centre. Tubercle and Lung Dis 1994; 74: 49–53.
Jansà M, Serrano J, Caylà JA, Vidal R, Ocaña I, Español T. Influence of the human immunodeficiency virus in the incidence of tuberculosis in a cohort of intravenous drug users: Effectiveness of anti-tuberculosis chemoprofilaxis. Int J Tuberc Lung Dis 1998; 2(2): 140–146.
Galdós-Tangüis H, Caylà JA, Jansà JM, García de Olalla P, Brugal T, Cortés PJ. La tuberculosi a Barcelona. Informe de 1996. Publicaciones del Institut Municipal de la Salut, Barcelona 1997.
Altet MN, Alcaide J, Plans P, et al. Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study. Tubercle and Lung Dis 1996; 77: 537–544.
Puigpinós R, Sanchez M, Borrell C, et al. La salut de la població sense sostre a la ciutat de Barcelona. Publicacions de l'Institut Municipal de la Salut, Barcelona 1998.
Capewell S, France AJ, Anderson M, Gordon A. The diagnosis and management of tuberculosis in common hostel dwellers. Tubercle and Lung Dis 1986; 67(2): 125–131.
Ellen A, Ferson L, Ferson M. Surveillance for tuberculosis among residents of hostels for homeless men. Australian and New Zealand J Public Health 1997; 21: 447–450.
Grybowsky S. Epidemiology of tuberculosis and the role of BCG. Clinic Chest Med 1980; 1: 175–187.
Menzies R, Veen J. How should contact investigations be conducted in special settings/populations? Symposium summary on investigation of contacts to tuberculosis cases. New-York: New York City Department of Health, Bureau of Tuberculosis Control, 1996, pp. 45–49.
Pilote L, Jacqueline P, Tulsky P, et al. Tuberculosis prophylaxis in the homeless. Arch Intern Med 1996; 156: 161–165.
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Solsona, J., Caylà, J., Nadal, J. et al. Screening for tuberculosis upon admission to shelters and free-meal services. Eur J Epidemiol 17, 123–128 (2001). https://doi.org/10.1023/A:1017580329538
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DOI: https://doi.org/10.1023/A:1017580329538