Multistate outbreak of MDR TB identified by genotype cluster investigation.

In 2008, diagnosis and investigation of 2 multidrug-resistant tuberculosis cases with matching genotypes led to identification of an outbreak among foreign-born persons who performed short-term seafood production work in Alaska during 2006. Tuberculosis control programs should consider the possibility of domestic transmission even among foreign-born patients.

Screening for Mycobacterium tuberculosis using an interferon-gamma release assay.

CONTEXT: The Centers for Disease Control and Prevention recommend analyzing characteristics of populations screened for Mycobacterium tuberculosis infection using interferon-gamma release assays (IGRAs). OBJECTIVE: We characterized requests for IGRA analyses submitted to the first laboratory in Washington State that began to offer IGRAs as a tuberculosis screening test. In addition, we chronicled the process by which this program was launched. DESIGN: Through a retrospective record review we recorded the IGRA results, source of the request, and reason(s) for each request along with demographic information, risk factors, and prior exposure for each subject. Through dissemination and quality control measures, IGRA analyses began within the health district but quickly spread throughout the state and the West. SETTING AND PARTICIPANTS: A regional health district clinical laboratory in the Pacific Northwest received 4422 IGRA requests for 4218 unique subjects from January 2, 2008, through June 5, 2009. RESULTS: Most (96%) requests originated from public health clinics or centers, hospitals, private laboratories or practitioners, and Indian Health Centers. Community and migrant health centers had the highest rates of positive IGRA results (28%, Φc = 0.159, P = .000). About one-half of all requests were for employment or high-risk surveillance. Persons with a positive IGRA had a larger TST induration (M = 16.66 mm, 95% CI: 15.18-18.14) than those with a negative IGRA (M = 13.53 mm, 95% CI: 12.92-14.15) but did not differ for those with an indeterminate IGRA (M = 13.29 mm, 95% CI: 5.95-20.62). CONCLUSIONS: Public and private agencies use IGRAs for surveillance of persons employed, routinely screened, at high risk, or foreign-born. The TST induration varies widely for persons with an indeterminate IGRA. The process for implementing IGRA analyses serves as a model for other programs seeking to conduct similar reviews of test use and results.

Educational competencies to strengthen tuberculosis curricula in undergraduate nursing programs.

Worldwide, at least two million people die annually from tuberculosis (TB), with projections of 36 million more global deaths between the years 2003 and 2020. To help nursing faculty strengthen TB curricula and standardize TB content in national and international undergraduate nursing programs, the Nurse Discipline Group of the National Tuberculosis Curriculum Consortium (NTCC) has developed comprehensive TB core competencies and specific student objectives for the classroom setting. These core competencies address the knowledge, ability, and/or skills required for an undergraduate nursing student to provide qualified holistic care for patients, families, and communities impacted by TB. The NTCC is comprised of a team of multidisciplinary health care educators in the United States, with the primary mission to instill knowledge, skills, and appropriate attitudes in the management of active and latent TB among undergraduate health care students.

Clinical nurse specialists and nurse practitioners: complementary roles for infectious disease and infection control.

BACKGROUND: The escalation of infectious diseases worldwide heralds an unprecedented need for nurses with advanced practice graduate preparation. OBJECTIVE: To describe how a graduate program prepares clinical nurse specialists and nurse practitioners in infectious diseases or infection control to provide distinct yet complementary care for patients with contagious disease and potentially antimicrobial-resistant infections. RESULTS: The University of Washington School of Nursing launched a new master of nursing program for infectious disease and infection control to reduce the threat of infectious diseases and multiple-resistant organisms.

Quantitative and qualitative QuantiFERON(®)-TB gold in-tube results among groups with varying risks of exposure to tuberculosis.

OBJECTIVE: We sought to describe qualitative and borderline quantitative QuantiFERON(®)-TB Gold In-Tube (QFT-IT; Cellestis, Valencia, CA) results among persons screened in the context of routine reasons, employment, contact investigation, high-risk foreign-born arrivals in the United States ≤ 5 years, and high-risk United States residents >5 years. METHODS: We performed a retrospective review of 3288 QFT-IT results from a clinical laboratory in the Pacific Northwest from January 2, 2008 to June 5, 2009. Interferon-γ (IFN-γ) responses were quantified as low, borderline, or high for tuberculosis (TB) antigens (IFN-γ [TB]) and a positive mitogen control (IFN-γ [mitogen]), after subtracting a background control (IFN-γ [nil]). Qualitative results were categorized as negative, positive, or indeterminate. RESULTS: Quantitative values categorized as borderline, well above, or well below the cut-point were associated with qualitative results for IFN-γ (TB-nil) (χ(2) = 2913.178, degrees of freedom [df] = 4, P < .001) and IFN-γ (mitogen-nil) values (χ(2) = 2559.758, df = 4, P < .001). CONCLUSION: Quantitative data enhance the interpretation of qualitative QFT-IT results for persons with varying risks of exposure.