The tuberculosis program of Catalonia's Central Health Region (1986-1993).

SETTING: Catalonia's Central Health Region antituberculosis program, which began in 1985. OBJECTIVE: To evaluate the cooperation of health staff and the program's effectiveness after 8 years. METHOD: The following data from the nominal notifications and the expanded case reports were processed: epidemiological, clinical and treatment data, each patient's end results and the outcome of the contact investigation. The implementation of the program was evaluated by means of the number of notifications and contact investigations received, and its effectiveness was assessed by the percentage of sputum smear positive cases having completed treatment. RESULTS: There was an increase in the number of patients with an expanded case report (from 74% to 100%), with a final notification (from 61% to 99%) and with contact investigation (from 29% to 79%). The sputum smear positive cases who completed the treatment after 1990 exceeded 85%. CONCLUSION: The implementation of the program in the Region's health system is good and is improving in parallel with the control of the disease.

[The tuberculin skin test in BCG-vaccinated individualse]. / La prueba de la tuberculina en los vacunados con BCG.

The aim of this study was to evaluate the tuberculin skin test in individuals vaccinated with bacillus Calmette-Guérin (BCG) using 2 IU of RT-23. One hundred ninety-six individuals aged 22-40 years-old who had been vaccinated with BCG between 1965 and 1974 were enrolled along with 375 non-vaccinated individuals of the same age and with similar level of risk of infection. The positive predictive value of the test was assessed for three levels of response as indicated by areas of thickening in three diameters: 5, 10 and 15 mm. Vaccinated individuals with negative results were given a second skin test 7 days later to detect a booster effect. Positive diameters 5 mm were observed in 66% of the vaccinated individuals and 24% of the non-vaccinated subjects. Positive diameters 10 mm were observed in 51% of the vaccinated individuals and 19% of the non vaccinated ones. Positive diameters 15 mm were observed in 29% of the vaccinated subjects and in 13% of the non vaccinated ones. The differences were significant for all diameters. The positive predictive value of the test was 36.4% for a diameter 5 mm, 37.6% for diameter 10 mm and 44.8% for diameter 15 mm. The booster effect was detected in 25.8% of the vaccinated individuals who had tested negative at first. In vaccinated individuals, no guidelines can be established to guarantee that a positive reaction is due to infection by Mycobacterium tuberculosis infection, although the likelihood of infection (increased positive predictive value) increases with diameter. It is also impossible to fix a time limit. A second skin test is needed to detect a booster effect in all vaccinated individuals whose first test is negative.

[Tuberculosis control in the Central Health Region of Catalonia during the period 1986-2000]. / El control de la tuberculosis en la Región Sanitaria Centro de Cataluña durante el período 1986-2000.

OBJECTIVE: To assess tuberculosis control in the Central Health Region, Catalonia, Spain, from the implementation of the area's Tuberculosis Control Program in 1986 until the year 2000. METHOD: To study the epidemiological profile of tuberculosis and the outcome of the following control measures in sputum smear-positive patients: final outcome of treatment and monitoring, and the percentage of patients for whom a contact investigation (CI) was carried out. Tuberculosis control is considered effective if the sum of noncompliant patients, plus the cases in which treatment failed, plus the patients transferred out remains below 10% of the cohort of patients studied, and if a CI has been conducted in at least 80% of this cohort. RESULTS: The number of cases reported was 6326, of which 7% were retreatments. A total of 5865 new cases was detected. Of these, 5652 (96%) were patients born in Spain. The number of cases reported annually peaked in 1990 (474) and then declined continuously until 2000, when it was 54% lower (220). Foreign-born patients numbered 213 (4%), and 95% of them came from countries with a high prevalence of tuberculosis. In the cohort of patients studied between 1997 and 2000, the sum of noncompliant patients, plus cases in which treatment failed, plus the patients transferred out came to 11%. Since 1994, a CI has been carried out for over 80% of patients, and this figure reached 92% in 2000. CONCLUSIONS: We consider that a substantial degree of tuberculosis control has been achieved given the decline in tuberculosis morbidity among people born in Spain, the fact that the percentage of noncompliant patients, treatment failures and transfers was only slightly over 10%, and that a CI has been conducted for over 80% of patients since 1994 (92% in 2000).

Tuberculin reactivity in Bacillus Calmette-Guérin vaccinated subjects.

SETTING: The Centre for Prevention and Control of Tuberculosis in Barcelona, Spain, where the staff appointed to Training Centers are examined. AIMS: To check for tuberculin sensitivity due to Bacillus Calmette-Guérin (BCG) vaccine and ascertain its duration. METHOD: We compared the results of a tuberculin test (TT) on vaccinated and non-vaccinated subjects. The induration diameter and the time elapsed between BCG vaccination and the TT were determined. RESULTS: Of the 2424 vaccinated subjects, 1489 (61.4%) reacted to TT (> or = 5 mm) and of the 3135 non-vaccinated, 905 (28.9%) reacted, a significant difference. Of 1978 subjects vaccinated between 6 and 14 years of age, 63.3% were TT reactors, compared to 23.9% of the 1948 non-vaccinated. Induration diameters > or = 15 mm amounted to 11% for vaccinated subjects and 8% for those not vaccinated, a significant difference. The time from vaccination to TT was 13-25 years. Of the 446 subjects vaccinated at birth, 237 were reactors (53.1%); of the 887 non-vaccinated subjects of the same age, 154 (17.4%) reacted. Reactors > or = 15 mm amounted to 40 (9%) for vaccinated subjects and 46 for non-vaccinated (5.2%), a significant difference. The time elapsed between vaccination and TT was 20-25 years. For 124 vaccinated subjects with a previous negative TT, a second test was positive for 87 (70.2%), and for 257 non-vaccinated it was positive for 64 (24.9%). The difference is due to a booster effect. CONCLUSIONS: BCG vaccination at birth and for school age children causes a reactivity to tuberculin which persists for 20 to 25 years. An induration diameter of > or = 15 mm does not exclude a vaccinal origin. For vaccinated subjects with a previous negative TT, it is necessary to exclude the booster effect.

El control de la tuberculosis en la Región Sanitaria Centro de Cataluña durante el período 1986-2000 / Tuberculosis control in the central Health Region of Catalonia during the period 1986-2000

OBJETIVO: Valorar el control de la tuberculosis en la Región Sanitaria Centro de Cataluña desde el inicio de su Programa de la Tuberculosis en 1986 hasta 2000. MÉTODO: Estudio de la evolución epidemiológica de la tuberculosis y el resultado de las siguientes medidas de control en los enfermos con baciloscopia de esputo positiva: resultado final de su seguimiento y tratamiento y porcentaje de enfermos con estudio de contactos (EC).Se considera que el control de la tuberculosis es correcto cuando la suma de no cumplidores del tratamiento, fracasos terapéuticos y traslados no supera el 10 por ciento de la cohorte de enfermos estudiados y si se ha realizado el EC en, al menos, el 80 por ciento de estos enfermos. RESULTADOS: El número de enfermos declarados fue de 6.326, y el porcentaje de retratamientos, del 7 por ciento. Se encontraron 5.865 casos nuevos. La cifra de los pacientes nacidos en España fue de 5.652 (96 por ciento) y el año 1990 fue en el que se presentaron más notificaciones (474) con descenso continuado del 54 por ciento hasta 2000 (220). La cifra de los pacientes nacidos fuera de España fue de 213 (4 por ciento), de los que el 95 por ciento procedía de países de alta prevalencia tuberculosa. En la cohorte de enfermos de 1997-2000, la tasa de no cumplidores, traslados y fracasos fue del 11 por ciento. En cuanto a los enfermos con EC, desde 1994 se venía superando el 80 por ciento hasta alcanzar el 92 por ciento en 2000. CONCLUSIONES: Dada la tendencia descendente de la morbilidad tuberculosa en los nacidos en España, la muy discreta elevación por encima del 10 por ciento de no cumplidores, traslados y fracasos y haber superado el 80 por ciento de enfermos con EC desde 1994 hasta alcanzar el 92 por ciento en 2000, consideramos que se ha logrado un notable grado de control de la tuberculosis (AU)