title: Tuberculosis among urban health care workers: a study using restriction fragment length polymorphism typing.
abstract: Cases of tuberculosis identified during 1992-1994 through an active tuberculosis surveillance network among six hospitals that serve New York City (the TBNetwork) were analyzed according to the occupational status of the patients. Clinical data were obtained by review of medical records, and restriction fragment length polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates was performed. No known nosocomial outbreaks of tuberculosis occurred at these hospitals in the study period. Occupational status was known for 142 of 201 patients whose isolates were available for strain typing. Patients infected by organisms with a clustered strain typing pattern, as determined by RFLP analysis, were presumed to have recently acquired disease. RFLP typing revealed that isolates from 13 (65%) of 20 health care workers and 50 (41%) of 122 non-health care workers had a clustered RFLP pattern. The strains infecting eight (89%) of nine health care workers seropositive for human immunodeficiency virus (HIV) had a clustered RFLP pattern. Multivariate analysis of 75 patients with known HIV and occupational status revealed that HIV status (P = .03) and health care worker status (P = .02; RR = 2.77) were independent risk factors for a clustered RFLP strain. These findings suggest that many of the apparently sporadic cases of tuberculosis among health care workers may be due to unrecognized occupational transmission.
authors.affiliation: Division of Infectious Diseases, Cornell University Medical College, New York, New York, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Sepkowitz
authors.forename: C R
authors.initials: CR
authors.lastname: Friedman
authors.forename: A
authors.initials: A
authors.lastname: Hafner
authors.forename: D
authors.initials: D
authors.lastname: Kwok
authors.forename: S
authors.initials: S
authors.lastname: Manoach
authors.forename: M
authors.initials: M
authors.lastname: Floris
authors.forename: D
authors.initials: D
authors.lastname: Martinez
authors.forename: K
authors.initials: K
authors.lastname: Sathianathan
authors.forename: E
authors.initials: E
authors.lastname: Brown
authors.forename: J J
authors.initials: JJ
authors.lastname: Berger
mesh_terms: D000328:Adult; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000382:microbiology; D012150:Polymorphism, Restriction Fragment Length; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D014505:Urban Population