Tuberculin skin test conversion among medical students at a teaching hospital in Rio de Janeiro, Brazil.
OBJECTIVE
To describe the cumulative incidence of and risk factors for tuberculosis (TB) infection among medical students.


METHODS
In 1999, a cohort study of medical students with negative results (induration < 10 mm) on tuberculin skin test (TST) was performed. Students who had undergone two-step testing in 1998 were retested.


METHODS
University and teaching hospital and referral center for TB and acquired immunodeficiency syndrome, and the Health Sciences Building of the Medical School of the Federal University of Rio de Janeiro, Brazil.


METHODS
A sample of 618 consecutive medical students with negative TST results who had been tested 12 months before were approached. Information about sociodemographic characteristics, bacille Calmette-Guérin vaccination history, and potential exposures to TB was obtained using a standardized questionnaire. Four hundred fourteen (67%) students completed the study. Students were at two different levels of their training programs (juniors = no contact with patients; seniors = intensive contact with patients).


RESULTS
Of 414 participants, 16 (3.9%; 95% confidence interval, 1.06% to 12.1%) had converted to a positive reaction after 1 year. In a multivariate logistic regression analysis, higher level of clinical training was confirmed to be an independent factor associated with TST conversion (odds ratio, 4.77; 95% confidence interval, 1.01 to 22.46; P= .048).


CONCLUSIONS
Senior medical students are at increased risk of Mycobacterium tuberculosis infection in this setting. Therefore, a program of routine tuberculin skin testing and specific TB infection control guidelines are needed for this population.
Silva
Vania M C
VM
Hospital Universitário Clementino Fraga Filho, Dept Clinica Medica, Rio de Janeiro, Brazil.
Cunha
Antonio Jose Ledo A
AJ
Kritski
Afranio L
AL
D000328:Adult; D001500:BCG Vaccine / Q000008:administration & dosage; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000592:standards; D008297:Male; D016273:Occupational Exposure / Q000706:statistics & numerical data; D012307:Risk Factors; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D000078329:Workforce
D001500:BCG Vaccine