title: Skin-test screening and tuberculosis transmission among the homeless.
abstract: We describe the implementation of a mandatory tuberculosis (TB) screening program that uses symptom screening and tuberculin skin testing in homeless shelters. We used the results of DNA fingerprinting of Mycobacterium tuberculosis isolates to evaluate the effect of the program on TB incidence and transmission. After the program was implemented, the proportion of cases among homeless persons detected by screening activities increased, and the estimated TB incidence decreased from 510 to 121 cases per 100000 population per year. Recent transmission, defined by DNA fingerprinting analysis as clustered patterns occurring within 2 years, decreased from 49% to 14% (p=0.03). Our results suggest that the shelter-based screening program decreased the incidence of TB by decreasing its transmission among the homeless.
authors.affiliation: Denver Public Health, Denver, Colorado, USA. pmkong@singnet.com.sg
authors.forename: Po-Marn
authors.initials: PM
authors.lastname: Kong
authors.forename: Jan
authors.initials: J
authors.lastname: Tapy
authors.forename: Patricia
authors.initials: P
authors.lastname: Calixto
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
authors.forename: Randall R
authors.initials: RR
authors.lastname: Reves
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Yang
authors.forename: M Donald
authors.initials: MD
authors.lastname: Cave
mesh_terms: D003120:Colorado / Q000453:epidemiology; D016172:DNA Fingerprinting; D006703:Ill-Housed Persons; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012307:Risk Factors; D013997:Time Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*