High annual risk of tuberculosis infection among nursing students in South India: a cohort study.
BACKGROUND
Nurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort.


RESULTS
436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3-12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort.


CONCLUSIONS
Our study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.
Christian Medical College, Vellore, India.
Devasahayam J
DJ
Christopher
Prince
P
James
Peter
P
Daley
Lois
L
Armstrong
Barney T J
BT
Isaac
Balamugesh
B
Thangakunam
Beulah
B
Premkumar
Alice
A
Zwerling
Madhukar
M
Pai
D015331:Cohort Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D013338:Students, Nursing / Q000706:statistics & numerical data*; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult