Attitudes about tuberculosis prevention in the elimination phase: a survey among physicians in Germany.
BACKGROUND
Targeted and stringent measures of tuberculosis prevention are necessary to achieve the goal of tuberculosis elimination in countries of low tuberculosis incidence.


METHODS
We ascertained the knowledge about tuberculosis risk factors and stringency of tuberculosis prevention measures by a standardized questionnaire among physicians in Germany involved in the care of individuals from classical risk groups for tuberculosis.


RESULTS
510 physicians responded to the online survey. Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany. Exposure to a patient with tuberculosis ranked on the 10th position. In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.


CONCLUSIONS
A remarkably low proportion of individuals with latent infection with Mycobacterium tuberculosis belonging to classical risk groups for tuberculosis are considered candidates for preventive chemotherapy in Germany. Better knowledge about the risk for tuberculosis in different groups and more stringent and targeted preventive interventions will probably be necessary to achieve tuberculosis elimination in Germany.
Division of Clinical Infectious Diseases, German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany; Department of Psychosomatic Medicine, Sachsenklinik, Bad Lausick, Germany.
Christian
C
Gutsfeld
Division of Clinical Infectious Diseases, German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany.
Ioana D
ID
Olaru
Institute of Medical Informatics and Statistics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Oliver
O
Vollrath
Division of Clinical Infectious Diseases, German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia; Department of Medicine, Karolinska Institute, Stockholm, Sweden.
Christoph
C
Lange
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001290:Attitude; D060085:Coinfection; D003625:Data Collection / Q000706:statistics & numerical data; D060740:Disease Eradication / Q000458:organization & administration*; D005260:Female; D005858:Germany; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010820:Physicians / Q000523:psychology*; D012307:Risk Factors; D014171:Transients and Migrants; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha