title: Preventing tuberculosis transmission at a maternity hospital by targeted screening radiography of migrants.
abstract: BACKGROUND
  Israel has been the destination of large numbers of illegal migrants from East African countries in recent years. Despite efforts to detect and treat active tuberculosis (TB) at the border, 75% of all active TB cases diagnosed in our hospital were illegal migrants. In 2012, there was a large-scale TB exposure in our maternity ward, neonatal, and paediatric intensive care units following the admission of an infectious but apparently asymptomatic migrant who was in labour. A hospital-wide screening programme was subsequently implemented to prevent exposure of patients and staff to TB.
  
  
  OBJECTIVE
  To report the results of the first year of this intervention in the maternity hospital.
  
  
  METHODS
  All illegal migrants from countries where TB is highly prevalent were screened by chest radiography (CR) upon admission to the maternity hospital. The results were immediately categorized by a radiologist as either 'suggestive of active pulmonary TB' or 'non-suggestive'. Patients with CR suggestive of TB were placed in airborne isolation and underwent further evaluation.
  
  
  RESULTS
  Four hundred and thirty-one apparently asymptomatic migrant women underwent CR screening. Most (363, 84%) presented in labour. Eleven women (2.6%) had a CR suggestive of active pulmonary TB which was confirmed in three (0.7% of screened women). No TB cases were missed by the CRs. Neither patients nor hospital staff were exposed to TB.
  
  
  CONCLUSIONS
  Targeted CR screening for TB among high-risk women upon their admission to a maternity hospital had a high yield and was an effective strategy to prevent in-hospital transmission of TB.
authors.affiliation: Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: vereds@tlvmc.gov.il.
authors.forename: V
authors.initials: V
authors.lastname: Schechner
authors.affiliation: Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J B
authors.initials: JB
authors.lastname: Lessing
authors.affiliation: Department of Pediatrics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Grisaru-Soen
authors.affiliation: Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Braun
authors.affiliation: Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Abu-Hanna
authors.affiliation: Department of Epidemiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: Department of Radiology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Aviram
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods; D000995:Antitubercular Agents / Q000627:therapeutic use; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007538:Isoniazid / Q000627:therapeutic use; D007557:Israel / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010356:Patient Isolation; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D011859:Radiography; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000635:transmission
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid
keywords: Israel; Migrants; Radiography; Screening; Tuberculosis