Jennifer L Merte1, Catherine M Kroll, Amy S Collins, Alan L Melnick. 1. Ms. Merte was a Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Fellow, Clark County Public Health, Vancouver, Wash., when this article was written. She now is a public health analyst, U.S. Public Health Service, Washington, D.C.
Abstract
BACKGROUND: The authors describe an investigation of a dental hygienist who developed active pulmonary tuberculosis (TB), worked for several months while infectious and likely transmitted Mycobacterium tuberculosis in a dental setting in Washington state. METHODS: Clark County Public Health (CCPH) conducted an epidemiologic investigation of 20 potentially exposed close contacts and 734 direct-care dental patients in 2010. RESULTS: Of 20 close contacts, one family member and two coworkers, all of whom were from countries in which TB is endemic, had latent TB infection (LTBI). One U.S.-born coworker experienced a tuberculin skin test (TST) conversion from 0 to 8 millimeters. Of the 305 of 731 (41.7 percent) potentially exposed patients who received a single TST, 23 (7.5 percent) had a positive TST result of at least 5 mm. Among the subset of 157 patients tested by CCPH staff, 16 (10.2 percent) had a positive TST result. The dental office did not have infection prevention and control policies related to TB identification, prevention or education. CONCLUSIONS: The coworker's TST conversion indicated a recent infection, likely owed to occupational transmission. The proportion of dental patients with positive TST results was greater than the 1999-2000 National Health and Nutrition Examination Survey prevalence estimate in the general population, and it may reflect transmission from the hygienist with active TB or a prevalence of LTBI in the community. Practical Implications All dental practices should implement administrative procedures for TB identification and control as described in this article, even if none of their patients are known to have TB.
BACKGROUND: The authors describe an investigation of a dental hygienist who developed active pulmonary tuberculosis (TB), worked for several months while infectious and likely transmitted Mycobacterium tuberculosis in a dental setting in Washington state. METHODS: Clark County Public Health (CCPH) conducted an epidemiologic investigation of 20 potentially exposed close contacts and 734 direct-care dental patients in 2010. RESULTS: Of 20 close contacts, one family member and two coworkers, all of whom were from countries in which TB is endemic, had latent TB infection (LTBI). One U.S.-born coworker experienced a tuberculin skin test (TST) conversion from 0 to 8 millimeters. Of the 305 of 731 (41.7 percent) potentially exposed patients who received a single TST, 23 (7.5 percent) had a positive TST result of at least 5 mm. Among the subset of 157 patients tested by CCPH staff, 16 (10.2 percent) had a positive TST result. The dental office did not have infection prevention and control policies related to TB identification, prevention or education. CONCLUSIONS: The coworker's TST conversion indicated a recent infection, likely owed to occupational transmission. The proportion of dental patients with positive TST results was greater than the 1999-2000 National Health and Nutrition Examination Survey prevalence estimate in the general population, and it may reflect transmission from the hygienist with active TB or a prevalence of LTBI in the community. Practical Implications All dental practices should implement administrative procedures for TB identification and control as described in this article, even if none of their patients are known to have TB.
Authors: Jennifer L Cleveland; Shellie Kolavic Gray; Jennifer A Harte; Valerie A Robison; Anne C Moorman; Barbara F Gooch Journal: J Am Dent Assoc Date: 2016-05-24 Impact factor: 3.634
Authors: Darya Dabiri; Samuel Richard Conti; Niloufar Sadoughi Pour; Andrew Chong; Shaahin Dadjoo; Donya Dabiri; Carol Wiese; Joyce Badal; Margaret Arleen Hoogland; Heather Raquel Conti; Travis Roger Taylor; George Choueiri; Omid Amili Journal: Front Dent Med Date: 2021-09-29