Universal Tuberculosis Screening in Pregnancy

ABSTRACT

We reviewed our practice of universal tuberculosis (TB) screening in an at-risk pregnant population with regards to utility and patient compliance. The Gouverneur Healthcare Services prenatal database was analyzed for compliance with TB screening. Age, ethnicity, country of origin, and education level were also analyzed. Of 4049 patients, 95.0% were compliant with their purified protein derivative (PPD) testing. Universal screening identified 1935 (50.4%) PPD+ patients, with chest X-rays (CXR) available for 95.1%. Only one patient had a CXR consistent with active TB, although sputum testing was negative for acid-fast bacilli. Asian women were more likely to be PPD-compliant (adjusted odds ratio [aOR]: 4.94, 95% confidence interval [CI]: 2.34 to 10.45). Similarly, PPD+ Asian women were more likely to be compliant with CXR (aOR: 12.67, 95% CI: 3.44 to 46.7). U.S.-born women were significantly less likely to be compliant with PPD (aOR: 0.44, 95% CI: 0.30 to 0.64) or with CXR (aOR: 0.22, 95% CI: 0.08 to 0.61). Universal prenatal TB screening is associated with excellent compliance rates and is an effective way to identify a high prevalence of latent TB, but not active disease.

KEYWORDS

Tuberculosis screening - latent tuberculosis - PPD

REFERENCES

• 1 Centers for Disease Control and Prevention .Reported tuberculosis in the United States, 2004. Atlanta, GA; U.S. Department of Health and Human Services, CDC 2005 Available at http://www.cdc.gov/nchstp/tb/surv/surv2004/default.htm
• 2 Bureau of Tuberculosis Control .TB-Annual Report. New York; NYC Department of Health and Mental Hygiene 2004 Available at: http://home2.nyc.gov/html/doh/downloads/pdf/tb/tb2004.pdf
• 3 U.S. Department of Health and Human Services .Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC; U.S. Government Printing Office 2000
• 4 Centers for Disease Control and Prevention . Trends in tuberculosis—United States, 2005.  MMWR Morb Mortal Wkly Rep. 2006;  55 305-308
• 5 Medchill M T. Prenatal purified protein derivative skin testing in a teaching clinic with a large Hispanic population.  Am J Obstet Gynecol. 1999;  180 1579-1583
• 6 Cruz C A, Caughey A B, Jasmer R. Postpartum follow-up of a purified protein derivative (PPD) among an indigent population.  Am J Obstet Gynecol. 2005;  192 1455-1457
• 7 American Thoracic Society, Centers for Disease Control . Targeted tuberculin testing and treatment of latent tuberculosis infection.  Am J Respir Crit Care Med. 2000;  161 S221-S24
• 8 Guidelines for Perinatal Care. 6th ed. 2007 American Academy of Pediatrics, Elk Grove Village, IL American College of Obstetrics and Gynecologists, Washington, DC
• 9 Bergeron K G, Bonebrake R G, Gray C J. Tuberculosis in pregnancy: current recommendations for screening and treatment in the United States.  Expert Rev Anti Infect Ther. 2004;  2 589-598
• 10 Boggess K A, Myers E R, Hamilton C D. Antepartum or postpartum isoniazid treatment of latent tuberculosis infection.  Obstet Gynecol. 2000;  96 757-762
• 11 Franks A L, Binkin N J, Snider D E et al.. Isoniazid hepatitis among pregnant and postpartum Hispanic patients.  Public Health Rep. 1989;  104 151-155
• 12 Frieden T R, Sbarbaro J A. Promoting adherence to treatment for tuberculosis: the importance of direct observation.  Bull World Health Organ. 2007;  85 407-409
• 13 Nyamathi A, Nahid P, Berg J et al.. Efficacy of nurse case-managed intervention for latent tuberculosis among homeless subsamples.  Nurs Res. 2008;  57 33-39
• 14 Jakubowiak W M, Bogorodskaya E M, Borisov S E, Danilova I D, Lomakina O B, Kourbatova E V. Social support and incentives programme for patients with tuberculosis: experience from the Russian Federation.  Int J Tuberc Lung Dis. 2007;  11 1210-1215
• 15 Thiam S, LeFevre A M, Hane F et al.. Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial.  JAMA. 2007;  297 380-386
• 16 Janmeja A K, Das S K, Bhargava R, Chavan B S. Psychotherapy improves compliance with tuberculosis treatment.  Respiration. 2005;  72 375-380
• 17 Collinson S. Payment for treatment adherence.  BMJ. 2007;  335 317
• 18 Nolan C M, Goldberg S V, Buskin S E. Hepatotoxicity associated with isoniazid preventive therapy: a 7-year survey from a public health tuberculosis clinic.  JAMA. 1999;  281 1014-1018
• 19 Lardizabal A, Passannante M, Kojakali F, Hayden C, Reichman L B. Enhancement of treatment completion for latent tuberculosis infection with 4 months of rifampin.  Chest. 2006;  130 1712-1717
• 20 Page K R, Sifakis F, Montes de Oca R et al.. Improved adherence and less toxicity with rifampin vs isoniazid for treatment of latent tuberculosis: a retrospective study.  Arch Intern Med. 2006;  166 1863-1870
• 21 Cook P P, Maldonado R A, Yarnell C T, Holbert D. Safety and completion rate of short-course therapy for treatment of latent tuberculosis infection.  Clin Infect Dis. 2006;  43 271-275