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Tuberculosis Prevention and Control Program |
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Despite efforts to control tuberculosis (TB) this infectious disease remains a major health problem. An estimated one-third of the global population is infected with latent tuberculosis, making this the most common human infection known (Long et al. 1999). In Canada approximately 1700 new cases of TB are reported each year (Ontario Lung Association 2003:3). Contact investigations, the process of identifying, examining, and evaluating all persons who are at risk of infection with Mycobacterium tuberculosis due to recent exposure, allows for early detection and treatment of a new infection, and early treatment of disease. In 2004, an audit of Toronto Public Health's tuberculosis program made a number of recommendations pertained specifically to contact investigations. Subsequently, a request for proposals was released with the goal of obtaining information on TB contact investigation through a search of relevant and current literature. The primary intent of this literature review was to identify program-relevant recommendations that could be used to inform future contact investigations. The primary research question guiding this literature review was: Who should be considered a contact needing TB follow-up?
Methodology
The methodology consisted of a website search of selected international, national, provincial, state and county health organizations that were analyzed for specific information on guidelines, protocols and standards relating to tuberculosis contact investigations. In addition, an electronic database search (Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, IngentaConnect, and Webspirs (Social Science Index and General Science Index)) was conducted for relevant studies or previous reviews that reported on experiences with contact investigations. Various U.S. state-level health departments were contacted in an effort to elicit specific information about duration of exposure. Contact investigation information pertaining to characteristics of the index case, characteristics of the contacts, characteristics of the environment, and exposure times, were extracted from these resources.
Results
This review of the literature on contact investigations brings together various current, expert professional guidelines on tuberculosis contact investigations and seeks to ensure some consistency of approach in the prevention and control of this disease. Each TB program must have in place a systematic approach to contact screening that ensures appropriate identification and investigation of contacts to prevent or control the spread of tuberculosis infection and disease.
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