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Jeremy M. McAnulty, MBBS, MPH; David W. Fleming, MD; Mary Ann Hawley, BSN, MA; Roy C. Baron, MD, MPH

Arch Intern Med. 1995;155(7):713-716.

Abstract
Background
With the recent resurgence of tuberculosis in the United States, it is unclear whether existing prevention strategies can successfully control and eliminate the disease. We determined the extent to which opportunities for prevention were missed among patients with tuberculosis.

Methods
For all patients with active tuberculosis reported to the Oregon Health Division, Portland, from July 1991 through June 1992, we determined previous history of tuberculosis therapy, previous tuberculin skin test status, the presence of medical conditions for which skin testing is recommended, and previous health care. We then determined whether they had undergone preventive procedures in accordance with current recommendations of the Advisory Council for the Elimination of Tuberculosis.

Results
Of 153 patients with active tuberculosis, 90 (59%) had indications for—but had not previously undergone—recommended procedures. Ten patients (7%) did not complete therapy for previous disease; two (1%) did not complete preventive therapy; 12 (8%) with known previous positive tuberculin skin tests and an indication for preventive therapy never received it; and 66 (43%) with known indications for screening never received a skin test. Indications for skin testing included exposure to active tuberculosis (44%), predisposing medical conditions (83%), previous residence in an institution (24%), and birth in a country with a high prevalence of tuberculosis (29%).

Conclusions
Based on their known effectiveness, a major reduction in tuberculosis morbidity could occur if preventive measures were fully implemented. Appropriate skin testing is a prevention strategy of major importance. Priorities should include working to change provider practice to better ensure that persons with indications routinely receive tuberculin skin tests.

(Arch Intern Med. 1995;155:713-716)

Author Affiliations
From the Centers for Disease Control and Prevention, Division of Field Epidemiology, Epidemic Intelligence Service, Atlanta, Ga (Drs McAnulty and Baron); and Oregon Health Division, Center for Disease Prevention and Epidemiology, Portland (Dr Fleming and Ms Hawley). Dr McAnulty is now with the Southern Sydney Public Health Unit, Level 1, James Laws House, St George Hospital, Kogarah, New South Wales, Australia.

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