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Biomedical subjects

S E Valway

Publications and source records attributed to S E Valway.

At least 37 records · Page 2Linked to original sources
PubMed1996

Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight.

BACKGROUND: In April 1994, a passenger with infectious multi-drug resistant tuberculosis traveled on commercial-airline flights from Honolulu to Chicago and from Chicago to Baltimore and returned one month later. We sought to determine whether she had infected any of her contacts on this extensive trip. METHODS: Passengers and crew were identified from airline records and were notified of their exposure, asked to complete a questionnaire, and screened by tuberculin skin tests. RESULTS: Of the 925 people on the airplanes, 802 (86.7 percent) responded. All 11 contacts with positive tuberculin skin tests who were on the April flights and 2 of 3 contacts with positive tests who were on the Baltimore-to-Chicago flight in May had other risk factors for tuberculosis. More contacts on the final, 8.75-hour flight from Chicago to Honolulu had positive skin tests than those on the other three flights (6 percent, as compared with 2.3, 3.8, and 2.8 percent). Of 15 contacts with positive tests on the May flight from Chicago to Honolulu, 6 (4 with skin-test conversion) had no other risk factors; all 6 had sat in the same section of the plane as the index patient (P=0.001). Passengers seated within two rows of the index patient were more likely to have positive tuberculin skin tests than those in the rest of the section (4 of 13, or 30.8 percent, vs. 2 of 55, or 3.6 percent; rate ratio, 8.5; 95 percent confidence interval, 1.7 to 41.3; P=0.01). CONCLUSIONS: The transmission of Mycobacterium tuberculosis that we describe aboard a commercial aircraft involved a highly infectious passenger, a long flight, and close proximity of contacts to the index patient.

Adult↗
PubMed1996

Tuberculin skin test screening in schoolchildren in the United States.

OBJECTIVE: To determine the current practices and results of tuberculin skin test (TST) screening of schoolchildren in the United States. METHODS: Tuberculosis program staff in all states and the District of Columbia were asked about current requirements, practices, and results of school-based TST screening. RESULTS: Thirty-four states and the District of Columbia (69%) reported no current statewide statutes or policies for tuberculin screening of schoolchildren, and 10 (19%) reported having statewide requirements. In 6 states (12%), requirements were instituted at the local level, and 24 localities in these states were known to require screening. Of the 34 areas requiring screening, 18 (53%) screened all new entrants, 7 (21%) screened children in specific grades, and 9 (26%) used other criteria for screening. TST results were collected for 26 (76%) of 34 areas, and 6 areas collected results of follow-up evaluation of tuberculin-positive children. Additionally, 8 localities in 7 states with no screening requirements conducted tuberculin surveys. Sixteen areas provided results. In 7 of the 8 areas that collected information about birthplace, less than 2% of US-born children were tuberculin positive; foreign-born children had rates 6 to 24 times higher than US-born children. TST screening identified new cases of tuberculosis, less than 0.02% of the children screened. CONCLUSIONS: School-based tuberculin screening identified low rates of positive TST results in US-born children. Resources should be directed toward screening children at high risk for tuberculous infection, as recommended by the American Academy of Pediatrics and the Advisory Committee for Elimination of Tuberculosis.

Child↗
PubMed1995

Multidrug-resistant Mycobacterium tuberculosis in an HIV dental clinic.

OBJECTIVE: To investigate possible transmission of multidrug-resistant tuberculosis (MDR-TB) in a dental setting. DESIGN: A retrospective, descriptive study of dental workers (DWs), patients, and practice characteristics. PATIENTS: Two dental workers (DW1 and DW2) with acquired immunodeficiency syndrome and MDR-TB. SETTING: A hospital-based (Hospital X) human immunodeficiency virus (HIV) dental clinic in New York City. METHODS: To identify dental patients with tuberculosis (TB), patients treated in the dental clinic at Hospital X during 1990 were cross-matched with those listed in the New York City Department of Health Tuberculosis Registry. Mycobacterium tuberculosis isolates from both DWs and from dental patients with TB were tested for antimicrobial susceptibility and typed by restriction fragment length polymorphism (RFLP) analysis. Infection control practices were reviewed. RESULTS: M tuberculosis isolates infecting DW1 and DW2 were resistant to isoniazid and rifampin and had identical RFLP patterns. DW1 and DW2 worked in close proximity to each other in a small HIV dental clinic in Hospital X during 1990. Of 472 patients treated in the dental clinic in 1990, 41 (8.7%) had culture-proven M tuberculosis infection. Of these 41, 5 had isolates with resistance patterns similar to both DWs; however, for four available isolates, the RFLP patterns were different from the patterns of the DWs. Sixteen of the 41 patients received dental treatment while potentially infectious. Dental patients were not routinely questioned about TB by dental staff, nor were all dental staff screened routinely for TB. No supplemental environmental measures for TB were employed in the dental clinic in 1990. CONCLUSIONS: Our investigation suggests that MDR-TB transmission may have occurred between two DWs in an HIV dental clinic. Opportunities for transmission of TB among dental staff and patients were identified. TB surveillance programs for DWs and appropriate infection control strategies, including worker education, are needed to monitor and minimize exposure to TB in dental settings providing care to patients at risk for TB.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Transmission of multidrug-resistant Mycobacterium tuberculosis among persons exposed in a medical examiner's office, New York.

OBJECTIVE: To determine the prevalence of and risk factors for having a positive tuberculin skin test (TST) result among employees at a medical examiner's office (MEO). DESIGN: Cohort study, environmental investigation. SETTING: Several employees at a medical examiner's office were found to have positive TST results after autopsies were performed on persons with multidrug-resistant tuberculosis (MDR-TB). PARTICIPANTS: Employees of the MEO. RESULTS: Of 18 MEO employees, 5 (28%) had a positive TST result; 2 of these 5 had TST conversions. We observed a trend between TST conversion and participation in autopsies on persons with MDR-TB (2 of 2 converters versus 3 of 13 employees with negative TST; relative risk = 4.3; 95% confidence interval 1.61 to 11.69; P = 0.10). The environmental investigation revealed that the autopsy room was at positive pressure relative to the rest of the MEO and that air from the autopsy room mixed throughout the facility. CONCLUSIONS: A systematic approach to preventing transmission of Mycobacterium tuberculosis in autopsy suites should include effective environmental controls and routine tuberculin skin testing of employees.

Autopsy↗
PubMed1995

Tuberculosis in children younger than five years old: New York City.

We examined medical and health department records for children < 5 years of age with suspected or confirmed tuberculosis reported to the New York City Health Department from January, 1992, through June, 1992, in order to describe the epidemiology of tuberculosis in young children and identify prevention strategies. Forty-seven children were treated for suspected or confirmed tuberculosis. Sixty-two percent (21 of 34) were foreign-born (n = 11) or had foreign-born caretakers (n = 10). A source case was found for 10 of 47 (21%) children; for 8 the adult source was diagnosed before the child. One child was human immunodeficiency virus-seropositive, however, 83% of children and 70% of adult source cases did not have human immunodeficiency virus test results available. Health care providers should test children at high risk for tuberculosis infection as recommended by the American Academy of Pediatrics and improve contact tracing to identify children exposed to adults with tuberculosis. Because most cases of tuberculosis in children are diagnosed clinically rather than by isolating Mycobacterium tuberculosis, identification of the source case is important for selecting appropriate treatment.

Child, Preschool↗
PubMed1995

Tuberculosis in a day-care center, Kentucky, 1993.

In November, 1993, a 33-month-old child in a day-care center was diagnosed with tuberculosis (TB). To identify her source of infection, close contacts, other day-care children and staff were screened by tuberculin skin test (TST). TB registry and medical/laboratory records were reviewed. The only 2 community TB cases reported in the past 3 years were investigated. Of 164 children 2 were diagnosed with TB; their TSTs were > or = 10 mm but no specimens were obtained. Six children had TSTs > or = 5 mm. Of these 4 had TST conversions between December, 1993, and March, 1994. There were no additional positive TST children in June, 1994. No TB case was identified among staff or parents. A possible epidemiologic link with the index case was found for 1 community case. No source of infection was found for the other children. Possible explanations for not finding a source are: an as yet unidentified case in the day-care center or community; or false positive TST results in children related to low community prevalence of TB infection.

Child Day Care Centers↗
PubMed1995

Tuberculosis screening among homeless persons with AIDS living in single-room-occupancy hotels.

Congregate facilities for homeless persons with the acquired immunodeficiency syndrome (AIDS) are often endemic for tuberculosis. We evaluated tuberculosis screening methods at single-room-occupancy hotels housing persons with AIDS. Residents were screened by cross matching the New York City Tuberculosis Registry, interviewing for tuberculosis history, skin testing, and chest radiography. Cases were classified as either previously or newly diagnosed. Among the 106 participants, 16 (15%) previously diagnosed tuberculosis cases were identified. Participants' tuberculosis histories were identified by the questionnaire (100%) or by registry match (69%). Eight participants (50%) were noncompliant with therapy. These findings prompted the establishment of a directly observed therapy program on site.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Transmission of Mycobacterium tuberculosis associated with air travel.

OBJECTIVE: To investigate potential transmission of Mycobacterium tuberculosis in aircraft from a crew member with tuberculosis. DESIGN: Retrospective cohort study and survey. SETTING: A large US airline carrier. PARTICIPANTS: A total of 212 crew members and 59 passengers who were exposed to a crew member with tuberculosis during a potentially infectious period (May through October 1992). Comparison volunteer sample of 247 unexposed crew members. MAIN OUTCOME MEASURES: Positive tuberculin skin test (TST) result or tuberculosis. RESULTS: Rates of positive TST results were higher among foreign-born persons in all study groups. Among US-born comparisons and contacts, rates of positive TST results did not differ between comparisons and contacts exposed from May through July (5.3% vs 5.9%, respectively). However, contacts exposed from August through October had significantly higher rates of positive TST results than did contacts exposed from May through July (30% vs 5.8%, respectively; P < .001); two had documented TST conversions between September 1992 and February 1993. The risk of infection increased with increasing hours of exposure to the index case. Four (6.7%) of 59 frequent flyers were TST-positive; all flew in October. CONCLUSIONS: Data support the conclusion that M tuberculosis was transmitted from an infectious crew member to other crew members on an aircraft. Because of the clustering of TST-positive frequent flyers in October when the index patient was most infectious, transmission of M tuberculosis to passengers cannot be excluded.

Air Pollution, Indoor↗
PubMed1994

Outbreak of multi-drug-resistant tuberculosis in a New York State prison, 1991.

In the summer of 1991, four inmates from prison A in Upstate New York died of multi-drug-resistant tuberculosis. To determine the extent of resistant tuberculosis at prison A and transmission patterns, the authors interviewed staff and reviewed medical records and inmate movement histories. Contact investigation results were examined to determine tuberculin skin test conversions and to estimate risk of infection and disease for inmates who were seropositive for human immunodeficiency virus (HIV). Eight HIV-positive inmates and one HIV-negative guard, who was immunocompromised with cancer, had multi-drug-resistant tuberculosis. Eight died, a median of 28 days after the first culture-positive specimen was collected. All isolates had identical seven-drug resistance and DNA fingerprint patterns. Of exposed inmates, 92 out of 306 (30%) had skin test conversions. HIV infection was not associated with becoming infected with drug-resistant tuberculosis (active disease or skin test conversion), but once infected, HIV-positive inmates were significantly more likely to develop disease than were HIV-negative inmates (p < 0.001). The source case transferred to prison A in February 1991, was ill with undiagnosed multi-drug-resistant tuberculosis, refused medical care, and lived in the general prison population, where he transmitted the disease to other inmates. Lapses in infection control and laboratory delays contributed to this outbreak. Prisons should fully implement infection control guidelines to prevent tuberculosis transmission.

Adult↗
PubMed1994

Multidrug-resistant tuberculosis in the New York State prison system, 1990-1991.

Three epidemiologically linked multidrug-resistant (MDR) tuberculosis (TB) outbreaks in 1990-1991 involving New York State (NYS) inmates suggested MDR-TB was widespread in NYS prisons. Inmate lists were linked to 1990-1992 TB registries, medical records were reviewed, and movement histories for inmates with MDR-TB were examined within and between prisons and hospitals. In 1990-1991, 171 inmates were diagnosed with TB. This rate (156.2/100,000) was significantly higher than the 1990-1991 US rate (10.4/100,000) and the 1986 rate among NYS inmates (105.5/100,000). Of 171 cases, 155 were cultured-confirmed; 37 (32%) of 116 with drug susceptibilities determined had MDR-TB. Two other inmates with TB before 1990 were diagnosed with MDR-TB in 1990-1991. Of 39 inmates with MDR-TB, 38 (97%) were infected with the human immunodeficiency virus and 34 (87%) have died. These 39 lived in 23 of the 68 NYS prisons while potentially infectious; 12 were transferred through 20 prisons while ill with MDR-TB. Policies of correctional systems on infection control and inmate transfers need to be reevaluated to prevent spread of TB.

Adult↗
PubMed1993

Diabetes and its complications among selected tribes in North Dakota, South Dakota, and Nebraska.

OBJECTIVE: To determine the prevalence and incidence rates of diabetes and two specific complications for selected American-Indian tribes in North Dakota, South Dakota, and Nebraska. RESEARCH DESIGN AND METHODS: A descriptive epidemiological study was conducted using ambulatory care data during 1987 for prevalence and diabetes registries and complication case reporting during 1988 from IHS facilities on reservations in these states. RESULTS: The Winnebago and Omaha tribes had the highest age-adjusted diabetes rates, with prevalence 8.8 times and incidence 7.7 times the respective U.S. rates. The diabetes prevalence rate of combined data for the Sioux was 3.7 times the U.S. rate. Among Sioux Indians, the age-adjusted incidence rate for ESRD was 4.8 times the American-Indian/Alaska-Native rate and 13.4 times the rate for U.S. whites. The proportion of new diabetes-related ESRD (86%) was almost 3 times greater than the general U.S. population rate (30%). Also, among the Sioux, the age-adjusted incidence rate for LEA (86.7/10,000 diabetic population) was 1.5 times higher than the U.S. rate; the proportion of diabetes-related LEA (84%) was 1.8 times higher than the general U.S. population rate (45%). CONCLUSIONS: The age-adjusted rates of diabetes and certain complications among these Northern Plains tribes are greater than the U.S. rates. Improved health services to detect and monitor diabetes and its complications and community-based prevention activities directed at the epidemic of diabetes among the various Indian tribes are urgently needed.

Age Factors↗
PubMed1993

Diabetes in a northern Minnesota Chippewa Tribe. Prevalence and incidence of diabetes and incidence of major complications, 1986-1988.

OBJECTIVE: To determine the prevalence and incidence of diabetes, and the incidence of major diabetic complications, in a Chippewa Indian population. RESEARCH DESIGN AND METHODS: The format was a longitudinal population study that used active community and health center-based surveillance. The setting was a North American Indian reservation community of 4075 residents, served by an IHS clinic from 1986 to 1988. Patients were American Indians of Chippewa descent living on or near the Red Lake Reservation. RESULTS: Midway through the study, 346 people had been diagnosed with diabetes, which yielded an age- and sex-adjusted point prevalence of 148/1000 population. The adjusted rate for individuals > or = 25 yr of age was 252/1000 population, 3.82 times the U.S. rate (CI 2.95-4.93). Some 97 new cases of diabetes were identified for an age- and sex-adjusted average annual incidence of 17/1000 population. The incidence of hospitalization for LEA was 26/1000 diabetic person-yr, 4.3 times the 1978 U.S. rate (95% CI 2.8-6.8). Twelve individuals developed proliferative retinopathy, for an incidence of 12/1000 diabetic person-yr. Newly diagnosed ESRD incidence was 6/1000 diabetic person-yr. Twenty-three acute myocardial infarctions were observed, yielding an incidence of 22/1000 diabetic person-yr. CONCLUSIONS: Diabetes and its complications are prevalent in this Chippewa population, and further surveillance is needed to evaluate the effectiveness of prevention efforts.

Adult↗
PubMed1993

Clinical hypertension and its interaction with diabetes among American Indians and Alaska Natives. Estimated rates from ambulatory care data.

OBJECTIVE: To estimate the prevalence of clinical hypertension and describe the coexistence with diabetes in American Indian and Alaska Native communities. RESEARCH DESIGN AND METHODS: A cross-sectional study of outpatient visits for hypertension and diabetes over a 1-yr period (1 October 1986 to 30 September 1987) in IHS facilities was conducted. RESULTS: The 1987 estimated age-adjusted prevalence of diagnosed hypertension for this group was 10.9/100 for people > or = 15 yr of age. Thirty-seven percent of diabetic patients were diagnosed with hypertension. The relative risk of hypertension in the diabetic populations compared with the nondiabetic population varied from 4.7 to 7.7 among the different IHS areas. CONCLUSIONS: Despite high rates of diabetes and obesity, hypertension rates were relatively low among American Indians and Alaska Natives when compared with other ethnic groups in the U.S.

Adolescent↗
PubMed1993

Diabetes-associated mortality in Native Americans.

OBJECTIVE: To describe diabetes-associated mortality among Native Americans. RESEARCH DESIGN AND METHODS: In this population-based study, we analyzed diabetes-associated mortality data from the IHS and the NCHS. We also examined diabetes data from the 1986 NMFS. RESULTS: IHS area-specific diabetes mortality rates for 1984-1986 ranged from 10 to 93/100,000, compared with 15/100,000 for the total U.S. population. NCHS data for the same period listed diabetes as the underlying cause of 708 deaths among Native Americans and the contributory cause of 1252 deaths; 63% of the latter deaths were attributable to circulatory diseases. The 1986 NMFS demonstrated that Native American heritage is underreported by 65% on death certificates. Using deaths identified as Native American by NMFS, the age-adjusted mortality rate for diabetes as the underlying cause for Native Americans (96/100,000) was 4.3 times that for whites and two times that for blacks. Where diabetes was a contributory cause of death, the mortality rate for Native Americans (264/100,000) was 3.7 times that for whites and 2.4 times that for blacks. CONCLUSIONS: The excessive diabetes-associated mortality among Native Americans is consistent with other indicators of the magnitude of the diabetes problem in this population. Further epidemiological research and expanded diabetes control interventions are needed.

Age Factors↗
PubMed1993

Epidemiology of lower-extremity amputations in the Indian Health Service, 1982-1987.

OBJECTIVE: To describe the LEA experience among IHS diabetic patients. RESEARCH DESIGN AND METHODS: A cross-sectional study of hospital discharges for nontraumatic LEAs from 1982 to 1987 in four IHS areas was conducted. RESULTS: Incidence rates of first LEA in the study period increased with increasing age. Compared with nondiabetic subjects, diabetic patients had increased risks in each age-group, with those between the ages of 15 and 44 yr having a 158-fold increased risk. The average annual age-adjusted incidence rates of all LEAs among diabetic subjects in the Tucson (240.8/10,000) and Phoenix (203.1/10,000) IHS areas were substantially higher than the rates for the U.S. (73.1/10,000), Navajo (74.0/10,000), and the Oklahoma (87.3/10,000) IHS areas. CONCLUSIONS: LEA rates varied in different IHS areas. Reasons for these findings need to be evaluated, but may include IHS area differences in preventive health-care practices or risk factors for LEA.

Adolescent↗