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PubMed1992

Epidemiological patterns of hepatitis A in different parts of the world.

Serological surveys in many communities show a high prevalence of antibodies to hepatitis A virus (HAV) in people over the age of 50 years. However, few of that age can recall a previous episode of hepatitis, indicating that subclinical infections are common. The outcome of infection with HAV depends on the age at which infection occurs and, perhaps, the infectious dose. Fulminant disease is well recorded, with the frequency varying from one to eight per 1000 cases. Information on the frequency of hepatitis A can be obtained by analysing hospital records and notifications to health authorities or by serological surveys. In many countries, these data are limited and seriously underestimate the true frequency of the disease. At a conservative estimate, the incidence of disease in most developed countries is probably four to five times higher than the number of notifications. HAV appears to circulate in most parts of the world and to be responsible for both epidemic and sporadic disease. Three major patterns of infection are known which reflect different epidemiological situations. These are demonstrated by different patterns of the age-specific prevalence of antibodies to HAV which reflect standards of hygiene and sanitation, the degree of crowding of the population and opportunities for the virus to survive and spread.

Age Factors↗

PubMed1993

Neuropsychiatric morbidity in early HIV disease: implications for military occupational function.

The Military Medical Consortium for Applied Retroviral Research Program's (MMCARR) Behavioral Medicine Human Immunodeficiency Virus (HIV) Research component is conducting a tri-service, comprehensive, and longitudinal research study in military HIV-infected personnel at all stages of infection. Identification of neuropsychiatric and psychosocial outcomes and their determinants will help the military minimize the impact of the HIV epidemic on military readiness and function. Neuropsychiatric and psychosocial findings are among the most common complications seen in early HIV disease and among the most likely to have an adverse impact on military readiness and function. The study has demonstrated that the average HIV-infected service person experiences at least transient military occupational difficulty following notification of HIV status. More than 15% at any given time have levels of clinical or subclinical anxiety or depression that are referrable for mental health intervention. Ten per cent of study subjects have a current major mood disorder and 5% have a psychoactive substance use disorder. Finally, 17% of study subjects have experienced serious suicidal ideation or behaviours at least once since notification of seropositivity. Fortunately, however, data also indicate at least partial effectiveness of current primary, secondary and tertiary preventive efforts. Only about 1% of Air Force HIV-infected persons are discharged for psychiatric reasons prior to eventual medical discharge. Further, a large majority of active-duty patients demonstrate solid military occupational and social performance. Though military HIV neurobehavioural research is still in progress, preliminary data identify social support and pre-HIV psychiatric predisposition as important factors associated with current neuropsychiatric status.

Aerospace Medicine↗

PubMed1995

MMR vaccination, measles epidemiology and sero-surveillance in the Republic of Ireland.

OBJECTIVE: Following the introduction of a national measles and subsequent MMR vaccination programme, to determine the susceptibility of 3-14-year-old children to measles, mumps and rubella and to relate the results to the epidemiology of measles and the need for vaccination policy changes. DESIGN: Cross-sectional sero-survey and trends in measles notifications and mortality. SETTING: Paediatric hospital outpatient departments in Dublin. SUBJECTS: Sera were collected from 837 children attending the clinics in 1991 and 1992. RESULTS: The prevalence of antibodies in children aged 3-6, 7-10 and 11-14 years was 84, 83 and 95% for measles; 48, 60 and 65% for mumps; and 78, 63 and 74% for rubella, respectively. The prevalence of mumps antibodies may be underestimated. Ninety-six per cent of girls aged 13-14 years had rubella antibodies. A widespread outbreak of measles occurred in 1993. Over recent years, an increasing proportion of measles notifications were in older children. CONCLUSION: Given sub-optimal uptake of MMR vaccine, outbreaks of infection in pre- and primary school children are inevitable. In such circumstances, a 2-shot MMR vaccine programme with high uptake is essential to prevent a shift of disease into older age groups.

Adolescent↗

PubMed1995

[Evaluation of the psychosocial care in maternity: experience at the Poitiers University Hospital].

BACKGROUND: High psychosocial risk pregnancies require specialized multidisciplinary help and follow-up in order to improve the outcome of babies. POPULATION AND METHODS: Thirty pregnancies were selected among 3500 and followed by a multidisciplinary team during 1990 and 1991. Evaluation included risk predictors, neurodevelopmental outcome of children at 9 and 24 months, number and time of judicial notifications. Evaluation of the mother-to-baby relationship by a psychologist as well as the environmental variables were performed. RESULTS: Four families had one or two, 20 families three or five and six families, six or more of the 15 risk predictors studied. Over the babies followed-up until the age of 24 months, four were placed out of the family, three hospitalizations were medically unjustified and there was no hospitalization for child abuse or neglect. Twelve children had development delay and two developed an environmental-related staturo-ponderal delay. Judicial notifications were realized 18 times during pregnancy or just after delivery and six times during the follow-up for child abuse and neglect. CONCLUSIONS: Taking care of high psychosocial risk pregnancies could be improved in special hospitalization units for mother and child. A better awareness of this problem could also improve the outcome of children, which remains very alarming.

Adolescent↗

PubMed1992

Childhood tuberculosis and tuberculous meningitis: high incidence rates in the Western Cape of South Africa.

In recent years higher incidence rates of tuberculosis (TB) have been reported from the Western Cape than from other health regions of South Africa. In contrast to the various pulmonary forms of tuberculosis, tuberculous meningitis (TBM) always requires hospital admission, and can thus be used as an indicator of the extent of the infection in a community, as well as providing a measure of the effectiveness of primary and secondary preventive measures. In the present study an attempt was made to identify all cases of tuberculous meningitis aged 14 years and younger which occurred in the region, by checking notifications and the records of all hospitals, and verifying diagnosis against set criteria. Rates for the entire period were calculated according to updated census data. There was a total of 689 confirmed cases, of which only 55% had been notified. Of the 238 cases confirmed in the 3-years period, 1985-1987, 25.2% were under 1 year, 51.7% under 2 years, and 79.8% under 5 years of age. Age-specific incidence per 100,000 children were respectively 31.5 (0-1 years), 17.1 (1-4 years), 4.8 (5-9 years), and 0.7 (10-14 years). Rates in rural areas were far higher than in metropolitan regions. Utilizing tuberculin test data and total notifications, the following risks could be calculated for 'Coloured' children (of mixed race) aged 0-4 years: 2-3% annual risk of infection; 15.7% risk of TB in infected population; 0.5% risk of TBM in infected population; 0.9% risk of TB in children aged 5-14 years; 0.01% risk of TBM in children aged 5-14 years.

Adolescent↗

PubMed1994

Tuberculosis case-finding in Nicaragua: evaluation of routine activities in the control programme.

SETTING: The new International Union against Tuberculosis and Lung Disease (IUATLD) tuberculosis strategy developed in the 1980s in Tanzania, Malawi and Mozambique, was simultaneously implemented in Nicaragua. OBJECTIVE: Present results of case-finding, identify trends in incidence and limitations in case-finding and reporting. DESIGN: Data are based upon the traditional reporting system until 1987, replaced as the programme was reorganized. Data were also collected directly from the Central Laboratory, Programme and Laboratory registers during supervision of health centres. RESULTS: Quality control of sputum smears shows 1.8% discordance between peripheral and central laboratories. Notification rate of smear-positive tuberculosis declined 1.7% yearly 1983-1991 and 2.6% for all cases. Half of the patients are new smear-positive pulmonary cases, 40% smear-negative pulmonary cases. Relapses represent 11-13% of all smear-positive patients, children 7-30% of all cases. One-third of extrapulmonary tuberculosis cases are pleural effusions, another third lymphadenitis. 41% of adult patients entered as smear-negative in the programme had no smear reported in the laboratory. CONCLUSIONS: Quality control of sputum smears was established and the reporting system improved in spite of adverse conditions. Notification rate declined gradually. Smears should be done in all patients classified as smear-negative pulmonary tuberculosis.

Adolescent↗

PubMed1996

Sexual contact tracing outcome in adolescent chlamydial and gonococcal cervicitis cases.

BACKGROUND AND OBJECTIVE: Treatment of sex partners is an essential part of sexually transmitted diseases (STD) control. This study examined the efficacy of contact tracing via patient self-referral in gonococcal and chlamydial cervicitis cases among adolescents, compared with the effectiveness of provider-referral. STUDY DESIGN: Adolescent females with culture-proven chlamydial or gonococcal cervicitis were the study subjects. This cohort study was done in an urban non-STD clinic setting. The subjects chose either provider-notification or self-notification method to inform their sex partner(s) in 2 months preceding the interview date. RESULTS: Two hundred and sixty-five eligible subjects (91% African-American, 9% white) were identified. One hundred and ninety-eight sex contacts were reported by 165 (62%) cases; no contact was elicited in the remaining 100 (38%). The follow-up data revealed that 129/198 (66%) contacts were informed: 63 contacts by 61 index cases, 54 contacts of 47 cases by the case manager, 9 by both methods, and 3 by unspecified means. History of treatment was obtained in 54 contacts, including 37% (23/63) of patient-notified contacts and 50% (27/54) of provider-notified contacts; these 54 contacts constituted 42% of informed contacts, or 27% of all named contacts. The mean number of sexual contacts treated per index case was 0.58 (27/47) for the provider-referral groups and 0.38 (23/61) for the self-referral groups. Successful contact tracing was documented in 19.3% (51/265) of all index cases, resulting in treatment of 54 contacts. CONCLUSION: This study demonstrates the need for more effective partner treatment strategies in adolescent STD cases.

Adolescent↗

PubMed2006

Expedited partner therapy for adolescents diagnosed with gonorrhea or chlamydia: a review and commentary.

Management of sex partners is a cornerstone of sexually transmitted infection control in the United States. Face-to-face investigation and notification of exposure of sex partners by public health professionals seems to be the most effective method of ensuring appropriate partner management. However, resources rarely permit such intensive partner management for gonorrhea and chlamydial infection. Alternatives to public health-assisted notification and referral include expedited partner therapy, in which partners are treated before evaluation, most typically through patient-delivered therapy. Results from trials have shown generally favorable biomedical and behavioral outcomes. This article discusses the evidence for expedited partner therapy and its associated liability, confidentiality, financial, and administrative issues relating to adolescent patients and their health care providers.

Adolescent↗

PubMed2006

Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France.

BACKGROUND: Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. OBJECTIVES: Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. METHODS: Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. RESULTS: In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). CONCLUSION: The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.

France↗

PubMed2005

Comparison of autotriggered memory loop recorders versus standard loop recorders versus 24-hour Holter monitors for arrhythmia detection.

To determine the relative yields of Holter monitoring (HM), memory loop recording (MLR), and autotriggered MLR (AT-MLR), we retrospectively interrogated the very large database of Lifewatch (a Card Guard company and a commercial monitoring company) and compared the results obtained by each method. From among a total database of approximately 100,000 patients, records of 1,800 patients from 2003 were randomly selected and examined, 600 from each of the 3 different monitoring groups. Each session of MLR and AT-MLR was applied for 30 days. For each patient we determined the symptomatic and asymptomatic events that were documented, including those that met predefined immediate physician notification criteria and the time to first notification event. The groups were identical in age and symptoms that necessitated monitoring; fewer women had HM. Information on the type of underlying structural heart disease, if present, and medications taken, if any, was not available to us in this database. The AT-MLR approach provided a higher yield of diagnostic events (e.g., 37, 108, and 216 total patients who had events; 37, 212, and 524 total events; and 6.2%, 17%, and 36% with a diagnostic yield for HM, MLR, and AT-MLR, respectively) and an earlier diagnosis. AT-MLR was also the most effective technique for capturing asymptomatic significant events, such as atrial fibrillation (52 with AT-MLR vs 1 for standard MLR). AT-MLR detected more than half as many asymptomatic episodes of atrial fibrillation (n = 52) as the total number of symptomatic episodes detected by patient activated recording (n = 94), thus confirming the common presence of asymptomatic atrial fibrillation. AT-MLR provided electrocardiographic documentation of tachyarrhythmias (n = 392) more often than MLR (n = 47) or HM (n = 44) and bradyarrhythmias/pauses/atrioventricular block (n = 38) more often than MLR (n = 13) or HM (n = 18). Thus, MLR and AT-MLR provide a diagnosis more often than does HM, thus confirming the benefit of prolonged monitoring. Further, the higher yield of AT-MLR versus MLR demonstrates the significantly enhanced benefit of autotriggered programmable recording.

Adult↗

PubMed2006

Statin safety: a systematic review.

A systematic review of cohort studies, randomized trials, voluntary notifications to national regulatory authorities, and published case reports was undertaken to assess the incidence and characteristics of adverse effects in patients treated with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins. For statins other than cerivastatin, the incidence of rhabdomyolysis in 2 cohort studies was 3.4 (1.6 to 6.5) per 100,000 person-years, an estimate supported by data from 20 randomized controlled trials. Case fatality was 10%. Incidence was about 10 times greater when gemfibrozil was used in combination with statins. Incidence was higher (4.2 per 100,000 person-years) with lovastatin, simvastatin, or atorvastatin (which are oxidized by cytochrome P450 3A4 [CYP3A4], which is inhibited by many drugs) than pravastatin or fluvastatin (which are not oxidized by CYP3A4). In persons taking simvastatin, lovastatin, or atorvastatin, 60% of cases involved drugs known to inhibit CYP3A4 (especially erythromycin and azole antifungals), and 19% involved fibrates, principally gemfibrozil. The incidence of myopathy in patients treated with statins, estimated from cohort studies supported by randomized trials, was 11 per 100,000 person-years. For liver disease, randomized trials reported fewer hepatobiliary disorders in patients allocated statins than in those allocated placebo. The notification rate of liver failure to regulatory authorities was about 1 per million person-years of statin use. Randomized trials show no excess of renal disease or proteinuria in statin-allocated participants, and the decline in glomerular filtration rate was smaller with statins than with placebo. Evidence from 4 cohort studies and case reports suggests that statins cause peripheral neuropathy, but the attributable risk is small (12 per 100,000 person-years). No change in cognitive function was found in randomized trials of statins in elderly patients.

Adverse Drug Reaction Reporting Systems↗

PubMed2005

[Postmarketing surveillance in patients with cardiac pace-makers or automatic implantable defibrillators].

This article includes an overview of the actual French control and regulation system of the safety alerts involving pacemakers and implantable cardioverter-defibrillator and an evaluation of the general information and trends about the characteristics of the reported incidents obtained in the last years in that field. The national security agencies have the mission to collect the data on safety and efficacy of medical devices but manufacturers, physicians and patients also have a role to play. The technical appreciation of the necessity of a notification is not easy in some cases but the lack of notification of a severe incident may lead to heavy penal consequences. If doubtful cases, one should keep in mind the spirit of these safety systems: a collective insurance against the risks related to the use of medical devices. In the 10 last years, the annual advisory rate was increased. The pacemakers were recalled more frequently than implantable cardioverter-defibrillators in absolute value but less frequently in relative value (advisories per 100 person-years). This increase may be related to the growing number of device implants and expanding indications for device therapy, to the increasing sophistication of the devices and to the modifications in the regulation aspects of these problems with a closer attention of users and physicians to the several types of malfunctions.

Consumer Product Safety↗

PubMed2005

The epidemiology of travel-associated shigellosis--regional risks, seasonality and serogroups.

OBJECTIVES: To give a detailed risk estimate of contracting travel-associated shigellosis in various regions of the world. METHODS: Data on notifications of travel-associated shigellosis in Sweden 1997-2003 were compared with information on recent travel abroad from a comprehensive database based on telephone interviews with more than 160,000 Swedish travellers. RESULTS: From the national notification database 2678 patients with travel-associated shigellosis were retrieved. The highest risk of being notified with shigellosis was seen in returning travellers from India and neighbouring countries (318/100,000 travellers), East Africa (219/100,000), West Africa (120/100,000), and North Africa (76/100,000). Data on serogroup was available for 2529 isolates. Shigella sonnei was the most common serogroup (67%), followed by Shigella flexneri (26%), Shigella boydii (5%), and Shigella dysenteriae (3%). A higher risk was seen in children below the age of six, compared to older children and adults and in women compared to men. A distinct seasonal pattern was noted with the highest risk of shigellosis in July-October and the lowest in May. CONCLUSIONS: Denominator based data on reported travel-associated infections are well suited to give risk estimates per region of infection, that could be used to target high-risk groups for pre-travel advice.

Adolescent↗

PubMed2005

[European surveillance of tuberculosis: description of the network and recent results].

A network for the surveillance of tuberculosis covering the WHO European Region was set up in 1996. It aims to improve the contribution of surveillance to TB control, promoting standardised methods to compare countries. Standardized individual or aggregate data on notified TB cases is provided annually from national surveillance institutions. In the enlarged European Union (EU), overall TB notification rates decreased in recent years (14/100 000 in 2002), but leveled off in some countries including France and the United Kingdom, partly due to increasing numbers of patients from high TB incidence areas (30% in 2002). Multidrug resistance (MDR) was much more frequent in the Baltic States (21% in 2002) than in other countries (1.7%; range: 0-3.7%). Treatment of new pulmonary TB cases notified in 2001 was completed within 12 months in 74% of cases, ongoing in 3%, interrupted due to death in 7%, and interrupted for other reasons or unknown in 15%. In the Balkans and Turkey, notification rates ranged between 20 and 62 per 100 000 in 2002, and decreasing or stable except for Romania (153 in 2002). In the East (former Soviet Union), TB surveillance data, although incomplete, shows an increasing incidence (97/100 000 in 2002), high prevalence of primary MDR (14% in Kazakhstan), and frequent treatment failures (10% in new cases). At the time of EU enlargement, European TB surveillance covering the whole WHO European Region should continue, with support of TB control in the East as a regional priority.

Community Networks↗

PubMed2005

Epidemiology of HIV infection among Israeli Arabs.

OBJECTIVE: Israeli Arab citizens comprise Israel's largest minority group (15.6% of Israelis>12 years old). The objectives of this study were to describe the epidemiology of human immunodeficiency virus (HIV) in this group for the first time at a national level, and to identify health promotion and treatment needs. METHODS: All HIV/acquired immunodeficiency syndrome (AIDS) cases among Israeli Arab citizens that were notified to the Ministry of Health between 1985 and 2002 were analysed and compared with other Israelis (excluding immigrants from sub-Saharan Africa and their children). RESULTS: Twenty-five AIDS cases and 51 HIV-positive cases were notified in adult/adolescent Israeli Arabs, (3.4% of all adult/adolescent cases). In addition, four child cases were reported. The cumulative rates for Arab and non-Arab Israelis were 10.1 and 37.8/100,000, respectively. The gender ratios (male/female) were 3.3 and 4.4 for AIDS cases and HIV cases, respectively. The median age was 31.5 years [interquartile range (IQR)=12] for AIDS cases and 30 (IQR=12) for HIV cases. Modes of transmission were heterosexual contact (34%), intravenous drug use (21%), male homosexual contact (19%), unknown (14%), haemophilia (6%), children of at-risk parents (4%) and blood (2%). The mean interval from HIV notification to AIDS diagnosis was 1.5 years until 1998 and 2.8 years thereafter. Knowledge, attitudes and practices studies on AIDS in Arabs are also discussed in this article. CONCLUSION: HIV prevalence is lower in Arab Israelis than in non-Arab Israelis and Arabs residing in neighbouring countries. Nevertheless, the shorter interval from HIV notification to AIDS diagnosis in Arab Israelis suggests a lower rate of HIV testing and diagnosis at a later stage of infection. Patterns of transmission in Arab Israelis need further evaluation, including behavioural surveys.

Adolescent↗

PubMed2005

The association between trauma system and trauma center components and outcome in a mature regionalized trauma system.

BACKGROUND: Regionalized trauma systems have been shown repeatedly to improve the outcome of seriously injured patients. However, we do not have data regarding which components of these systems have the most impact on outcome and to what degree. The objective of this study was to understand the association between various components that make up a trauma system and outcome. METHODS: Surveys were administered to trauma directors at 59 hospitals in the province of Quebec, Canada. Data from the surveys were then linked with specific outcome variables obtained from a regionalized trauma database. Specific outcomes were assigned to trauma system- and in-hospital-based components after controlling for injury severity. RESULTS: Over 4.8 years, 72,073 patients met inclusion criteria. Components found to affect survival after risk adjustment were prehospital notification (OR, 0.61; 95% CI, 0.39-0.94) and the presence of a performance improvement program in that hospital (OR, 0.44; 95% CI, 0.20-0.94). Increased patient volume was associated with a reduction in risk-adjusted mortality (OR, 0.98; 95% CI, 0.97-0.99). Tertiary trauma centers were also associated with a reduction in risk-adjusted mortality compared with both secondary and primary centers (OR, 0.68; 95% CI, 0.48-0.99). CONCLUSIONS: Improvements in outcome in a regionalized trauma system are secondary to a combination of elements, as well as to the interplay of these elements on each other. Prehospital notification protocols and performance improvement programs appear to be most associated with decreased risk-adjusted odds of death.

Emergency Medical Service Communication Systems↗

PubMed2005

[Transfusion incidents reports of grade zero: a national and descriptive analysis upon two years of practical survey].

A grade zero transfusion incident is defined as an inappropriate transfusion of blood component due to one or several failures without immediate clinical or biological consequences for the recipient. Two years after the setting up of the mandatory notification of these incidents, Afssaps haemovigilance unit performed a first descriptive national analysis of the data collected in years 2003 and 2004 at the national level. This analysis was based on one part on computarised e-Fit national database and on the other part on investigation results documents and additional surveys set up by the network professionals. From a quantitative point of view, this study reveals differences in notification as well as in the type of analysis from one region to another. Quantitatively, 45% of grade zero transfusion incidents correspond to attribution errors. The site of origin of grade zero incidents is for almost 73% linked to health establishment, clinical unit or hospital blood bank, and for almost 23% linked to blood establishment. Complete analysis has notably shown that 9% of the incidents are due to errors in blood component prescription. This descriptive analysis, which identifies recurrent failure and critical points originating from non-appropriated transfusions, should constitute the starting point of a reflection aiming at optimising and standardising methods of analysis of grade zero transfusion incidents and at elaborating suggestions to better control critical points.

France↗

PubMed2004

Risk factors of tuberculosis among health care workers in Sabah, Malaysia.

Tuberculosis (TB) is one of the main public health problems in Sabah; 30% of the total number of TB cases reported in Malaysia every year occur in Sabah. The average incidence of TB among health care workers over the past 5 years is 280.4 per 100,000 population (1, Annual Report of Sabah State TB Control Programme, 1998). At present, there are no specific measures for the prevention of TB transmission in health care facilities. A case-control study was conducted among health care workers in Sabah in 2000-2001. Cases were health care workers with TB diagnosed between January 1990 and June 2000. Controls were health care workers without TB and working in the same facility as cases during the disease episode. The study attempted to identify risk factors for TB among the study population. Data were collected through structured interviews and review of patients' records. The notification rate of TB among health care workers was significantly higher than that to the general population (Z=4.893, p<0.01). The average notification rate of TB among health care workers over the last 5 years was two times higher than in the general population (280.4/100,000 compared to 153.9/100,000). Regression results showed that ethnicity, designation, family contact and TB related knowledge did not significantly contribute to the risk of contracting TB in this study. However, after controlling for the above factors, age, gender, history of TB contact outside the workplace (other than family contact), duration of service and failure to use respiratory protection when performing high-risk procedures, were the main risk factors of TB among health care workers. This study succeeded in identifying some of the risk factors of TB among health care workers. We managed to include the large ratio of controls to case (3:1) and those cases spanned over a period of 10 years. However, the findings from the study have to be applied with caution due to the limitations of this study, which include recall bias, dropouts, and small sample size. Based on the study findings, we recommend that health care workers in the first 10 years of service should take extra precautions, such as using respiratory protection when performing procedures that are considered to be of high risk with respect to TB infection. They should also undergo TB screening at least once every 2 years and, if symptomatic, offered prophylactic treatment. The Respiratory Protection Programme should be fully implemented to help reduce the risk of TB among health care workers in Sabah.

Case-Control Studies↗