Re: Italy - 1271 newborns exposed, 16 infected with tuberculosis at Rome hospital
Re: Italy - 1271 newborns exposed, 16 infected with tuberculosis at Rome hospital
Archive Number 20110825.2587
Published Date 25-AUG-2011
Subject PRO/EDR> Tuberculosis, latent, nosocomial, infants - Italy: (Rome)
TUBERCULOSIS, LATENT, NOSOCOMIAL, INFANTS - ITALY: (ROME)
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[1]
Date: Thu 18 Aug 2011
Source: Corriere Della Sera [in Italian, machine trans., summ. &
edited]
<http://roma.corriere.it/roma/notizie/cronaca/11_agosto_18/tubercolosi-infermiera-gemelli-1901313451980.shtml>
About 1000 infants are at risk of tuberculosis. The red alarm was
tripped at the Gemelli Polyclinic in Rome, after a nurse in the
neonatology unit of what is considered the best Roman hospital
discovered that she had fallen ill. She was removed from work as a
precaution and to receive the standard antituberculosis therapy. But
for the families of the children now begins a period of anxiety and
fear, even if the head of the department, Costantino Romagnoli,
ensures the risk is not considered to be high. … a clinic was
dedicated to all the families of children born [at the hospital]
between early March and mid-July [2011]. … about 1000 children will
be [invited to undergo testing]. To explain the details, Enrico Di
Rosa, Director of the Department of Hygiene and Public Health said,
"The infants' blood will be tested with Quantiferon, which is capable
of assessing the patient's immune response [to tuberculosis]."
[QuantiFERON-TB Gold is a blood test approved by the US Food and Drug
Administration (FDA) that is used to detect _Mycobacterium
tuberculosis_ infection in place of the tuberculin skin test. This
test measures the release of interferon-gamma from sensitized
lymphocytes in whole blood incubated overnight with proteins specific
for _M tuberculosis_. Results can be available within 24 hours and are
not affected by prior BCG (bacillus Calmette-Guerin) vaccination. -
Mod.ML]
[Byline: Clarida Salvatori]
--
Communicated by:
ProMED-mail
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******
[2]
Date: Wed 24 Aug 2011
Source: La Gazzetta del Mezzogiorno [edited]
<http://www.lagazzettadelmezzogiorno.it/notizia.php?IDNotizia=450654&IDCategoria=2694>
At least 10 babies have been infected by tuberculosis [TB] after being
born at Rome's Gemelli hospital in recent months, the Lazio regional
government has confirmed.
Health officials ordered the screening of newborns after a 38-year-old
nurse who worked at Gemelli's neonatal ward between March and July
[2011] tested positive for tuberculosis. The nurse is being treated at
another hospital. It is not clear how or where she became infected, in
spite of being vaccinated against TB.
''The children are not ill or contagious,'' said Costantino Romagnoli,
the head of Gemelli's neonatal department. ''The tests indicate
exposure to the TB bacteria. The children might develop the disease
only if they were not immediately given prophylactic treatment, but
they will be''.
Regional officials said the families of the 1271 babies born between
March and July 2011 will be contacted by Friday [26 Aug 2011] for
screening appointments. Screenings have been stepped up from 25 to 150
per day, in order to reach all babies at risk by the end of August
2011.
It is impossible to predict how many of them will turn up positive,
Romagnoli added. A statement with screening results will be issued at
8 pm daily, health officials said. Another 5-month-old child who
tested positive for TB has been admitted to Bambino Gesu hospital, but
it is unclear whether her exposure is related to the same nurse.
Lazio regional authorities confirmed that people exposed to TB do not
necessarily develop the disease, as long as prophylactic protocols are
followed. ''This is not an epidemic,'' said Lazio Governor Renata
Polverini. Health Minister Ferruccio Fazio also said there was no need
to panic. ''Millions are exposed every year, but only 4000 are likely
to develop full-blown TB,'' he said. ''It's a completely curable
disease. There is no cause for alarm''. A parliamentary health
committee has requested a report from Polverini.
--
Communicated by:
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[Ronan Kelly for FluTrackers.com (<ronankelly@comcast.net>) submitted
a similar news release for posting.
A HealthMap/ProMED-mail interactive map of Italy can be accessed at
<http://healthmap.org/r/1asU>.
Lazio is a region of west central Italy, in which Rome, capital of
Italy, is located (<http://en.wikipedia.org/wiki/Lazio>). The Agostino
Gemelli University Polyclinic is a large general hospital of 1850 beds
in Rome. It serves as the teaching hospital for the medical school of
the Universita Cattolica del Sacro Cuore (the largest privately owned
university in Italy)
(<http://en.wikipedia.org/wiki/Agostino_Gemelli_University_Polyclinic>).
Tuberculosis (TB) is usually spread by means of aerosolized droplet
nuclei, about 1-5 microns in diameter, that contain one or 2 tubercle
bacilli (<http://ajrccm.atsjournals.org/cgi/content/full/169/5/553>).
Droplet nuclei are expelled from a person with active pulmonary,
especially cavitary, tuberculosis during activities such as coughing
or sneezing; the airborne particles can remain suspended in the air
for several hours, depending on the environment, and can be carried by
air currents.
Although not stated in the news releases above, presumably the nurse
has active, most likely cavitary, TB in order to have infected
multiple neonatal contacts. The infected infants are said not to be
sick and thus likely have latent TB infection (LTBI). However,
children under 5 years of age with LTBI are at high risk for
progressing to primary TB and its sequellae, disseminated TB, and TB
meningitis. Therefore all the children exposed to active TB must be
evaluated promptly for LTBI.
A report by the US CDC highlighted the difficulty of contact tracing
of infants and provision of appropriate follow-up for those exposed to
a TB-infected nurse in New York City in 2003
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm>).
Consequently,
the CDC emphasized in the report the importance of
annual screening for LTBI in healthcare workers (HCWs) by use of
tuberculin skin test (TST) or interferon gamma release assays (IGRAs),
despite a history of bacillus Calmette-Guerin (BCG) vaccination in
some HCWs, and LTBI treatment programs for HCWs to prevent TB disease
and subsequent healthcare-associated transmission
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm>).
BCG vaccination is used in many developing countries with a high
prevalence of TB to prevent childhood TB meningitis and miliary
disease. HCWs born in developing countries frequently attribute a
positive TST result to their BCG vaccination in infancy. However, in
the absence of TB infection, tuberculin reactivity caused by BCG
vaccination wanes over time and is unlikely to persist for more than
10 years after vaccination. Current guidelines recommend considering
LTBI treatment of HCWs who have a TST result larger than 10 mm,
especially if they emigrated from a country with high TB prevalence
during the preceding 5 years
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm>). A history
of vaccination with BCG should not influence the decision to treat
LTBI and healthcare facilities should promote LTBI treatment for
employees with positive TST results during annual screenings for TB.
In any case, IGRAs can be used to replace TST in these programs
(<http://www.businesswire.com/news/home/20110627006209/en/Oxford-Immunotec-Study-Results-Show-Switching-Tuberculin>
and <http://www.igrasymposium.com/J14_mor.pdf>) and results of IGRAS
are not affected by prior BCG vaccination.
The diagnosis of perinatal tuberculosis is difficult because of its
nonspecific presentation, the difficulty of obtaining microbiological
confirmation, and the unreliability of the tuberculin skin test. The
CDC recommends that if the chest radiograph is normal, LTBI treatment
should be initiated in TST-negative children 5 years of age and
younger. Treatment should be continued until the results of the 2nd
TST 3 months later and other medical evaluation are known (see
<http://www.cdc.gov/tb/publications/LTBI/treatment.htm>). If the 2nd
TST result is negative, treatment may be stopped
(<http://www.cdc.gov/tb/publications/LTBI/treatment.htm>). TST is the
preferred method for testing of children under the age of 5 years
(<http://www.cdc.gov/tb/publications/LTBI/diagnosis.htm>), because of
limited data on the use of IGRAs in this age group
(<http://www.cdc.gov/mmwr/PDF/rr/rr5905.pdf>). - Mod.ML]
[see also:
Tuberculosis, inaccurate blood tests, WHO statement (03)
20110726.2255
Tuberculosis, inaccurate blood tests, WHO statement (02)
20110724.2233
Tuberculosis, inaccurate blood tests, WHO statement 20110723.2217
2010
----
Tuberculosis, children - UK: use of BCG vaccine 20100717.2386]
.................................................ml/mj/dk
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