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1 February 2007

Volume 44, Number 3
Clinical Infectious Diseases 2007;44:317–323
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4403-0001$15.00
DOI: 10.1086/509926
MAJOR ARTICLE

Nursing and Community Rates of Mycobacterium tuberculosis Infection among Students in Harare, Zimbabwe

Elizabeth L. Corbett,1,2

Joyce Muzangwa,2

Kathryn Chaka,2

Ethel Dauya,2

Yin Bun Cheung,1

Shungu S. Munyati,2,3

Andrew Reid,4

James Hakim,4

Steven Chandiwana,2,6

Peter R. Mason,2,5

Anthony E. Butterworth,1,2 and

Stan Houston7

1Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; 2Biomedical Research and Training Institute, 3National Institute of Health Research, 4Department of Medicine, University of Zimbabwe Medical School, and 5Department of Medical and Laboratory Sciences, University of Zimbabwe, Harare, Zimbabwe; 6Faculty of Health Sciences, University of the Witwatersrand, South Africa; and 7Department of Medicine, University of Alberta, Edmonton, Canada

Background.African hospitals have experienced major increases in admissions for tuberculosis, but they are ill‐equipped to prevent institutional transmission. We compared institutional rates and community rates of tuberculin skin test (TST) conversion in Harare, Zimbabwe

Methods.We conducted a cohort study of TST conversion 6, 12, and 18 months into training among 159 nursing and 195 polytechnic school students in Harare. Students had negative TST results (induration diameter, 9 mm) with 2‐step testing at the start of training.

Results.Nursing students experienced 19.3 TST conversions (increase in induration diameter, 10 mm) per 100 person‐years (95% confidence interval [CI], 14.2–26.2 conversions per 100 person‐years), and polytechnic school students experienced 6.0 (95% CI, 3.5–10.4) conversions per 100 person‐years. The rate of difference was 13.2 conversions (95% CI, 6.5–20.0) per 100 person‐years. With a more stringent definition of conversion (increase in the induration diameter of 10 mm to at least 15 mm), which is likely to increase specificity but decrease sensitivity, conversion rates were 12.5 and 2.8 conversions per 100 person‐years in nursing and polytechnic school students, respectively (rate difference, 9.7 conversions per 100 person‐years; 95% CI, 4.5–14.8 conversions per 100 person‐years). Nursing students reportedly nursed 20,868 inpatients with tuberculosis during 315 person‐years of training.

Conclusions.Both groups had high TST conversion rates, but the extremely high rates among nursing students imply high occupational exposure to Mycobacterium tuberculosis. Intense exposure to inpatients with tuberculosis was reported during training. Better prevention, surveillance, and management of institutional M. tuberculosis transmission need to be supported as part of the international response to the severe human immunodeficiency virus infection epidemic and health care worker crisis in Africa.

Received 2 July 2006; accepted 29 August 2006; electronically published 29 December 2006.

  • (See the editorial commentary by Cobelens on pages 324–6)

Reprints or correspondence: Dr. Elizabeth Corbett, Biomedical Research and Training Institute, National Institute of Health Research, Josiah Tongogara Ave., PO Box CY 1753 Causeway, Harare, Zimbabwe ().

Cited by

Stephen D Lawn, Gavin Churchyard. (2009) Epidemiology of HIV-associated tuberculosis. Current Opinion in HIV and AIDS 4:4, 325-333
Online publication date: 1-Aug-2009.
CrossRef
Frank G. J. Cobelens. (2007) Editorial Commentary: Tuberculosis Risks for Health Care Workers in Africa. Clinical Infectious Diseases 44:3, 324-326
Online publication date: 1-Feb-2007.
Citation-Full Text-PDF Version (180 kB)
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