1547. Changes in Mycobacterium tuberculosis Epidemiology at a Large Cancer Center: Development of a Pre-Arrival Screening Strategy for Exposure Control
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • TB Poster v1_SP.pdf (395.3 kB)
  • Background:

    A single M. tuberculosis (TB) case has the potential to lead to transmission in cancer centers where the majority of patients are immunocompromised.  Patients with active TB can present with symptoms and or pulmonary abnormalities that raise suspicion for cancer, leading to referral to such centers.

    Methods:  

    The Seattle Cancer Care Alliance (SCCA) Infection Prevention Program initiated a TB risk assessment after two unrelated cases of pulmonary TB were diagnosed in May 2012.  We developed a screening questionnaire of TB risk factors that was administered prior to arrival.  Targeting two high-risk subspecialty clinics (head, neck and lung oncology and pulmonary nodule clinics), patients at risk for TB underwent testing prior to arrival or were seen in airborne precautions on first visit.

    Results:

    Prior to 2012, TB incidence at the SCCA was low, with a frequency of approximately one case per 300,000 unduplicated patients served annually.  During 2012, four cases of TB were identified: two pulmonary and two extrapulmonary.  All cases were from countries with high TB incidence (75-385/100,000 per year).  From June 2012 to April 2013, targeted TB screening for patients receiving care in two clinics detected risk factors in 24/860 (2.7%); an additional seven patients were identified in other clinics.  The most common risk factors identified were: history of living in or extensive travel to a TB endemic country, 18 (58%); symptoms of active TB, 10 (32%); history of a positive TB test, 6 (23%); close contact/family with TB, 4 (13%); reported history of TB, 3 (10%); living situation/employment, 2 (6%).  Of those with risk factors who completed TB evaluation, 23 (74%) were ruled out, three (10%) were diagnosed with nontuberculous mycobacteria, and two (6%) had extrapulmonary TB.  Three (10%) additional patients were referred to other healthcare organizations; their TB-related outcomes are unknown.  Due to pre-visit screening, only a small number of patients required isolation 22.6% (7/31) at their first visit.

    Conclusion:

    Administration of a standardized TB screening questionnaire in targeted oncology populations is an effective means to identify at high-risk patients. Pre-arrival evaluation of these patients has the potential to reduce unprotected exposures in outpatient environments with such vulnerable populations.

    Sara Podczervinski, RN, MPH1, Christopher Spitters, MD, MA, MPH2,3,4, Lois Helbert, RN1, David Madtes, MD1,3,5, Guang-Shing Cheng, MD1,3,5, Nicole Kelimoff, BS1, Anna Westburg, BS1, Keith Eaton, MD, PhD1,3,5, Masa Narita, MD2,3 and Steven Pergam, MD, MPH1,3,5, (1)Seattle Cancer Care Alliance, Seattle, WA, (2)Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, WA, (3)Department of Medicine, University of Washington, Seattle, WA, (4)Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, (5)Fred Hutchinson Cancer Research Center, Seattle, WA

    Disclosures:

    S. Podczervinski, None

    C. Spitters, None

    L. Helbert, None

    D. Madtes, None

    G. S. Cheng, None

    N. Kelimoff, None

    A. Westburg, None

    K. Eaton, None

    M. Narita, None

    S. Pergam, None

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