Suspected transmission of tuberculosis in a maternity ward from a smear-positive nurse: preliminary results of clinical evaluations and testing of neonates potentially exposed, Rome, Italy, 1 January to 28 July 2011

Abstract

We report preventive measures adopted after tuberculosis (TB) transmission from a nurse to a newborn assessed in late July 2011. All exposed neonates born between January and July 2011 were clinically evaluated and tested by QuantiFERON TB gold in-tube; newborns testing positive were referred for prophylaxis. Of 1,340 newborns, 118 (9%) tested positive and no other active cases of TB were found. Active surveillance for TB will be continued over the next three years for all those exposed.

High rate of Quantiferon positive and tuberculin negative tests in infants born at a large Italian University Hospital in 2011: a cautionary hypothesis

“…1 The absence of precise estimates of QTF-IT sensitivity and specificity in neonates and infants (,2 years old children) in current literature is of serious concern, and actually implies inability of accepting a single, isolated positive QTF-IT result as indicative of LTBI in this age setting. In one of the very few studies in this area that was conducted in a Several additional considerations seem to be appropriate to this case.…”

“…The possible exposure timeframe was therefore limited to a couple of days maximum in most children. 1 Henceforth, the likelihood/risk of infection under this setting would be estimated to be very low. In fact, this is supported by previous work showing that in closely similar events, no or very few infants were infected).…”

“…Noteworthy, a case of pulmonary and extrapulmonary (spleen) TB in a four-month-old infant was suspected to be linked to the index case. 1 Immediately after TB diagnosis, a protocol for epidemiological investigation and adoption of preventive measures was established by an ad hoc task force of hospital infection specialists and public health officers. Extensive contact investigations in newborns for latent TB infection (LTBI) were initially made by the use of Quantiferon TB Gold in-tube (QTF-IT) rather than the tuberculin skin test (TST, Mantoux reaction) for the reasons detailed below.…”

Costs of a contact screening activity in a neonatal intensive care unit

“…[2][3][4][5][6][7][13][14][15][16][17] This may add confidence that a staged approach for future TB screening activities in neonatal settings can be a safe and cost-effective alternative to initially screening all potentially exposed neonates.…”

“…2,5,[13][14][15][16] We estimate the total cost to the hospital of this screening investigation was $128 430. This may underestimate the true cost as some items could not be quantified, including the cost of screening the 15 neonates and their relatives who attended other facilities for screening, the cost to families of travel to the clinics and pharmacy, and the investigation hotline.…”