Volume 12, Number 9—September 2006
Perspective
Nosocomial Tuberculosis in India
Madhukar Pai*†
, Shriprakash Kalantri†, Ashutosh Nath Aggarwal‡, Dick Menzies§, and Henry M. Blumberg¶
, Shriprakash Kalantri†, Ashutosh Nath Aggarwal‡, Dick Menzies§, and Henry M. Blumberg¶
Table 3
Research needs on nosocomial TB in India*
| Area | Specific research questions |
|---|---|
| Epidemiology and prevalence of disease | What is the prevalence and incidence of latent and active TB among HCWs? Is TB in HCWs more prevalent than in the community? |
| Molecular epidemiology of transmission of Mycobacterium tuberculosis in healthcare settings | What is the likelihood of person-to-person transmission in healthcare settings? How common are nosocomial outbreaks? |
| Risk factors for exposure to M. tuberculosis and risk factors for acquiring LTBI and active disease | What are risk factors for acquiring TB? What are risk factors for patient-to-patient transmission? Why is extrapulmonary disease more common than pulmonary TB among HCWs? |
| Evaluation of newer diagnostic tools | What is the utility of IGRAs to estimate risk of infection among HCWs? Are IGRAs more accurate, feasible, and cost-effective than TSTs for serial testing of HCWs? |
| Interventions to reduce nosocomial transmission | What simple, feasible interventions can reduce nosocomial transmission? What is the cost-effectiveness of control programs, and what are long-term benefits to the health system? In HCWs with repeated exposure, what is the long-term efficacy of preventive therapy? |
| Social, operational, and behavioral issues | What operational and logistic factors increase risk for nosocomial exposure? How common are diagnostic and treatment delays, and how do they affect exposure levels? How does prolonged hospital stay affect risk for nosocomial transmission? How knowledgeable and aware of nosocomial TB are HCWs? What factors affect HCW adherence to interventions that might reduce transmission? How does TB among HCWs affect the healthcare workforce, and how does it affect healthcare delivery? What resources for TB infection control are available in India, and what type of variability exists across healthcare facilities in various states? |
*TB, tuberculosis; HCW, healthcare worker; LTBI, latent TB infection; IGRA, interferon-γ release assay; TST, tuberculin skin test.
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