Article
Tuberculosis in 14 au pairs in Germany
Tuberkulose bei 14 Au Pairs in Deutschland
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Published: | June 2, 2010 |
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Objectives: To assess the risk of tuberculosis infection in host families of au pairs with tuberculosis in Germany.
Methods: Retrospective study of au pairs with tuberculosis and their contacts. Data were registered by German local health authorities.
Results: Between 2002 and 2009, ten au pairs with sputum smear positive (ss+) tuberculosis were registered by local health authorities in Bavaria; three individual reports of other states (Baden-Wurttemberg, Hessen, Northrhine-Westfalia) are included in the report. One case was detected by screening. Demographic data: 14 women, mean age 22.5 yrs (range 19–27). Country of origin: Kenia (5 cases), Georgia (4 cases), Mongolia (2 cases), Russia, Romania, Nepal (1 case each). Time between entry and first symptoms: median 6 months (range 0–18 months). Time between first symptoms and diagnosis: median 2.8 months (range 0.7–4.7 months).
Infection in contacts: In two cases, the diagnosis was established in less than four weeks after the onset of symptoms. There was no tuberculosis infection in the respective host families; one ss+ tuberculosis occurred 12 months later in the sister of one au pair; fingerprinting was not performed.
One case was detected by screening with an interferon-gamma-release-assay; diagnosis was made by x-ray, sputum cultures were negative; no infection occurred in the host familiy.
In 11 cases, diagnosis of ss+ tb was established after a delay of 1.3–5 months after the onset of symptoms. In each of these 11 cases, at least one infection occurred; a total of 39 persons were infected: 12 children, 4 mothers and 5 fathers in the host families as well as 7 children and 11 adults with close contact to the au pairs. Most infected children adhered to isoniazid prophylaxis. One child and two adults developed tuberculosis; in one case, molecular fingerprinting confirmed mycobacterial identity.
Conclusions: Tuberculosis in au pairs from high prevalence countries represents a risk for tuberculosis infection in the host families, especially in young children. Since first symptoms of tuberculosis developed after 0–18 months after entry, screening by x-ray before entry would not have been diagnostic in most cases. Screening should be performed after the arrival of au pairs in Germany and consist of a check for symptoms and an interferon-gamma-release-assay. If either is positive, a chest x-ray should be performed, and information about tuberculosis should be given to the au pair and the host family.