MISSED OPPORTUNITIES FOR TUBERCULOSIS PREVENTION

Background: With the recent resurgence of tuberculosis in the United S tates, it is unclear whether existing prevention strategies can succes sfully control and eliminate the disease. We determined the extent to which opportunities for prevention were missed among patients with tub erculosis. Methods: For all patients with active tuberculosis reported to the Oregon Health Division, Portland, from July 1991 through June 1992, we determined previous history of tuberculosis therapy, previous tuberculin skin test status, the presence of medical conditions for w hich skin testing is recommended, and previous health care. We then de termined whether they had undergone preventive procedures in accordanc e with current recommendations of the Advisory Council for the Elimina tion of Tuberculosis. Results: Of 153 patients with active tuberculosi s, 90 (59%) had indications for-but had not previously undergone-recom mended procedures. Ten patients (7%) did not complete therapy for prev ious disease; two (1%) did not complete preventive therapy; 12 (8%) wi th known previous positive tuberculin skin tests and an indication for preventive therapy never received it; and 66 (43%) with known indicat ions for screening never received a skin test. Indications for skin te sting included exposure to active tuberculosis (44%), predisposing med ical conditions (83%), previous residence in an institution (24%), and birth in a country with a high prevalence of tuberculosis (29%). Conc lusions: Based on their known effectiveness, a major reduction in tube rculosis morbidity could occur if preventive measures were fully imple mented. Appropriate skin testing is a prevention strategy of major imp ortance. Priorities should include working to change provider practice to better ensure that persons with indications routinely receive tube rculin skin tests.