TUBERCULOSIS IN ELDERLY RESIDENTS OF LONG-TERM-CARE FACILITIES IN QUEBEC - ARE SCREENING AND CHEMOPROPHYLAXIS INDICATED

Different strategies for the prevention and control of tuberculosis in facilities providing long-term care (LTCF) to the elderly were propos ed by the U.S. Public Health Service (USPHS) and the Quebec Ministry o f Health and Social Services (MHSS). Controversies regarding the scree ning and chemoprophylaxis of tuberculosis in the elderly were reviewed , the epidemiology of tuberculosis in the United States and Quebec was compared and the number of cases expected annually was estimated from estimates available in the literature. Method: Fifty-five scientific articles and official documents identified in the Medline database wer e analyzed. Results: U.S. epidemiologic data support screening and che moprophylaxis but in Quebec, the absence of reported increase risk in LTCF explains the reservations of the MHSS. According to our estimates , expected cases of tuberculosis might be underestimated. Conclusion: In Quebec, the best strategy to control tuberculosis is not yet obviou s. A precise estimation of the number of undiagnosed cases in this env ironment would help clarify the dilemma.