TUBERCULOSIS - MEDICAL-STUDENTS AT RISK

In 1979 an outbreak of tuberculosis occurred in medical students at th e University of Sydney. Eight of 35 Mantoux-negative students who atte nded the autopsy of an immunosuppressed patient with unsuspected activ e tuberculosis became infected and one developed clinical disease. A r eport of the incident was prepared for publication because it supporte d the then controversial University policy of recommending BCG vaccina tion to medical and dental students in a country where the reported pr evalence of tuberculosis is very low. The report was never published, mainly in order to protect the privacy of the individual students invo lved, but also because it was felt by the administration of the time t hat it might undermine confidence in infection control procedures in t he autopsy room. The original report, updated and reproduced here, sug gested that tuberculosis might be an emerging nosocomial problem. This has been all too clearly realised since its re-emergence as an opport unistic infection in AIDS patients. Worldwide, the problem of antibiot ic resistance in Mycobacterium tuberculosis(1,2) provides an added ris k of a return to the situation which prevailed early this century when tuberculosis was a major occupational risk for young health care work ers. Infection often restricted career choices, even in those whose di sease was relatively benign. Our purpose in bringing this incident to light after so many years is to point out the relevance of the extensi ve studies of the problem which were conducted in the 1930s and 1940s to the current situation and to suggest that health care students are vulnerable to airborne infections as well as those spread by inoculati on injuries. In retrospect, our 1979 conclusions about prospects for p reventing nosocomial tuberculosis appear optimistic.