News Scan for Sep 29, 2015

Immigrant TB screening
New Bronx Legionella cluster

Blanket immigrant TB screening inefficient, study says

Blanket screening of all immigrants for tuberculosis (TB)—as is done in Canada, the United States, Australia, and some European countries—wastes resources and should instead focus on only those arriving from high-risk countries, according to a study from University of Toronto researchers published yesterday in the Canadian Medical Association Journal (CMAJ).

The investigators linked pre-immigration medical records for 944,375 immigrants who settled in Ontario from 2002 to 2011 to active TB reporting data in Ontario in the same period.

They found that immigrants from 6 countries accounted for 87.3% of active TB cases detected through pre-immigration screening, and 10 countries accounted for 80.4% of cases detected. Although immigrants hailed from 214 countries, all cases of active TB were detected in people from just 35 nations.

"While the pre-immigration chest X-ray identifies active TB in some new immigrants, the risk of disease varies widely by the immigrants' country of origin," said lead author Kamran Khan, MD, MPH, a TB specialist at St. Michael's Hospital at the University of Toronto, according to a hospital press release.

"When we screen every new immigrant in precisely the same way, we unnecessarily consume valuable resources looking for active TB in populations where the probability of disease is essentially zero," he added.

The authors conclude, "Focusing preimmigration screening in countries with high incidence rates and revising criteria for postimmigration surveillance could increase the effectiveness and efficiency of screening."
Sep 28 CMAJ study
Sep 28 St. Michael's Hospital press release
Sep 28 CMAJ news release


Seven new Legionnaire's cases confirmed in Bronx

New York City health officials are investigating 7 new cases of legionellosis in the Bronx that are not related to a 128-case outbreak in the borough over the summer that killed 12, the New York City Department of Health and Mental Hygiene (NYC Health) said in a news release yesterday.

"We are investigating a cluster of seven cases of Legionnaires' disease in Morris Park. I urge all New Yorkers to seek care immediately if they have flu-like symptoms, including fever, cough, headache, or difficulty breathing. The Department is taking immediate steps to determine the source and protect the people who live and work in Morris Park," said NYC Health Commissioner Mary T. Bassett, MD, MPH.

The earlier outbreak was pinpointed to a cooling tower contaminated with Legionella bacteria at the Opera House Hotel in South Bronx. The source of the current cluster, located farther northeast, near the Bronx Zoo, has not been identified, but scientists have sampled area cooling towers in hopes of identifying a cause.

The newly confirmed patients range in age from 45 to 75, and all are hospitalized. Their cases were reported to NYC Health from Sep 21 to Sep 27.
Sep 28 NYC Health news release

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