The Infectivity of Pulmonary Tuberculosis in Korean Army Units: Evidence from Outbreak Investigations / 결핵

BACKGROUND: Tuberculosis (TB) causes substantial health burden to the Korean military. This study aims to assess the impact of infectious TB cases on close and casual contacts in the Korean Army settings based on contact investigation data. METHODS: Six Army units with infectious TB cases from September 2012 to May 2013 were enrolled in the study. We analyzed the clinical data from close and casual contacts screened using the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube to identify latent tuberculosis infection (LTBI) cases. For the control group, 286 military conscripts with no reported TB exposure were tested by TST only. RESULTS: Of the 667 contacts of index cases, LTBI cases identified were as follows: 21.8% of close contacts of smear-positive cases (71/326), 8.5% of casual contacts of smear-positive cases (26/305), and 2.8% of close contacts of smear-negative cases (1/36). In the control group, 16.8% showed positivity in TST. In a multivariate analysis, having stayed in the same room or next room with TB patients was identified as a risk factor of LTBI. CONCLUSION: Using the data from TB contact investigations in the Korean Army units, we found an overall LTBI rate of 14.7% among the contacts screened. This study demonstrates that contacts living in the same building, especially the same room or next room, with TB patients are at a high risk of acquiring LTBI, serving as additional evidence for defining close and casual contacts of a TB patient with regard to Army barrack settings.

Experiences of Latent Tuberculosis Infection Treatment for the North Korean Refugees / 결핵

BACKGROUND: Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC). METHODS: TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively. RESULTS: Among tuberculin skin test (TST) ≥10 mm (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea (42.8±9.9 years vs. 35.4±10.0 years, p<0.01). Additionally, the mean TST size was significantly bigger in NKR (17.39±3.9 mm vs. 16.57±4.2 mm, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159–20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191–9.974; p=0.02). CONCLUSION: LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.

The Infectivity of Pulmonary Tuberculosis in Korean Army Units: Evidence from Outbreak Investigations / 결핵및호흡기질환

BACKGROUND@#Tuberculosis (TB) causes substantial health burden to the Korean military. This study aims to assess the impact of infectious TB cases on close and casual contacts in the Korean Army settings based on contact investigation data.@*METHODS@#Six Army units with infectious TB cases from September 2012 to May 2013 were enrolled in the study. We analyzed the clinical data from close and casual contacts screened using the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube to identify latent tuberculosis infection (LTBI) cases. For the control group, 286 military conscripts with no reported TB exposure were tested by TST only.@*RESULTS@#Of the 667 contacts of index cases, LTBI cases identified were as follows: 21.8% of close contacts of smear-positive cases (71/326), 8.5% of casual contacts of smear-positive cases (26/305), and 2.8% of close contacts of smear-negative cases (1/36). In the control group, 16.8% showed positivity in TST. In a multivariate analysis, having stayed in the same room or next room with TB patients was identified as a risk factor of LTBI.@*CONCLUSION@#Using the data from TB contact investigations in the Korean Army units, we found an overall LTBI rate of 14.7% among the contacts screened. This study demonstrates that contacts living in the same building, especially the same room or next room, with TB patients are at a high risk of acquiring LTBI, serving as additional evidence for defining close and casual contacts of a TB patient with regard to Army barrack settings.

Experiences of Latent Tuberculosis Infection Treatment for the North Korean Refugees / 결핵및호흡기질환

BACKGROUND@#Tuberculosis (TB) is increasing in immigrants. We aimed to investigate the current status of latent tuberculosis infection (LTBI) treatment for North Korean Refugees (NKR) compared to South Koreans Contacts (SKC).@*METHODS@#TB close contacts in a closed facility of SKC and NKR who underwent LTBI screening in a settlement support center for NKR were analyzed retrospectively.@*RESULTS@#Among tuberculin skin test (TST) ≥10 mm (n=298) reactors, the males accounted for 72.2% in SKC (n=126) and 19.5% in NKR (n=172) (p<0.01). The mean age was higher in South Korea (42.8±9.9 years vs. 35.4±10.0 years, p<0.01). Additionally, the mean TST size was significantly bigger in NKR (17.39±3.9 mm vs. 16.57±4.2 mm, p=0.03). The LTBI treatments were initiated for all screened NKR, and LTBI completion rate was only 68.0%. However, in NKR, LTBI treatment completion rate was significantly increased by shorter 4R regimen (odds ratio [OR], 9.296; 95% confidence interval [CI], 4.159–20.774; p<0.01) and male (OR, 3.447; 95% CI, 1.191–9.974; p=0.02).@*CONCLUSION@#LTBI treatment compliance must be improved in NKR with a shorter regimen. In addition, a larger study regarding a focus on LTBI with easy access to related data for NKR should be conducted.

Occupational Risk of Latent Tuberculosis Infection in Health Workers of 14 Military Hospitals

Tuberculosis (TB) is a known occupational risk to health workers. Identifying risk factors in health care settings is critical to the prevention of TB for health workers and patients. In 2014, we carried out a TB screening and survey for 902 health workers from 14 selected military hospitals to determine the prevalence rate of latent tuberculosis infection (LTBI) as well as occupational risk factors. Of all subjects, 19.5% reported having provided TB patient care for 1 year or more (176/902), and 26.9% (243/902) were positive for the tuberculin skin test (TST) (10 mm or more of induration). Additionally, 21.4% (52/243) of those who tested positive were also positive for the interferon-gamma release assay (IGRA). The proportion of LTBI in the study population was 5.8% (52/902). In a multivariate logistic regression analysis, providing TB patient care for one year or more was the only significant occupational risk factor (adjusted odds ratio [aOR], 2.27; 95% confidence interval [CI], 1.13–4.56). This study suggests that military health workers working with TB patients should be regularly examined by chest radiography, TST and IGRA to detect LTBI in the early stage and control nosocomial infection of TB.

The Prevalence Rate of Tuberculin Skin Test Positive by Contacts Group to Predict the Development of Active Tuberculosis After School Outbreaks / 결핵및호흡기질환

BACKGROUND: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. METHODS: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. RESULTS: The mean duration of follow-up was 3.9+/-0.9 years. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ > or = 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). CONCLUSION: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.

Factors Affecting on the Work-related Performance Level of TB Control Manpower / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the degree of performance of TB control manpower in Korea and to identify the affecting factors associated with it. METHODS: This study employed a quantitative observational with cross-sectional design and the subjects were consisted of 189 TB (Tuberculosis) control manpower who were working in both community health centers and private hospitals. Variables included in this study were demographic, social, work-related characteristics, aqhnd self-efficacy. A reliability of the instrument for the performance was Cronbach's alpha=.91. Data were analyzed by t-test, ANOVA and multiple regression using SPSS (19th version). RESULTS: The mean value of the degree of work-related performance of TB control manpower was 4.4+/-0.49 and it was higher than those of general nurses working in any other health care departments. The mean differences in the degree of work-related performance were in self-efficacy, workplace, the number of full charge manpower in TB, the number of participation in in-depth education, and the willingness to job maintenance. In multiple regression analysis, factors associated with TB control manpower' work-related performance were self-efficacy (beta =.164, p=.025), workplace (beta=-.186, p=.023), the number of participation in in-depth education(beta=.339, p<.002), and the willingness to job maintenance (beta=-.157, p=.036). CONCLUSION: Results of this study showed that work-related performances of manpower working in private hospital were higher than those of manpower in public health centers. So, it is necessary to enhance nation's active intervention to improve effectiveness and reduction of risk factors in TB policy.

Factors Affecting Tuberculosis (TB) Control Nurses' Job Satisfaction

PURPOSE: The purpose of this study was to investigate factors associated with perceived job satisfaction of TB control nurses in Korea. METHODS: This study employed a descriptive survey research design using data for 189 TB control nurses. Variables included in this study were demographic, social, and work-related characteristics (including job stress), and job satisfaction. ANOVA, t-test,and multiple regression analyses were performed using SPSS/WIN 19.0 program. RESULTS: The mean value of perceived job satisfaction was lower in the subjects (2.9+/-0.41) than in general nurses working in other departments. In multiple regression analysis, factors associated with TB control nurses' job satisfaction were job stress (beta=-.281, p<.001), marital status (beta=-.229, p<.001), and the number of TB control nurses employed (beta=.200, p<.001). CONCLUSION: The results of this study showed that job satisfaction was associated more significantly with job-related characteristics than with non-job-related variables in workplace. Along with increased TB control nurse staffing, efforts should be made to reduce negative workplace issues such as job stress and inappropriate pay to improve the subject's job satisfaction.

Factors Affecting on the Work-related Performance Level of TB Control Manpower / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the degree of performance of TB control manpower in Korea and to identify the affecting factors associated with it. METHODS: This study employed a quantitative observational with cross-sectional design and the subjects were consisted of 189 TB (Tuberculosis) control manpower who were working in both community health centers and private hospitals. Variables included in this study were demographic, social, work-related characteristics, aqhnd self-efficacy. A reliability of the instrument for the performance was Cronbach's alpha=.91. Data were analyzed by t-test, ANOVA and multiple regression using SPSS (19th version). RESULTS: The mean value of the degree of work-related performance of TB control manpower was 4.4+/-0.49 and it was higher than those of general nurses working in any other health care departments. The mean differences in the degree of work-related performance were in self-efficacy, workplace, the number of full charge manpower in TB, the number of participation in in-depth education, and the willingness to job maintenance. In multiple regression analysis, factors associated with TB control manpower' work-related performance were self-efficacy (beta =.164, p=.025), workplace (beta=-.186, p=.023), the number of participation in in-depth education(beta=.339, p<.002), and the willingness to job maintenance (beta=-.157, p=.036). CONCLUSION: Results of this study showed that work-related performances of manpower working in private hospital were higher than those of manpower in public health centers. So, it is necessary to enhance nation's active intervention to improve effectiveness and reduction of risk factors in TB policy.

Diagnostic Accuracy of Notified Cases as Pulmonary Tuberculosis in Private Sectors of Korea

The diagnostic accuracy of the data reported in the Korean tuberculosis surveillance system (KTBS) has not been adequately investigated. We reviewed the clinical data of pulmonary tuberculosis (PTB) cases notified from private medical facilities through KTBS between January and June, 2004. PTB cases were classified into definite (culture-proven), probable (based on smear, polymerase chain reaction, histology, bronchoscopic finding, computed tomography, or both chest radiograph and symptoms) or possible (based only on chest radiograph) tuberculosis. Of the 1126 PTB cases, sputum AFB smear and culture were requested in 79% and 51% of the cases, respectively. Positive results of sputum smear and culture were obtained in 43% and 29% of all the patients, respectively. A total of 73.2% of the notified PTB cases could be classified as definite or probable and 81.7% as definite, probable, or possible. However, where infection was not confirmed bacteriologically or histologically, only 60.1% of the patients were definite, probable, or possible cases. More than 70% of PTB notified from private sectors in Korea can be regarded as real TB. The results may also suggest the possibility of over-estimation of TB burden in the use of the notification-based TB data.

Boosted Reaction on Two-Step Tuberculin Skin Test among Military Personnel in South Korea, a Setting with an Intermediate Burden of Tuberculosis and Routine Bacille Calmette-Guerin Vaccination

This study was performed to estimate the rate of boosted reaction in the two-step tuberculin skin test (TST) and to evaluate the associated factors among military personnel of South Korea, which has an intermediate burden of tuberculosis (TB) and a routine bacille Calmette-Guerin (BCG) vaccination policy. Two-step TST was performed on 264 military personnel who did not have a history of close contact to TB. Subjects with a negative reaction to the first test of or =10 mm) on the initial TST was observed in 126 (48%) of the subjects. A boosted reaction on the second TST developed in 32 (23%) of the 124 subjects with a negative initial TST. In multiple logistic regression analysis, the size of the initial TST reaction was the only factor associated with a boosted reaction on the second TST. The high rate of boosted reaction among healthy adults in South Korea suggests that two-step TST should be performed to assess the baseline TST reactivity in settings with an intermediate burden of TB and routine BCG vaccination policy, especially among subjects with an initial TST reaction that is > or =5 mm.

Tuberculosis among Dislocated North Koreans Entering Republic of Korea since 1999

The collapse of North Korea's public health system has increased the development of tuberculosis (TB) in its populace. This study investigated the prevalence of active and latent TB infection (LTBI) in such people who have settled in the Republic of Korea since 1999. From 1999 to August 2006, 7,722 dislocated North Koreans entered the Republic of Korea and all were screened immediately for active TB. Demographic and clinical characteristics were reviewed from the official records of the Settlement Support Office for Dislocated North Koreans, based in the Ministry of Unification. Of 7,722 participants, 87 (1.13%) were diagnosed with active TB from 1999 to August 2006. Of these, 78 (90%) had pulmonary TB. Checking for the presence of a Bacille Calmette-Guerin (BCG) scar and tuberculin skin test has been performed in all dislocated North Koreans since November 2005. Of 1,112 participants, BCG vaccination scars were found in 67.4%. The tuberculin-positive rate using two tuberculin unit doses of the purified protein derivative RT23 (> or =10 mm in diameter) was 81.5%. The prevalence of active TB and LTBI in dislocated North Koreans was high. Because this group bears a disproportionate burden of TB, we need to initiate a specific control programme and to plan for the impact of this disease in the Republic of Korea.

A Clinical Manifestation of Meckel's Diverticulum

PURPOSE: The diagnosis of Meckel's diverticulum is difficult and delayed because it presents with various clinical symptoms. We evaluated clinical, imaging and pathologic findings of Meckel's diverticulum to facilitate detection of Meckel's diverticulum in children. METHODS: Review of clinical, imaging, surgical and pathological findings in 10 children aged 7 days to 14 years with Meckel's diverticulum during an 8-year period, 1993-2001, at Ewha Womans University Hospital was undertaken. RESULTS: The male to female ratio was 2.3 : 1. The chief complaint was painless lower gastrointestinal(GI) bleeding; others were abdominal pain, abdominal distention and vomiting, in order of frequency. The diagonsis before surgery were Meckel's diverticulum in 5 patients, non-reducible intussusception in 3 patients and intestinal obstruction in 2 patients. The diverticulum was located between 35 cm to 70 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 4 cm to 12 cm and 80% of it was within 5 cm. A Meckel scan(99mTc-pertechnetate scintigraphy) after cimetidine administration was done in 6 cases. All 5 cases that presented with lower GI bleeding had ectopic gastric mucosa confirmed on pathology. Out of 5 cases of ectopic gastric mucosa, only 4 cases were positive on the Meckel's scan. CONCLUSION: In cases of unexplained GI bleeding, obstruction, or inflammation diagnostic workup should be carried out to rule out Meckel's diverticulum. Laparoscopy, high resolution ultrasonography and computed tomography of the abdomen may be indicated in the assessment of pediatric patient with lower GI bleeding, especially in patients with suspected bleeding from Meckel's diverticulum showing negative Meckel's scan.