A population-based study determining the incidence of tuberculosis attributable to HIV infection.

Although the tuberculosis (TB) epidemic has been attributed in part to the AIDS epidemic, few studies in the United States have measured the risk attributable to HIV infection. We linked the TB registry of Alameda County, California, 1985 to 1994, with the AIDS registry, 1982 to 1994. We defined a person with TB and HIV infection as a patient in the TB registry with the same name, race/ethnicity, gender, and date of birth as a patient in the AIDS registry. We used population and HIV seroprevalence estimates to determine the HIV-seropositive and -seronegative population at risk of TB in 1994. Of 1990 TB cases reported by Alameda County from 1985 to 1994, 116 (5.8%) had an AIDS diagnosis. Among 25- to 44-year-old TB patients, 25.2% of U.S.-born men and 8.4% of U.S.-born women had an AIDS diagnosis. In 1994, the estimated TB incidence rate in persons with HIV infection was 198.1 per 100,000 versus a rate of 13.9 of 100,000 among persons without HIV infection (rate ratio, 13.8; 95% confidence interval, 8.0, 23.8). In 1994, 93% of TB cases among HIV seropositive persons, 6.4% of all TB cases, and 16.7% of TB cases aged 25 to 44 years were attributable to HIV infection. The high attributable risk underscores the impact of HIV on the TB epidemic. All persons with HIV infection should be screened for TB, and persons with TB infection should be screened for HIV infection. TB/HIV coinfected patients should be provided with TB preventive therapy.

Sensitivity and specificity of pooled versus individual sera in a human immunodeficiency virus antibody prevalence study.

We evaluated the efficacy of testing pooled versus individual sera for the detection of human immunodeficiency virus antibody. A total of 5,000 individual specimens and 500 pools of 10 specimens each were assayed by an enzyme-linked immunosorbent assay. There was complete agreement in human immunodeficiency virus enzyme-linked immunosorbent assay reactivity for pooled versus individual specimens. An estimated savings of 60 to 80% (labor and supplies) can be realized dependent upon pooling and assay format.

Transfusion-acquired hepatitis A in a premature infant with secondary nosocomial spread in an intensive care nursery.

An outbreak of hepatitis A involving 15 nurses, two premature infants, and the mother of one infant occurred in an intensive care nursery. The infants became infected after receiving blood transfusions from a donor who shortly thereafter experienced symptoms compatible with hepatitis A and was later found to have serologic evidence of acute hepatitis A. Hepatitis was not suspected clinically in the infants but was documented serologically. One of the infants had an ileostomy with liquid intestinal drainage. Her mother and most, if not all, of the nurses acquired hepatitis from this infant. All 15 nurses had contact with this infant, whereas only four nurses had contact with the second infant. The amount of contact nurses had with this infant clearly was related to their risk of infection. Nurses not actually assigned to this infant but who reported some contact had a significantly lower attack rate than those assigned to the infant. Among assigned nurses, those assigned to more than one shift had 4.7 times the risk of acquiring hepatitis than those assigned to one shift only. No specific nursing techniques or personal habits were documented as being significant risk factors in the infected group of nurses.