Funeral Homes Two cases of tuberculosis transmission from cadavers to embalmers have recently been documented (Lauzardo et al., 2000; Sterling et al., 2000a). Before death, one individual had been under treatment for AIDS and active tuberculosis. The employee who embalmed the body was diagnosed with active tuberculosis, and DNA fingerprinting showed that the strain matched that from the cadaver (Sterling et al., 2000a). Investigators suggested aerosolization from the airway during the embalming process as a possible means of transmission. In the other case of transmission related to embalming, DNA fingerprinting again linked the disease in the embalmer to a deceased person under treatment for AIDS and rifampin-resistant tuberculosis (Lauzardo et al., 2000).

COMMITTEE CONCLUSIONS

Context

Are health care, correctional, and selected other categories of workers at greater risk of infection, disease, or mortality due to tuberculosis than others in the community in which they reside? This question has no simple yes-or-no answer. Instead, conclusions must be qualified to reflect the

  • changing epidemiology of tuberculosis,

  • continuing geographic variation in tuberculosis case rates,

  • evolving institutional and public responses to tuberculosis in the community and the workplace, and

  • ongoing risk from people with undiagnosed infectious tuberculosis.

The changing epidemiology of tuberculosis encompasses both the decline in the number of tuberculosis cases and case rates since 1993 and the decline in the proportion of cases accounted for by multidrug-resistant disease, as described in Chapter 1. Overall, fewer cases of tuberculosis and less multidrug-resistant disease means less risk for nurses, doctors, correctional officers, and others who work for organizations that serve people who have tuberculosis or who are at increased risk of the disease.

Despite the general decline in rates of tuberculosis in recent years, marked geographic variation in tuberculosis case rates persists. Today, as in the past, a few states and cities account for a disproportionate share of cases of active tuberculosis. Nonetheless, even within areas with relatively high rates of tuberculosis, risks to health care and other workers are not equal. Some hospitals have policies to transfer rather than treat patients with suspected or confirmed tuberculosis. Many nursing homes, jails, and other facilities will not accept persons known to have active tuberculosis. Although these policies should reduce risk, workers may still be exposed to individuals with undetected disease. In contrast to these “transfer rather than treat” institutions are the so-called safety net hospitals whose workers



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