Tuberculosis and homelessness in Montreal: a retrospective cohort study

BMC Public Health

Research Article

Paul Rivest¹  Louise Thibert²  Fiona McIntosh³  Marcel A Behr⁴  Jason Tan de Bibiana⁵  Alice Zwerling⁶  Carmine Rossi⁶  Dick Menzies⁷  Kevin Schwartzman⁸ 

[1] Direction de la Santé publique, Agence de la santé et des services sociaux, Montreal, Quebec, Canada;Département de médecine social et préventive, Université de Montréal, Montreal, Quebec, Canada;Laboratoire de Santé publique du Québec, Ste-Anne-de-Bellevue, Quebec, Canada;Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada;Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada;Division of Infectious Diseases and Medical Microbiology, McGill University, Montreal, Quebec, Canada;Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada;Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada;Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada;Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada;Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;Respiratory Division, McGill University, Montreal, Quebec, Canada;Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada;Respiratory Division, McGill University, Montreal, Quebec, Canada;

关键词: Tuberculin Skin Testing;    Contact Investigation;    Homeless Person;    Homeless Population;    Public Health Department;   

DOI  :  10.1186/1471-2458-11-833

 received in 2011-07-15, accepted in 2011-10-28,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundMontreal is Canada's second-largest city, where mean annual tuberculosis (TB) incidence from 1996 to 2007 was 8.9/100,000. The objectives of this study were to describe the epidemiology of TB among homeless persons in Montreal and assess patterns of transmission and sharing of key locations.MethodsWe reviewed demographic, clinical, and microbiologic data for all active TB cases reported in Montreal from 1996 to 2007 and identified persons who were homeless in the year prior to TB diagnosis. We genotyped all available Mycobacterium tuberculosis isolates by IS6110 restriction fragment length polymorphism (IS6110-RFLP) and spoligotyping, and used a geographic information system to identify potential locations for transmission between persons with matching isolates.ResultsThere were 20 cases of TB in homeless persons, out of 1823 total reported from 1996-2007. 17/20 were Canadian-born, including 5 Aboriginals. Homeless persons were more likely than non-homeless persons to have pulmonary TB (20/20), smear-positive disease (17/20, odds ratio (OR) = 5.7, 95% confidence interval (CI): 1.7-20), HIV co-infection (12/20, OR = 14, 95%CI: 4.8-40), and a history of substance use. The median duration from symptom onset to diagnosis was 61 days for homeless persons vs. 28 days for non-homeless persons (P = 0.022). Eleven homeless persons with TB belonged to genotype-defined clusters (OR = 5.4, 95%CI: 2.2-13), and ten potential locations for transmission were identified, including health care facilities, homeless shelters/drop-in centres, and an Aboriginal community centre.ConclusionsTB cases among homeless persons in Montreal raise concerns about delayed diagnosis and ongoing local transmission.

【 授权许可】

Unknown   
© de Bibiana et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.