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Dear all,

I would like to hear your opinions and recommendations regarding infection control measures for patients on MDR TB treatment that have already achieved sputum conversion; particularly, measures related to activities out of household and health units, like attending schools, churches, social gatherings, etc. What do you routinely recommend to patients? Thank you.

 
Grigory Volchenkov, MD
Replied at 4:25 AM, 8 Jul 2010

Dear Marcio,

I would like to share our experience in Vladimir, Russia regarding TB IC measures for sputum converted MDR TB patients on SLD treatment.

Most of these patients continue directly observed treatment on out-patient basis. Since the both susceptible and DR TB patients became much less contagiuos in few weeks or even days after beginning of effective treatment based on DST results, we do not require for them to use surgical mask (or for family members or HCW to use respirator).

To further decrease TB transmission risk we have to be sure that the patient stays at least most of the time in the separate room (or out doors) at home, avoids social gatherings which take place indoors, does not attend classes etc. For children it is recommended to organize education at home. All these measures are to be followed as long as the treatment is not completed successfully.

I believe that the risk of TB transmission from sputum converted patient on effective treatment is very low. But in real life we in some cases can not be sure that the treatment is really based on reliable DST. So at least monthly sputum smear microscopy should be recommended for at least symptomatic patients.

Would be interesting to learn what is the aproach to such patients in other parts of the world?

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