TB Infection Control

Hi D'Arcy,

I have a draft policy for Harvard University prompted by an email from a medical student who expected to be doing sputum induction on MDR/XDR patients in S. Africa and wondered if there was more to do than just bring a box of PRs. I did not know where to begin.

I drafted a policy that is hung up in university legal offices, so I would prefer to share the draft with you one on one. It includes being very clear about the risks involved as best they can be predicted and excluding students, researchers, and others where safety cannot be reasonably addressed. I recommend building capacity in-country since workers are often self conscious about wearing respirators, for example, if no local workers wear them. I have some suggestions about better reusable respirators. I recommend BCG vaccination for US health workers and researchers who are working in endemic MDR/XDR areas. Having IGRAs to diagnose TB infection without the confounding of BCG-induced TST reactions is one argument for returning to BCG. Although there is no good data on adult HCWs being vaccinated to prevent drug resistant TB, there are sound reasons to believe that having your ...

Hi D'Arcy,

I have a draft policy for Harvard University prompted by an email from a medical student who expected to be doing sputum induction on MDR/XDR patients in S. Africa and wondered if there was more to do than just bring a box of PRs. I did not know where to begin.

I drafted a policy that is hung up in university legal offices, so I would prefer to share the draft with you one on one. It includes being very clear about the risks involved as best they can be predicted and excluding students, researchers, and others where safety cannot be reasonably addressed. I recommend building capacity in-country since workers are often self conscious about wearing respirators, for example, if no local workers wear them. I have some suggestions about better reusable respirators. I recommend BCG vaccination for US health workers and researchers who are working in endemic MDR/XDR areas. Having IGRAs to diagnose TB infection without the confounding of BCG-induced TST reactions is one argument for returning to BCG. Although there is no good data on adult HCWs being vaccinated to prevent drug resistant TB, there are sound reasons to believe that having your macrophages and lymphocytes primed with BCG is better than encountering TB immunologically naïve. I also recommend some unproven preventive treatments for MDR/XDR.

There are hordes of health care workers finding their way to help in Africa. A few cases of XDR TB among students, etc. could quickly sink these programs. I have been a lone voice at Harvard making this case, so others need to get on board.

Ed

Edward A. Nardell, M.D.
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)

Brigham and Women's Hospital
Divisions of Global Health Equity and Pulmonary Medicine
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115

In addition, I will e-mail Robin Vincent-Smith (MSF) in the morning . . . Robin did a lot of work in South Africa.

Regards,

Paul J

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