Investigation of tuberculosis contacts in the tuberculosis control program of a medium-sized municipality in the southeast of Brazil in 2002

559 Investigation of tuberculosis contacts in the tuberculosis control program of a medium-sized municipality in the southeast of Brazil in 2002 Original Article Investigation of tuberculosis contacts in the tuberculosis control program of a medium-sized municipality in the southeast of Brazil in 2002* CLÁUDIA ELI GAZETTA 1, ANTONIO RUFFINO NETTO 2 , JOSÉ MARTINS PINTO NETO 3, MARIA DE LOURDES SPERLI GERALDES SANTOS 4, MARIA RITA DE CÁSSIA OLIVEIRA CURY 5 , SILVIA HELENA FIGUEIREDO VENDRAMINI 6 , TEREZA CRISTINA SCATENA VILLA 7 ABSTRACT Objective: This study aimed to describe the investigation of tuberculosis contacts enrolled in the Tuberculosis Control Program of the municipality of São José do Rio Preto, Brazil in 2002. Methods: A descriptive study was conducted using secondary data obtained from the Tuberculosis Notification Database, as well as charts and registries compiled by the São José do Rio Preto Tuberculosis Control Program in 2002. Results: A total of 166 household tuberculosis contacts were enrolled in the Program. Of those, 82 were male, and 84 were females. The incidence of tuberculosis was highest (70%) in the 15 to 59 age bracket: 42 (25.3%) of the cases occurred in individuals from 0 to 19 years of age; 73 (44%) in those from 20 to 49; and 44 (25.5%) in those 50 or over. In terms of their relationship with the index patient, 41 (24.7%) were children; 29 (17.5%) were partners; 22 (13.2%) were siblings, and 15 (9.1%) were mothers. The following tests were requested: (in 12%) sputum smear microscopy, culture or both; (in 100%) chest X-ray, revealing 2 suspected cases of pulmonary tuberculosis and 5 cases of other diseases; (in 7.2%) tuberculin skin test, the results of which showed that 4.2% were nonreactors, and that 1.2% presented an induration of 8 mm. Among the contacts examined, the disease was detected in 3 (1.8%). Conclusion: There is no systematization in the monitoring of individuals who are in contact with tuberculosis patients. Keywords: Tuberculosis/mortality; Information systems; Prevalence * Study carried out at the Faculdade de Medicina de São José do Rio Preto (FAMERP, São José do Rio Preto School of Medicine) - São José do Rio Preto, Brazil. 1. Department of Collective Health Nursing and Professional Orientation of the Faculdade de Medicina de São José do Rio Preto (FAMERP, São José do Rio Preto School of Medicine) - São José do Rio Preto, Brazil 2. Full Professor at the University of São Paulo (USP) at Ribeirão Preto School of Medicine. Assistant Coordinator of the Rede Brasileira de Pesquisas em Tuberculose (REDE-TB, Brazilian Tuberculosis Research Network) and Coordinator of the REDE-TB Area of Epidemiological Studies on Tuberculosis 3. PhD Professor at the Fundação Educacional de Fernandópolis (FEF, Fernandópolis Educational Foundation) - Fernandópolis, Brazil 4. Professor in the Department of Collective Health Nursing and Professional Orientation of the Faculdade de Medicina de São José do Rio Preto (FAMERP, São José do Rio Preto School of Medicine) - São José do Rio Preto, Brazil. 5. Coordinator of the Tuberculosis Control Program of the São José do Rio Preto Municipal Secretary of Health - São José do Rio Preto, Brazil 6. Professor in the Department of Collective Health Nursing and Professional Orientation of the Faculdade de Medicina de São José do Rio Preto (FAMERP, São José do Rio Preto School of Medicine) - São José do Rio Preto, Brazil.7. Tenured Professor at the Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP, University of São Paulo at Ribeirão Preto School of Nursing) and at the EERP-USP Collaborative Center for World Health Organization Research, Ribeirão Preto, Brazil Correspondence to: Cláudia Eli Gazetta. Rua Jair Martins Mil Homens, 277, Bairro Nova Redentora - CEP: 15090-080, São José do Rio Preto, SP, Brasil. Tel: 55 17 227-7167. Email: Submitted: 4 November 2004. Accepted, after review: 6 March 2006. J Bras Pneumol. 2006;32(6):559-65 560 Gazetta CE, Ruffino-Netto A, Pinto Neto JM, Santos MLSG, Cury MRCO, Vendramini SHF, Villa TCS INTRODUCTION The World Health Organization estimates that approximately 100 million people worldwide are infected with tuberculosis each year, and that, in developing countries, the infection of adults is as high as 30% to 60%. It is estimated that, of those infected worldwide, 8 to 10 million will develop the disease in their lifetime, and that half of that number will present one of the infectious forms.(1) The tendencies of case reports to update the incidence estimates used by 210 countries in 2003 revealed that, in 2002, there were 8.8 million new cases of tuberculosis, 3.9 million of which were of active tuberculosis. During this period, the global per capita incidence of the disease increased by approximately 1.1%, and the prevalence increased by 2.4%.(2) It is estimated that 1.9 million tuberculosisrelated deaths occur annually, and that 98% of those cases occur in developing countries. By 2020, if this scenario is not reversed, a billion people will be infected, and the active form of the disease will appear in 200 million of those, 35 million of which could die.(3) The Ministry of Health estimates that the prevalence of tuberculosis in Brazil is 58 cases per 100,000 inhabitants, with approximately 50 million infected individuals. Annually, there are 111,000 new cases and 6000 deaths.(4) In the state of São Paulo as a whole, the incidence of tuberculosis remained stable from 1981 to 2002. In recent years, the number of tuberculosisrelated deaths has increased by 1400 deaths/year.(5) The city of São José do Rio Preto, is considered a priority in the tuberculosis control program (TCP), accounting for nearly 50% of the cases reported to the XXII Regional Health Board of the São Paulo State Secretary of Health. In 2002, 135 cases of tuberculosis were reported in the city. Of those, 108 were of the pulmonary form and 27 were of the extrapulmonary form, with an incidence rate of 34.69/100,000 inhabitants. In 2003, tuberculosis was the third leading public health problem (among those for which reporting is compulsory) in the city, with 190 cases.(6) With this in mind, many scholars are unanimous in emphasizing that the investigation of contacts contributes to the control of tuberculosis, either directly, through the detection of the source of J Bras Pneumol. 2006;32(6):559-65 infection, or indirectly, preventing the occurrence of other cases of the disease. The source of infection is frequently an individual with the pulmonary form of the disease and shedding bacilli, depending on the bacteriological index (state). In a given community/year, it is estimated that one infection source can infect from ten to fifteen people who come into contact with that individual.(7) The TCP recommends that all contacts of patients with tuberculosis, especially those that testing positive for the pulmonary form, should be referred to a health care facility for (...truncated)