[Tuberculosis in 22 Au-pairs in Germany and Austria - rapid diagnosis reduces risk of infection for host families]

Abstract

Background and objectives: The aim of this study was to investigate tuberculosis (TB) in au-pairs in Germany and Austria and to assess the risk of infection for the host families.

Methods: Reports from local health authorities were obtained between 2002 and 2010 (Bavaria, 12 cases) and from 2006 to 2010 (Baden-Wuerttemberg 6, North Rhine-Westphalia and Hesse, 1 each, additionally 2 from Austria).

Results: 22 cases of tuberculosis were reported to the local health authorities, all of them concerning young female au-pairs, age 19 - 27 years. Countries of origin were: Kenya (9), Georgia (4), Mongolia (3), Indonesia (2), Nepal, Russia, Romania, and Peru (1 each). In 17 au-pairs, sputum-smear positive pulmonary tuberculosis was diagnosed. Three au-pairs presented with extrapulmonary tuberculosis without or only with minor pulmonary involvement. In two asymptomatic cases, sputum-smear negative tuberculosis was diagnosed by screening. The time between entry and the beginning of symptoms was 7.5 ± 5.8 months (0 - 19.3). 10.0 ± 6.1 weeks (range 3 - 20 weeks) elapsed between the first symptoms and the diagnosis. No infection of the host families was caused by 5 au-pairs who had no or only minor pulmonary involvement. In 17 au-pairs with high mycobacterial burden, the infection rate increased with the duration of time between symptoms and diagnosis (1 - 11 infections per au-pair). A total of 46 contacts (21 children, 25 adults) were infected. 17 children received chemoprophylaxis with isoniazid (INH); none of them developed active disease. One child out of four who did not get INH was diagnosed with pulmonary TB. In addition, 5 out of 24 adults without chemoprevention developed active TB. 4 TB-strains were drug-resistant strains, one of them multidrug-resistant.

Conclusions: In au-pairs from countries with high burden of tuberculosis, long lasting cough and weariness should prompt diagnostics for tuberculosis. By screening, the disease can be detected before it gets infectious. If infection has occurred, chemoprevention with INH for nine months can prevent overt tuberculosis.