[Tuberculosis in aged persons residing in Quebec facilities: are screening and chemoprophylaxis indicated?]

Abstract

Focus: Different strategies for the prevention and control of tuberculosis in facilities providing long-term care (LTCF) to the elderly were proposed by the U.S. Public Health Service (USPHS) and the Quebec Ministry of Health and Social Services (MHSS). Controversies regarding the screening and chemoprophylaxis of tuberculosis in the elderly were reviewed, the epidemiology of tuberculosis in the United States and Quebec was compared and the number of cases expected annually was estimated from estimates available in the literature.

Method: Fifty-five scientific articles and official documents identified in the Medline database were analyzed.

Results: U.S. epidemiologic data support screening and chemoprophylaxis but in Quebec, the absence of reported increased risk in LTCF explains the reservations of the MHSS. According to our estimates, expected cases of tuberculosis might be underestimated.

Conclusion: In Quebec, the best strategy to control tuberculosis is not yet obvious. A precise estimation of the number of undiagnosed cases in this environment would help clarify the dilemma.