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Anergy compromises screening for tuberculosis in high-risk populations
S R Zoloth1, S Safyer, J Rosen
1Montefiore Rikers Island Health Services, New York, NY.
American Journal of Public Health
|May 1, 1993
Summary
Tuberculosis screening using skin tests is less effective in opiate users due to high rates of anergy. This study found 25% of opiate users in NYC jails were anergic, highlighting the need for alternative screening methods like chest X-rays for this population.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Medical Diagnostics
Background:
- Tuberculosis (TB) remains a significant global health concern, particularly in high-risk populations.
- Anergy, a suppressed immune response, can interfere with the accuracy of tuberculin skin testing (TST) for TB detection.
- Correctional facilities and substance abuse treatment programs often house individuals at increased risk for TB.
Purpose of the Study:
- To investigate the prevalence of anergy in opiate users within New York City's correctional system.
- To identify factors associated with anergy in this high-risk group.
- To evaluate the implications of anergy prevalence for TB screening strategies.
Main Methods:
- Cross-sectional study conducted within the New York City correctional system.
- Participants included opiate users in detoxification programs and the general inmate population.
- Data collection involved assessing anergy status and identifying potential correlates such as recent weight loss and needle sharing.
Main Results:
- Anergy prevalence was significantly higher among opiate users (25%) compared to the general population (3%).
- Recent weight loss and needle sharing were identified as correlates of anergy in opiate users.
- The high anergy rate compromises the effectiveness of TST for TB screening in this population.
Conclusions:
- The high prevalence of anergy among opiate users in the correctional system limits the utility of TST for TB screening.
- Routine chest X-rays are recommended as a more reliable method for detecting pulmonary tuberculosis in opiate-using populations within correctional settings.
- Public health strategies for TB control must consider immune status and adapt screening methods for vulnerable groups.