Publications

An enhanced, refocused research agenda is critical to reducing the burden of tuberculosis (TB) in the human immunodeficiency virus (HIV) epidemic in developing countries. TB threatens HIV-infected patients before and after initiation of antiretroviral therapy, is difficult to diagnose, is rapidly fatal when it is drug resistant, and is being spread in clinics and hospitals. Research priorities include improved and point-of-care TB diagnostics; TB treatment and prevention during HIV infection, drug-resistant TB, and childhood TB; and optimization of TB and HIV program integration. With new TB diagnostics and drugs reaching approval, research must focus on effectively deploying these advancements. Research must include evaluations of individual, household, health care, and community approaches. Studies must apply implementation science to determine how to increase and adapt effective interventions to reduce TB burden in the context of HIV infection. Investment in this research will improve the lives of persons infected with HIV and contribute to efforts to reduce the global TB burden.

Antimicrobial pesticides (e.g., sterilizers, disinfectants, and sanitizers) are chemicals used to destroy or suppress the growth of harmful microorganisms on inanimate objects and surfaces. Health-care facilities use antimicrobial pesticides to prevent pathogen transmission from contaminated environmental surfaces. Occupational exposures to antimicrobial pesticides are known to cause adverse health effects. To assess the nature and frequency of such exposures in health-care settings, CDC analyzed data from pesticide poisoning surveillance programs in California, Louisiana, Michigan, and Texas (the only four states that regularly collect data on antimicrobial pesticide-related illness) for the period 2002-2007. This report summarizes the results of that analysis, which identified 401 cases of work-related illness associated with antimicrobial pesticide exposures in health-care facilities. Most cases were identified through workers compensation systems (61%) and occurred among females (82%) and persons aged 25-54 years (73%). The most frequent occupations reported were janitors/housekeepers (24%) and nursing/medical assistants (16%). The reported mechanism of injury usually was splashes/spills (51%). The eyes were the most common organ/system affected (55%); only 15% of the 265 persons who had exposures while handling antimicrobial pesticides reported using eye protection. Reported symptoms were mostly mild and temporary. One fatality due to acute asthma and subsequent cardiopulmonary collapse was identified. Health-care facilities should educate workers about antimicrobial pesticide hazards, promote the use of personal protective equipment (PPE) as appropriate, and implement effective risk communication strategies for antimicrobial pesticide use to prevent bystander exposure. Improved design of handling equipment might prevent handler and bystander exposure.