The epidemiology of tuberculosis in physicians

Abstract

The incidence of tuberculosis in physicians was determined by mailed questionnaire. Since 1950 tuberculosis infection preceding entry into medical school decreased by 73%; at the same time, infection after beginning medical school decreased by 78%. Tuberculin conversion rates among recent graduates exceeded 1%/yr, and age-specific infection rates among physicians were at least twice the USA average. Tuberculosis developed in nearly 1 in 10 physicians infected after medical school entry; in 2/3, disease preceded or coincided with recognized tuberculin positivity. No tuberculosis occurred in physicians who used isoniazid chemoprophylaxis, but 2/3 of tuberculin-negative physicians did not have annual skin tests, 56% of known recent converters used no chemoprophylaxis and 25% of those initiating isoniazid prophylaxis did not complete a 12 mo. course. The BCG vaccine recipients had 80% less tuberculosis than unimmunized physicians infected after beginning medical school.