Recommend a tuberculin skin test to patients returning from regions where tuberculosis is endemic.
August 8, 2000
NEW YORK, August 7 (Praxis Press) Tuberculosis remains endemic in many countries, and the risk of infection to international travelers visiting these destinations is unknown. Cobelens and colleagues studied the incidence of and risk factors for tuberculin skin test conversion among Bacille Calmette-Guérin (BCG)-naive Dutch travelers; all travelers spent three to 12 months in countries with an estimated annual risk of Mycobacterium tuberculosis infection of at least 1%. Among 656 travelers who had a negative pretravel purified protein derivative (PPD) skin test result, 1.8% had a positive posttravel PPD skin test result. Risks of infection were 7.9 and 2.8 per 1,000 person-months of travel for health-care workers and non-health-care workers, respectively. Travelers to regions where tuberculosis is endemic have a risk of infection similar to the risk of the local population; physicians should advise travelers to obtain prophylactic BCG vaccination before travel or a tuberculin skin test after travel.
Regularly taking breaks from eating—for hours or days—can trigger changes both expected, such as in metabolic dynamics and inflammation, and surprising, as in immune system function and cancer progression.