Health hazard evaluation report: HETA-2007-0012-3046, evaluation of tuberculin skin test conversions at a Mississippi fire department, City of Meridian Fire Department, Meridian, Mississippi.
In October 2006, NIOSH received a management request for an HHE at the City of Meridian Fire Department in Meridian, Mississippi. The Fire Chief submitted the HHE request because 12 firefighters tested positive for latent tuberculosis infection from 2005-2006. On October 24-26, 2006, NIOSH medical investigators conducted a site visit. We held an opening conference with management and union representatives to discuss the HHE request. We conducted employee interviews and collected blood samples for TB testing. Individuals were mailed their blood test results on October 31, 2006. A follow-up site visit was conducted on December 11-13, 2006. NIOSH medical investigators, in conjunction with State of Mississippi District 6 Tuberculosis Program staff, conducted follow-up TSTs for participants to determine their eligibility for future TST as part of their medical surveillance program and to help confirm the results of our investigation. Individuals were verbally notified of their test results at the time of TST interpretation, and written results were mailed to participants on December 15, 2006. Interviews with Fire Department management, firefighters, District 6 Tuberculosis Program personnel; and an evaluation of the department's EMS procedures (no patient transport) found the department to be at low risk for TB, using CDC guidelines. All twelve participants' blood samples were tested for evidence of TB infection using QuantiFERONŽ-TB Gold methodology; all twelve samples tested negative, indicating that these firefighters were not infected with Mycobacterium tuberculosis. We found discrepancies in the TB screening program at the hospital that administered the Fire Department's occupational medical screening program, when compared to CDC recommendations. These discrepancies led to the false-positive TST results that were confirmed by the blood test and subsequent follow-up TST performed in December 2006. We recommend two options concerning future tuberculosis screening for Meridian Fire Department firefighters. If management decides to continue annual tuberculosis screening, it should be conducted following CDC guidelines. If management decides to conduct an annual TB risk assessment for department firefighters to determine testing frequency, this assessment should be conducted with the assistance and close cooperation of the State of Mississippi District 6 Tuberculosis Program staff. Management and union officials should emphasize the importance of attending all medical appointments, continue periodic refresher training on tuberculosis and bloodborne pathogens, and incorporate N95 respirator training and fit-testing into their respiratory protection program.