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Changes in Tuberculin Skin Test Positivity Over 20 Years in Periurban Shantytowns in Lima, Peru
Leonardo Martinez
Leonardo Martinez
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Alyssa Arman
Alyssa Arman
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Nathan Haveman
Nathan Haveman
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ashley Lundgren
Ashley Lundgren
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Lilia Cabrera
Lilia Cabrera
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Carlton A. Evans
Carlton A. Evans
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Tom F. Pelly
Tom F. Pelly
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Mayuko Saito
Mayuko Saito
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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David Callacondo
David Callacondo
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Richard Oberhelman
Richard Oberhelman
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gisela Collazo
Gisela Collazo
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Andrés M. Carnero
Andrés M. Carnero
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Robert H. Gilman
Robert H. Gilman
Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; California State University, Fullerton, Fullerton, California; Weill Cornell Medical College, New York, New York; Asociación Benefica PRISMA, Lima, Peru; Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, United Kingdom; IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru; University of California, San Diego, San Diego, California; Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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A cross-sectional, community-based study was performed in 2012 with 428 residents of periurban shantytowns in Lima, Peru to study risk factors for and changes in latent tuberculosis infection in age-stratified groups compared with our data from the same region in 1990 (N = 219) and 2005 (N = 103). Tuberculin skin test positivity in these communities was highly prevalent at 52% overall, increased with age (P < 0.01) and was similar to 2005 (53%) and 1990 (48%). From 1990 to 2012, the prevalence of tuberculin positivity decreased in 5–14 and 15–24 year old groups (to 17% and 34%, respectively, both P < 0.05). However, this may be explained by cessation of Bacille Calmette-Guérin revaccination during this period, because Bacille Calmette-Guérin revaccination doubled tuberculin positivity. Over the same 22-year period, tuberculin positivity in the ≥ 25 year old group remained high (71%, P = 0.3), suggesting that prevalent latent tuberculosis infection persists in the adult population despite improving medical care and socioeconomic development in this region.
Author Notes
Financial support: LM and GC were supported through the Tulane-Xavier Minority Health International Research Training (MHIRT) Program, funded by a training grant from the National Institutes of Health (T37 MD001424). CAE, TFP, and the 2005 study were supported by IFHAD: Innovation For Health And Development and The Wellcome Trust. This study was funded in part by the anonymous RG–ER fund and NIH RO1 HD059005.
Authors' addresses: Leonardo Martinez and Richard Oberhelman, Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, E-mails: lmartin7@tulane.edu and oberhel@tulane.edu. Alyssa Arman and Nathan Haveman, California State University, Fullerton, San Diego, CA, E-mails: lyssiejoy@gmail.com and n.eight.h@gmail.com. Ashley Lundgren, Weill Cornell Medical College, New York, NY, E-mail: ashley.diana@gmail.com. Lilia Cabrera, Asociación Benefica PRISMA, Lima, Peru, E-mail: lilia_deviaje@yahoo.com. Carlton A. Evans, Wellcome Trust Centre for Clinical Tropical Medicine, Department of Infectious Diseases and Immunity, Imperial College London Hammersmith Hospital Campus, London, UK, E-mail: carlton.evans@ifhad.org. Tom F. Pelly, IFHAD - Innovation For Health And Development, Universidad Peruana Cayetano Heredia LID#218, Lima, Peru, E-mail: tompelly@doctors.org.uk. Mayuko Saito, University of California, San Diego, San Diego, CA, E-mail: msaitop@gmail.com. David Callacondo, Molecular and Clinical Hematology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, E-mail: david.callacondo@upch.pe. Gisela Collazo, Tulane University, New Orleans, LA, E-mail: gcollazo@tulane.edu. Andrés M. Carnero, Postgraduate School, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: andrescarnero@gmail.com. Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: rgilman@jhsph.edu.
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-
1.
World Health Organization, 2012. Global Tuberculosis Report 2012. Available at: http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf. Accessed November 1, 2012.
-
2.
Saito M, Bautista CT, Gilman RH, Bowering A, Levy MZ, Evans CA, 2004. The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shantytown, Peru. Int J Tuberc Lung Dis 8: 842–847.
-
3.
Millet JP, Moreno A, Fina L, Del Baño L, Orcau A, de Olalla PG, Caylà JA, 2012. Factors that influence current tuberculosis epidemiology [published online ahead of print 8 May 2012]. Eur Spine J. Available at: http://link.springer.com/article/10.1007%2Fs00586-012-2334-8. Accessed May 21, 2012.
-
4.
World Health Organization, 2012. Tuberculosis. Available at: http://www.who.int/mediacentre/factsheets/fs104/en/index.html. Accessed July 1, 2012.
-
5.
Suárez PG, Watt CJ, Alarcón E, Portocarrero J, Zavala D, Canales R, Luelmo F, Espinal MA, Dye C, 2001. The dynamics of tuberculosis in response to 10 years of intensive control effort in Peru. J Infect Dis 184: 473–478.
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