Reporting and interviewing delays in contact investigation of tuberculosis, Seine-Saint-Denis, from April to June 2008

Background. - In France, one of the main components of the tuberculosis control program is contact investigation around all tuberculosis cases. For this purpose, all cases of tuberculosis are to be reported to the health authorities (Centre de lutte antituberculeuse) within 48 hours of diagnosis. The Centre then conducts an initial patient interview within three days of the report in order to establish a list of contacts requiring evaluation. Given that a delay in action may play a role in the continued disease transmission, it appeared necessary to study more precisely this subject in a French area with a high annual new case rate, the Seine-Saint-Denis. Methods. - A descriptive and retrospective study included all tuberculosis cases reported and received between April and June 2008. The two periods were statistically analyzed with socio-demographic, clinical-biological and investigations data. Results. - For the 148 cases reported during this period, a first interview was required for 123. The average time period between initiation of anti-tuberculosis therapy and reception of the report was 11.08 days. The overly long delay could be explained in part by the inappropriate use of the notification form (45.5%) designed for non-urgent collection of epidemiological data, and in part by the underuse of telephone reporting (8.1%). The first interview was not performed for 19 cases and the average time between reception of the notification and the patient interview was 6.58 days. Having the patient's phone number appeared essential to meet the deadline (odds ratio: 5.3; 95% confidence interval [1.7-16.9]). Few interviews were made in person. Shortage in financial and human resources and the delayed case reporting could be part of the explanations. Deadlines were met much better for cases of pleuro-pulmonary tuberculosis compared with other localizations, for reporting (39.2% versus 13.5%, p < 0.01) and for the first interview (48.8% versus 28.6%, p = 0.03). Conclusion. - This study reports some risk factors associated with delayed action and highlights the need for improved reporting of tuberculosis cases and contact investigations. (c) 2012 Elsevier Masson SAS. All rights reserved.