Australia has one of the lowest incidence rates of tuberculosis (TB) in the world, approximately five per 100,000 per year 1, although in some parts of the country the incidence is considerably higher. In the former Central Sydney Area Health Service the incidence rate in 2003 was 14 per 100,000 per year.2 The incidence is also higher in those aged 65 years and over1, a population that has declining immunocompetence due to a variety of factors.3 Furthermore, the subpopulation of this group (and, indeed, of people of any age) living in residential institutions such as nursing homes and hostels are at even greater risk of TB infection and disease due to their chronic ill health and multiple medical problems.3 Despite this, there are no guidelines in NSW regarding TB screening of the elderly, either in response to potential exposure or with regard to screening at entry to a residential facility. There are also very few reports in the literature of TB contact investigations in residential facilities. Those that have been published come from the United States and are concerned with TB in hospitals or correctional facilities.3,4,5,6 There has been one report of TB transmission in a school setting in Sydney7, but there is a paucity of Australian literature that clarifies what is required for contact investigations in the local residential care setting.

This paper describes a contact investigation resulting from a case of active TB in a health care worker employed by a number of nursing homes in inner-western Sydney and highlights the need for policies with regard to TB screening of the elderly residing in nursing homes.



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