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News — As the number of foreign-born health care workers in the United States has risen, so has the potential for transmitting tuberculosis in health-care settings.

According to Vanderbilt infectious disease experts Timothy R. Sterling, M.D., and David W. Haas, M.D., treatment should be provided to health care workers with latent TB infection as indicated by a positive tuberculin skin test, particularly if they meet certain high-risk criteria.

"It is important that patients be able to trust their health care providers to 'do no harm,'" Sterling and Haas, both associate professors of Medicine at Vanderbilt University Medical Center, wrote in the current issue of the New England Journal of Medicine.

"All health care workers in the United States, regardless of their country of birth, must earn that trust by doing everything possible to minimize risk to patients," they wrote.

"In this regard, assiduous adherence to the available guidelines for the prevention of transmission of M. tuberculosis in health care settings, including aggressive management of latent tuberculosis infection, is a crucial step in the right direction."

Today the incidence of TB in the United States is the lowest ever recorded.Yet during the past three years, foreign-born health care workers with untreated latent TB in New York City and Boston exposed hundreds of patients and others to the infection after they developed active disease. The workers had positive skin tests but declined treatment.

While few of the people they exposed actually became infected, "both episodes demonstrate the tremendous potential for a bad outcome when infection is left untreated," the Vanderbilt experts wrote.

Sterling and Haas recommended adherence to updated guidelines published last December 30 by the U.S. Centers for Disease Control and Prevention (CDC) in the agency's Morbidity and Mortality Weekly Report.