Screening for tuberculosis among orphans in a developing country 2 <FN ID="FN1"><NO>2</NO><B>BEST PAPER IN PREVENTIVE MEDICINE BY A MEDICAL STUDENT Judith Francis, BS, Alison Reed, BA, Fitsum Yohannes, BS—Award Winners</B></FN> 3 <FN ID="FN2"><NO>3</NO>This paper is the award winner for this year’s annual competition for the “Best Paper in Preventive Medicine by a Medical Student.” Since its inception in 1992, this award has been co-sponsored by the American College of Preventive Medicine, the Association of Teachers of Preventive Medicine, the Association of American Medical Colleges, and the Ulrich and Ruth Frank Foundation for International Health. The monetary prize for the best paper is $1000.Anyone interested in learning more about this award should contact: Erica Frank, MD, MPH, President and Founder of the Ulrich and Ruth Frank Foundation, c/o Department of Family and Preventive Medicine, Emory University School of Medicine, 69 Butler Street, Atlanta GA 30303-3219; telephone: (404) 616-5603; fax: (404) 616-6847; E-mail: efrank@fpm.eusch.org.</FN>

<bold>Background: </bold>There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned.<bold>Methods: </bold>A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease).<bold>Results: </bold>The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases.<bold>Conclusions: </bold>The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries. [ABSTRACT FROM AUTHOR]