|
|
|||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
|
Threat Matrix HTML designed by: Ian Livingston
|
||||||||||||||||||||||||||||||||||||||
| This thread has been locked, it will not receive new replies. |
| Locked on 01/31/2006 12:08:46 AM PST by Admin Moderator, reason: |
Posted on 12/15/2005 5:40:46 PM PST by nwctwx
|
|
|||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
|
Threat Matrix HTML designed by: Ian Livingston
|
||||||||||||||||||||||||||||||||||||||
BTTT
THANKS JellyJam.
I was just coming back from grocery shopping and heard that, BUT I DIDN'T HEAR if the xplosives were recovered.
Yep, of course, not terrorism-related.
Snip: Yahya Ibrahim arrived at the Detroit airport Monday, where an immigration inspector denied him entry. Ibrahim, who was traveling from Australia, could not be reached for comment.He was scheduled to speak at the Texas Dawah Convention, an annual event for Muslims expected to attract 4,000 participants from across the country. The government confirmed that Ibrahim was denied entry, but refused to say why.
British missionaries killed by Al Qaeda gunmen while watching TV
Snip: A husband and wife who dedicated their lives to helping African children were murdered in cold blood by Islamic terrorists, an inquest heard yesterday.
Dick and Enid Eyeington were watching television at their home in Somaliland when a terrorist linked to al-Qaeda shot them. The couple were considered "infidels" by their attackers, who wrongly believed that they were trying to convert Africans to Christianity.
Radical muslim cleric predicted London bombings
Snip: Saturday Dec 24 12:53 - Television footage was screened Friday of radical Muslim cleric Omar Bakri Mohammed apparently predicting terrorists would strike on the British mainland several months before the July 7 London bombings.
Snip: The $934,000 camp, proposed by the Muslim Youth Camps of America, would include a 2,400-square-foor central lodge, five cabins, five tent pads, a central bathroom facility and a trail system on 106 acres of land two miles northeast of North Liberty along Coralville Lake.
Muslims impose blasphemy laws on Victoria
Snip: Pastor Danny Nalliah and Pastor Daniel Scot addressed the crowd. Pastor Daniel Scot, who had been sentenced to death in Pakistan for his Christian beliefs, accurately cited passages from the Koran and the Hadith, pointing out that these had been used by fanatical clerics to justify jihad against the West, lying for Islam, murdering apostates, raping female prisoners, etc. (Tell me, little Miss Sisely, do these passages make the Koran hate speech?)
The Pastors’ response to this barbarism was that Christians should pray and that Muslims “should be loved”. (This just goes to show how viciously intolerant these Christians really are). Well, this was just too much for our freedom-loving Muslim converts. Seething with trumped-up indignation, these monuments to the unquestionable benefits of multiculturalism complained, surprise, surprise, to May Helou who immediately brought the EOC down on the heads of our oh so dangerous Pastors.......
4 arrested in stolen explosives case
Snip: 12.23.2005, 09:52 PM - Four men, including two brothers, were taken into custody Friday by federal authorities in connection with the theft of 400 pounds of explosives from a storage depot southwest of Albuquerque.
The explosives were reported stolen Sunday from Cherry Engineering's storage depot eight miles southwest of New Mexico's largest city. Federal authorities have said it was enough to flatten a large building.
The men, whose names were not immediately released, all face federal charges, including possession of stolen explosives. Three of the arrests were made in Bloomfield, in the northwest corner of the state, and the other was made in Ignacio, Colo., said Tom Mangan, a spokesman for the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives.
Federal authorities were processing a crime scene in a remote area of New Mexico, but Mangan did not release any details.
Thanks M.D., that looks closer to the version of Neosgirl's movie, that I read..
see 1118 post
Ok, I found a url to go with story, but still couldn't find any confirmation the explosives were recovered.
---
http://www.foxnews.com/story/0,2933,179645,00.html
AP
"Four Men Arrested in New Mexico Stolen Explosives Case"
I found this:
Four People In Custody For Alleged Explosives Heist
Police Searching For Fifth Suspect Around Bloomfield
Action 7 News has learned that four people are in custody in connection with a stolen explosives heist from a site west of Albuquerque.
According to police, all of the explosives have also been recovered.
Two of the suspects are brothers, David and Les Brown.
The men, previously convicted felons, now face federal charges of possessing stolen explosives.
Authorities are still searching for a fifth suspect in the Bloomfield area.
Action 7 News has been covering the arrests for the past 24 hours and covered the arrest of one of the suspects as law enforcement descended on his home.
Action 7 News has learned that investigators recovered some of the explosive material near Durango, Colo.
http://www.thenewmexicochannel.com/news/5633410/detail.html
Note: 4 Suspects Arrested.
Note 2: Unknown if the explosives were recovered.
Note 3: Will watch this link for updates...
http://news.google.com/news?hl=en&tab=wn&ie=UTF-8&ncl=http://www.chinapost.com.tw/i_latestdetail.asp%3Fid%3D33824
Thanks for all the info, this is one of those days, that I am not up to thinking.
I know there is stuff in my yahoo mail, but i won't be up for long.
http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/12/23/nmission23.xml
"Islamic terrorists shot aid couple as they watched TV"
By Auslan Cramb
(Filed: 23/12/2005)
ARTICLE SNIPPET: "A husband and wife who dedicated their lives to helping African children were murdered in cold blood by Islamic terrorists, an inquest heard yesterday.
Dick and Enid Eyeington were watching television at their home in Somaliland when a terrorist linked to al-Qaeda shot them."
ARTICLE SNIPPET #2: "Det Chief Insp Jill Bailey told the hearing that last month four men, including Mohammed Ali Essa, who fired the AK47, had been convicted of murder and sentenced to death by firing squad. The terrorists shouted "Allah Akbar" (God is Great) after being sentenced and are still awaiting execution.
Miss Bailey said the men were part of a terrorist cell called El Itihad which had killed an Italian nun a week earlier. She also said that Essa's brother-in-law, Adan Ayro, who owned the house in which Essa was captured, could have had links to al-Qa'eda. A plan to blow up an Ethiopian airliner and bomb-making manuals were uncovered during the investigations.
"The defendants did not recognise their actions as crimes," Miss Bailey said. "They felt justified in murdering infidels who they believed were offending Muslim fundamentalism.""
Yep.
Smiling...
good work
From: "Jamestown Foundation" brdcst@jamestown.org
Date: Fri, 23 Dec 2005 17:21:22 -0500 (EST)
If you have trouble reading this email, go to the online version.
Position Title: Associate Editor, China Brief
The Jamestown Foundation, Washington, D.C.
The Jamestown Foundation is a non-profit research organization specializing in conflict, instability and security issues in Eurasia and the Middle East. Utilizing our global network of indigenous sources, Jamestown enlists world-class experts to analyze and interpret new challenges facing the U.S. in the post-9/11 world. The Foundation is nonpartisan and has earned a reputation for providing valuable insights and objective analysis to the diplomatic, intelligence, business, and academic communities.
Jamestown seeks an Associate Editor for China Brief, a biweekly publication on Chinese strategic, political, and economic issues. The ideal candidate will have publishing experience, especially online publications, with an interest and background in Asia-Pacific affairs. The position requires substantial research on China; Chinese language ability is preferred, but not required. The position is full-time and located in Jamestown's Washington, DC office.
The position is scheduled to open in late spring/early summer 2006.
Responsibilities include:
--Managing all aspects of China Brief's content production, including copyediting and online dissemination;
--Recruiting, corresponding with, and providing editorial oversight for the network of China Brief's freelance authors;
--Conducting outreach activities and building China Brief's readership base;
--Drafting donor correspondence and aiding Jamestown's President in development activities for the China program;
--Assisting in the editorial process of Jamestown's other publications (Terrorism Monitor, Terrorism Focus, and Chechnya Weekly). Duties may include copyediting and research. Candidates are therefore encouraged to be familiar with Jamestown's entire publication portfolio, as well as have an interest in Eurasian and terrorism issues;
--Various organizational tasks may also include: conference and event planning and arranging media interviews.
Qualifications:
--BA Political Science, Asian Studies, International Studies or related field; MA preferred;
--Strong background in publishing and editing; familiarity with publishing IT, HTML and web design a plus;
--Outstanding editing, organizational and administrative skills;
--Working knowledge of Asian politics required.
Salary commensurate with experience. Position provides health, dental, and retirement benefits.
To apply, send cover letter and resume to jobs@jamestown.org
This may seem off topic to some, but I don't know who fits which job and some of our lurkers might want to look at this and one more to post. granny
http://www.freerepublic.com/focus/f-news/1546418/posts
"The Terrorist Round-Up for 12/24/05 (attn: dial-up users - lots of images )"
Posted on 12/23/2005 9:33:28 PM PST by Straight Vermonter
Most of the earthquake notices I get for Calif. are in the
3 range. This is over 4 and there was also a 4.7 at sea off California. NOt a shocking size, but if it goes over 5, then you are getting into the possiblity of damage to things.
granny
== PRELIMINARY EARTHQUAKE REPORT ==
California Integrated Seismic Network
http://www.cisn.org
USGS/Caltech/CGS/UCB/UCSD/UNR
Version 2: This report supersedes any earlier reports about this event.
This is a computer-generated message and has not yet been reviewed by a
seismologist.
PRINCIPAL EARTHQUAKE PARAMETERS
_______________________________
Magnitude : 4.55 ML (A light quake)
Event Date & Time : 12/23/2005 01:38:32 PM PST
12/23/2005 21:38:31 UTC
Coordinates : 40.4277 N, 125.4607 W
: (40 deg. 25.66 min. N, 125 deg. 27.64 min. W)
Depth : 1.5 miles ( 2.5 km)
Location Quality : Poor
100 km ( 62 miles) W (277 degrees) of Petrolia, CA
103 km ( 64 miles) W (261 degrees) of Ferndale, CA
111 km ( 69 miles) WSW (253 degrees) of Humboldt Hill, CA
113 km ( 70 miles) W (261 degrees) of Fortuna, CA
114 km ( 71 miles) WSW (251 degrees) of Bayview, CA
117 km ( 73 miles) WSW (250 degrees) of Eureka, CA
More Information about this event and other earthquakes is available at
http://quake.wr.usgs.gov/recenteqs/latestfault.htm
ADDITIONAL EARTHQUAKE PARAMETERS
________________________________
number of phases : 243
rms misfit : 0.54 seconds
horizontal location error : 2.4 km
vertical location error : 44.9 km
maximum azimuthal gap : 243 degrees
distance to nearest station : 95. km
event ID: 51167135
SOURCE OF INFORMATION/CONTACTS
________________________________
CISN Northern California Management Center
U.S. Geological Survey
Berkeley Seismological Laboratory
http://www.cisn.org/ncmc.html
http://www.freerepublic.com/focus/f-news/1546411/posts
"Body of former RCMP officer slain in Haiti returns to Quebec City"
Canadian Press via Sun Media ^ | 2005-12-23
Posted on 12/23/2005 8:39:37 PM PST by Clive
ARTICLE SNIPPET: "MONTREAL (CP) - The body of the retired RCMP officer killed earlier this week in Haiti returned home to Quebec City on Friday afternoon.
Uniformed RCMP officers escorted the coffin across the airport tarmac, where a brief ceremony was held. The body was then taken to a city funeral home. Mark Bourque, 57, from Stoneham, Que., was on UN security duty in the impoverished country when he was shot Tuesday while driving a fellow Canadian to the Port-au-Prince airport to catch a flight home for the holidays,
He died in hospital, less than two hours after someone opened fire on the unmarked rental vehicle he was driving.
The shooting occurred in Cite Soleil, a volatile slum in the Haitian capital that is controlled by gangs and where shootings occur daily.
"The country started off well and now its chaos," Perreault told Radio-Canada. "You could say we've returned to the starting blocks."
The UN said its military police will conduct an investigation into the incident.
A funeral for Bourque will be held in Quebec City on Wednesday."
http://www.msnbc.msn.com/id/10564941/
File bin Laden phone leak under `urban myths'
President repeats tale blaming media for aiding terrorism
By Glenn Kessler
The Washington Post
Updated: 3:14 p.m. ET Dec. 22, 2005
President Bush asserted this week that the news media published a
U.S. government leak in 1998 about Osama bin Laden's use of a
satellite phone, alerting the al Qaeda leader to government
monitoring and prompting him to abandon the device.
The story of the vicious leak that destroyed a valuable intelligence
operation was first reported by a best-selling book, validated by the
Sept. 11 commission and then repeated by the president.
But it appears to be an urban myth.
The al Qaeda leader's communication to aides via satellite phone had
already been reported in 1996 — and the source of the information was
another government, the Taliban, which ruled Afghanistan at the time.
The second time a news organization reported on the satellite phone,
the source was bin Laden himself.
Causal effects are hard to prove, but other factors could have
persuaded bin Laden to turn off his satellite phone in August 1998. A
day earlier, the United States had fired dozens of cruise missiles at
his training camps, missing him by hours.
Bush made his assertion at a news conference Monday, in which he
defended his authorization of warrantless monitoring of
communications between some U.S. citizens and suspected terrorists
overseas. He fumed that "the fact that we were following Osama bin
Laden because he was using a certain type of telephone made it into
the press as the result of a leak." He berated the media
for "revealing sources, methods and what we use the information for"
and thus helping "the enemy" change its operations.
White House spokesman Scott McClellan said Monday that the president
was referring to an article that appeared in the Washington Times on
Aug. 21, 1998, the day after the cruise missile attack, which was
launched in retaliation for the bombings of two U.S. embassies in
Africa two weeks earlier. The Sept. 11 commission also cited the
article as "a leak" that prompted bin Laden to stop using his
satellite phone, though it noted that he had added more bodyguards
and began moving his sleeping place "frequently and unpredictably"
after the missile attack.
Two former Clinton administration officials first fingered the Times
article in a 2002 book, "The Age of Sacred Terror." Daniel Benjamin
and Steven Simon wrote that after the "unabashed right-wing
newspaper" published the story, bin Laden "stopped using the
satellite phone instantly" and "the United States lost its best
chance to find him."
The article, a profile of bin Laden, buried the information about his
satellite phone in the 21st paragraph. It never said that the United
States was listening in on bin Laden, as the president alleged. The
writer, Martin Sieff, said yesterday that the information about the
phone was "already in the public domain" when he wrote the story.
A search of media databases shows that Time magazine had first
reported on Dec. 16, 1996, that bin Laden "uses satellite phones to
contact fellow Islamic militants in Europe, the Middle East and
Africa." Taliban officials provided the information, with one
official — security chief Mulla Abdul Mannan Niazi — telling
Time, "He's in high spirits."
The day before the Washington Times article was published — and the
day of the attacks — CNN producer Peter Bergen appeared on the
network to talk about an interview he had with bin Laden in 1997.
"He communicates by satellite phone, even though Afghanistan in some
levels is back in the Middle Ages and a country that barely
functions," Bergen said.
Bergen noted that as early as 1997, bin Laden's men were very
concerned about electronic surveillance. "They scanned us
electronically," he said, because they were worried that anyone
meeting with bin Laden "might have some tracking device from some
intelligence agency." In 1996, the Chechen insurgent leader Dzhokhar
Dudayev was killed by a Russian missile that locked in to his
satellite phone signal.
That same day, CBS reported that bin Laden used a satellite phone to
give a television interview. USA Today ran a profile of bin Laden on
the same day as the Washington Times's article, quoting a former U.S.
official about his "fondness for his cell phone."
It was not until Sept. 7, 1998 — after bin Laden apparently stopped
using his phone — that a newspaper reported that the United States
had intercepted his phone calls and obtained his voiceprint. U.S.
authorities "used their communications intercept capacity to pick up
calls placed by bin Laden on his Inmarsat satellite phone, despite
his apparent use of electronic 'scramblers,' " the Los Angeles Times
reported.
This is continued at link....................
Date: Fri, 23 Dec 2005 From: ProMED-mail----promed@promedmail.org
Source: Morbid Mortal Weekly Rep 2005; 54:1280-1283 [edited] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm?s_cid=mm5450a2_e
Mycobacterium tuberculosis Transmission in a Newborn Nursery and Maternity Ward --- New York City, 2003
----------------------------------- Evaluating young children recently exposed to airborne _Mycobacterium tuberculosis_ is a public health priority. If infected, children aged less than 2 years are at high risk for severe tuberculosis (TB) disease (e.g., TB meningitis) (1). In Dec 2003, infectious pulmonary TB disease was diagnosed in a foreign-born nurse working in the newborn nursery and maternity ward of a New York City hospital (hospital A); the nurse had declined treatment for latent TB infection (LTBI) after testing positive 11 years earlier. An investigation including medical evaluation of contacts in the nursery and maternity ward was conducted by the Bureau of TB Control (BTBC) at the New York City Department of Health and Mental Hygiene, hospital A, and CDC.
This report summarizes the results of that investigation, which determined that approximately 1500 patients had been exposed to the nurse but the majority could not be located for evaluation. Among those who were tested, 4 infants had positive tuberculin skin test (TST) results, likely attributable to recent transmission of _M. tuberculosis_. The findings emphasize the difficulty of conducting contact investigations in certain settings and the importance of effective LTBI testing and treatment programs for health care workers (HCWs) to prevent TB disease and subsequent health care-associated transmission.
In Dec 2003, a female nurse (nurse A) working in the newborn nursery and maternity ward at hospital A received a diagnosis of acid-fast bacilli (AFB) sputum smear positive, noncavitary pulmonary TB disease. 11 years earlier, nurse A had LTBI diagnosed with a TST result of 15 mm induration during screening for employment at hospital A, after emigrating from the Philippines. She had elected not to take the isoniazid prescribed for treatment. The reason nurse A gave for declining treatment was that most adults from the Philippines, where TB is endemic, have positive TST results and generally do not take treatment for LTBI. She also stated that the positive TST result might have been caused by her bacille Calmette-Guerin (BCG) vaccination for TB disease at birth or potential exposures while she was employed as a nurse in the Philippines. Nurse A had an annual TB symptom screen on 8 other occasions and had one other chest radiograph (when she began work in a different area of the hospital) without evidence of TB disease.
Nurse A's symptoms began in Sep 2003 as a productive cough, wheezing, and shortness of breath. Her initial chest radiograph was interpreted as "normal heart and lungs" by a radiologist at hospital A. She was symptomatically treated for asthma with inhaled beta-agonists, inhaled steroids, oral steroids, antihistamines, and a cough suppressant. After her symptoms persisted for approximately 8 weeks, she underwent a chest computed tomography scan (CT) and, approximately one week later, bronchoscopy. The CT revealed bilateral upper-lobe disease with volume loss and calcified mediastinal lymph nodes. The leading diagnosis at the time was hypersensitivity pneumonitis. Specimens from a transbronchial biopsy, routinely sent for microscopic examination, revealed rare AFB; culture of bronchial alveolar lavage subsequently yielded _M. tuberculosis_ that was susceptible to the 4 first-line anti-TB drugs. Genotyping of the _M. tuberculosis_ isolate did not match any pattern in the New York City or national databases. Nurse A subsequently was screened for human immunodeficiency virus (HIV) and had a negative HIV test result.
On the basis of nurse A's AFB smear status at start of treatment, her infectious period was defined as 1 Sep - 29 Nov 2003. Work schedules and hospital records for all coworkers and patients in the newborn nursery and maternity ward who were contacts of nurse A during this period were reviewed to identify and prioritize contacts and to assess risk factors for transmission. During her infectious period, nurse A worked 60 night shifts at hospital A and potentially exposed 32 coworkers, 613 infants in the newborn nursery, and 900 patients in the maternity ward. During a 7-month period, hospital A and BTBC took the following measures to notify contacts: 1) mailing certified letters, making telephone calls, and attempting home visits to hospital patients and to mothers and guardians of all infants; 2) faxing notifications to all pediatric providers in the area; and 3) cross-matching the list of exposed infants with names in the city's immunization registry. All contacts were offered a free medical evaluation, including a TST; if indicated, contacts also were offered chest radiography and sputum specimen collection to exclude a diagnosis of TB disease. Results were reviewed to estimate the extent of transmission.
Of the 32 potentially exposed coworkers, 25 (78 percent) had a previously documented positive TST baseline result, and none had taken treatment for LTBI. On screening, none of these 25 persons had symptoms for TB; they were offered LTBI treatment, but all 25 declined. TSTs were administered to the remaining 7 coworkers, all with negative results.
The majority of patients in the maternity ward had received TSTs and HIV screening during the prenatal period. Extensive outreach by the hospital and city health department workers resulted in medical evaluation of 227 (37 percent) of the 613 infant contacts and 216 (24 percent) of the 900 female contacts. None of these contacts were determined to have TB disease. TST results were positive (induration larger than 5 mm) for 5 (2 percent) of 227 infants, including one who had received BCG vaccination during a family trip to the Dominican Republic. A positive TST result among infants was determined to be associated with cesarean delivery (relative risk [RR] = 11.8, 95 percent confidence interval [CI] = 1.3-103.1). TST results of 19 (9 percent) of 216 women with a prior negative test changed to positive (greater than 5 mm). Change in TST result was associated with foreign birth among women (RR = 5.9, CI = 1.4-24.5).
No association was evident between a positive TST result or change in TST result and duration of contact (e.g., estimated time in the hospital while nurse A was working) or type of contact (e.g., receiving direct care) with nurse A.
Of the 900 patients admitted to the maternity ward during nurse A's infectious period, 807 were admitted for postpartum care and 93 for gynecologic indications or complications during pregnancy. Documentation of HIV test results were available for 806 of the 807 postpartum patients; 16 (2 percent) tested positive for HIV infection. Of these HIV-infected females, 13 delivered infants admitted to the newborn nursery (12 single infants and one twin birth).
These 16 women and 14 infants were assigned the highest priority for follow-up testing. 3 of the women and 7 of the infants were located and tested for TB; none had evidence of LTBI or TB disease.
BTBC recommended LTBI treatment with isoniazid daily for 9 months for all contacts with a positive TST result, after TB disease was excluded. BTBC also recommended LTBI treatment for all HIV-infected persons exposed to nurse A and infants whose mothers had known HIV infection, regardless of their TST results, after TB disease was excluded http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm
[Reported by: Fitzpatrick F, Purswani M, Fazal B, et al]
MMWR Editorial Note
-------------- The findings in this report underscore the difficulty and substantial resources required to conduct contact investigations and provide appropriate follow-up for patients exposed to _M. tuberculosis_ in health-care settings. Despite extensive outreach efforts, approximately 70 percent of nurse A's patient contacts could not be traced.
Hospital A was located in an economically depressed community. Hospital records of telephone numbers and addresses for many of the patients were incorrect.
Nonetheless, evidence indicated that limited transmission of _M. tuberculosis_ had occurred in hospital A. The strongest evidence of transmission was that 4 infants had positive TST results (a 5th infant tested positive but had recently received BCG vaccination), which in children is a sentinel indicator for recent transmission of _M. tuberculosis_.
In this investigation, the only risk factor significantly associated with _M. tuberculosis_ transmission to the infants was cesarean delivery. Post-cesarean infants might have required more nursing care, thus resulting in more exposure. A major limitation of this investigation was the incomplete follow-up of all exposed patients. In addition, the extent of _M. tuberculosis_ transmission to the most heavily exposed group, nurse A's coworkers, was difficult to ascertain because 78 percent had positive TST baseline results.
Nurse A underwent bronchoscopy before TB disease was clinically suspected. Because bronchoscopy is a cough-inducing procedure that can result in increased transmission of _M. tuberculosis_, diagnosis of TB disease and microscopic examination of sputum for AFB should be considered before bronchoscopy (3). CDC recommends avoiding bronchoscopy if possible for patients with suspected or confirmed TB disease or postponing the procedure until the patient is determined to be noninfectious by confirmation of 3 negative AFB sputum smear results. If the patient cannot produce sputum, CDC recommends considering sputum induction before bronchoscopy (3).
11 years after her LTBI was detected, nurse A had infectious pulmonary TB disease diagnosed. An opportunity to prevent TB disease was missed when she did not complete treatment for LTBI [The report does not specifically mention any chemopreventative therapy for LTBI - Mod.LL].
In light of the investigation described in this report, hospital A began exploring ways to promote LTBI treatment for employees with positive TST results during annual screenings for TB.
Although the nurse did not have HIV infection, it is the greatest risk factor for progression from LTBI to TB disease (2). Therefore, voluntary HIV counseling, testing, and referral should be routinely offered to all persons at risk for LTBI.
Health care settings should be particularly aware of the need to prevent transmission of _M. tuberculosis_ in settings where persons infected with HIV might be encountered or might work.
In 2002, the incidence of TB disease among foreign-born HCWs in the state of New York was 17.5 per 100 000, compared with 2.0 among USA-born HCWs (4).
During 1998-2002, among 297 HCWs (employed in hospitals, home health care, nursing homes, and ambulatory care facilities) who were reported to have TB disease, 221 (74 percent) had had LTBI diagnosed previously. Of these, 111 (50 percent) had met criteria for treatment for LTBI, but only 26 (23 percent) of these received treatment (4). Those data and the circumstances described in this report support the need for effective LTBI testing and treatment programs among HCWs, particularly those born outside the USA.
Studies have demonstrated poor adherence to LTBI treatment among HCWs (5). HCWs might attribute a positive TST result to BCG vaccination (6).
Compared with USA-born physicians, foreign-born physicians in one USA medical residency program were less likely to recommend LTBI treatment for themselves, their family members, or recent immigrants if they had received BCG vaccination (7).
However, in the absence of _M. tuberculosis_ infection, tuberculin reactivity caused by BCG vaccination wanes over time and is unlikely to persist longer than 10 years after vaccination (8).
Current guidelines recommend considering treatment for HCWs who have a TST result of greater than 10 mm, especially if they emigrated from a country with high TB prevalence during the preceding 5 years (3). A history of vaccination with BCG should not influence the decision to treat LTBI.
The proportion of HCWs in the USA who were born outside the country is growing (9,10). Approximately 25 percent of all USA practicing physicians graduated from medical schools outside of the country (9).
Moreover, the shortage of registered nurses in the USA is anticipated to increase from 6 percent in 2000 to 29 percent by 2020, and foreign-born nurses likely will increasingly be sought to fill this gap (10).
All HCWs in the USA, particularly those foreign-born or foreign-trained, should be encouraged to follow USA guidelines for LTBI treatment. Guidelines for preventing transmission of _M. tuberculosis_ in health care settings, including baseline and periodic TB screening and effective LTBI treatment programs for HCWs in high-risk settings, should be followed (3). In addition, infection-control programs in health care settings should implement interventions to increase adherence to treatment for infected HCWs working in high-risk settings. On-site, directly observed preventive therapy is one such option.
1.Marais BJ, Gie RP, Schaaf HS, et al: The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004; 8:278-85.
2.CDC: Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000; 49(No. RR-6). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm
3.CDC: Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005 (in press).
4.Driver CR, Stricof RL, Granville K, et al: Tuberculosis in health care workers during declining tuberculosis incidence in New York State. Am J Infect Control 2005; 33:519-26.
5.Geiseler PJ, Nelson KE, Crispen RG: Tuberculosis in physicians: compliance with preventive measures. Am Rev Respir Dis 1987; 135:3-9.
6.Joseph HA, Shrestha-Kuwahara R, Lowry D, et al: Factors influencing health care workers' adherence to work site tuberculosis screening and treatment policies. Am J Infect Control 2004; 32:456-61.
7.Tsiouris S, Muttana H, Salazar-Schicchi J, et al:. Attitudes about BCG vaccination and treatment for latent tuberculosis infection among international and U.S. medical graduates. In: Proceedings of the 100th International Conference of the American Thoracic Society, Orlando, FL; 21-26 May 2003.
8.CDC. The role of BCG vaccine in the prevention and control of tuberculosis in the United States: a joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices. MMWR 1996; 45(No. RR-4). http://www.cdc.gov/mmwr/preview/mmwrhtml/00041047.htm
9.American Medical Association. Physician characteristics. In: Pasko T, Smart DR, eds. Physician characteristics and distribution in the U.S. 25th ed. Chicago, IL: American Medical Association; 2005:1-44.
10.Health Resources and Services Administration. Projected supply, demand, and shortage of registered nurses: 2000--2020. Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration; 2002. Available at http://bhpr.hrsa.gov/healthworkforce
-- ProMED-mail promed@promedmail.org
****** [2] Date: Fri, 23 Dec 2005 From: ProMED-mail promed@promedmail.org
Source: New York Times [edited] http://www.nytimes.com/2005/12/23/nyregion/23tb.html
A New York City maternity ward nurse who had infectious tuberculosis exposed as many as 1500 patients to the disease over 2 months in 2003, and most likely infected at least 4 infants, according to a joint investigation by the city's health department and the CDC.
More than 1000 of the patients the nurse came in contact with could not be found, the CDC said. It is not clear whether any of them contracted the disease, but city health officials say they have all the patients' names and are watching TB registries to see if they appear. The CDC says it believes that transmission was limited.
So far, the only patients known to have been infected are the 4 infants, who were treated and are now healthy, city health officials said. So is the nurse, whose identity was not revealed.
While the agency declined to name the hospital, health officials confirmed that it was the Bronx-Lebanon Hospital Center.
Dr. Kenneth G. Castro, director of the Division of Tuberculosis Elimination at the CDC, said New York was fortunate to have a health department with an active tuberculosis control program, because if the infection of the 4 infants had not been detected, the number of those who caught the disease could have grown exponentially. Still, the case underscores the difficulty of providing appropriate follow-up care for patients exposed to TB in hospitals and other health-care settings.
Infectious tuberculosis can be treated with an aggressive and extensive drug treatment regimen, but it is essential that the regimen be followed precisely and the disease diagnosed early. The case also highlights a challenge that increasingly worries public-health officials: screening and treating foreign-born health-care workers for tuberculosis.
Most people with latent tuberculosis never develop the more deadly form of the disease and therefore are unlikely to submit to the 9-month course of medication treatment requires. In fact, a recent survey by the department found that fewer than 1/4 of health care workers eligible for TB treatment actually receive care. Still, scares like the one at Bronx-Lebanon are very rare.
[Byline: Marc Santora]
-- ProMED-mail
[Early trials of tuberculosis chemoprevention were carried out using isoniazid between 1955 and 1964. The studies were performed in the USA as well as Denmark, Tunisia, Kenya, Japan, the Netherlands, and the Philippines. An extensive monograph by Ferebee published in 1970 (1) reviewed the data, which showed by treatment with isoniazid greatly reduced -- but not completely prevented -- the incidence of clinically apparent TB as compared with placebo. Its use is based on this reduction balanced against the risk of hepatotoxicity, which can be severe enough to result in the need for liver transplantation (2).
Given the observations that the amount of use of this therapy in health care workers is not substantial and the treatment is not completely preventative, it is vitally important for the health care worker individually to seek medical care and diagnosis for any respiratory illness lasting more than 1-2 weeks or so. Because of the risk of risk of TB and a variety of other respiratory diseases, this should be the case whether the individual is known to be tuberculin-reactive or not. In this case, the index case was symptomatic for 8 weeks and even when seen with a history of a known reactive tuberculin test, the diagnosis was not suspected. Even when a CT scan showed upper lobe volume loss in a patient with a known reactive tuberculin test, the diagnosis was not suspected.
It is fortunate that the infants found did not have progressive infection, although it is certainly possible that morbidity and mortality occurred among the large number of infants and mothers lost to follow-up.
1. Ferebee SH: Controlled chemoprophylaxis trials in tuberculosis: A general review. Adv Tuberc Res 1970; 17:28-106.
2. CDC: Severe INH-associated hepatitis - New York, 1991-1993. MMWR 1993; 43:545-47. - Mod.LL]
[see also: Tuberculosis, school - Sweden (Stockholm) 20051028.3140 Tuberculosis, hospital exposures - USA (MA) 20050616.1702 Tuberculosis - Iraq (Missan) 20050613.1652 Tuberculosis, nursery school - Spain (Catalonia) 20050523.1416 Tuberculosis, supermarket exposure - Netherlands (Zeist)(03) 20050225.0602 Tuberculosis, supermarket exposure - Netherlands (Zeist) 20050207.0411] ...................................................ll/pg/lm *#################
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.
