In order to estimate the risk of tuberculosis infection among employees in the funeral service industry, we conducted a risk-assessment study of a convenience sample of funeral home employees. Study participants completed a risk-assessment questionnaire and underwent tuberculin skin testing. Of 864 employees tested, 101 (11.7%) had a reactive tuberculin skin test. Reactivity to the tuberculin skin test was significantly associated with job category; funeral home employees with a present or past history of embalming deceased-human remains were twice as likely to be reactive as were non-embalming personnel (14.9% versus 7.2%, P < 0.01). Reactivity was also associated with age, gender, race, past history of close contact with a person diagnosed with tuberculosis, and work history. After controlling for age and other factors, tuberculin reactivity was found to be associated in embalming personnel with the number of years spent performing embalmings(≥20), and, in non-embalming personnel, with a history of close contact with infected individuals. Based on these results, it is recommended that funeral home employees who routinely embalm cadavers undergo annual tuberculin skin testing, receive initial training on tuberculosis prevention, and wear respiratory protection when preparing known tuberculosis cases.
From the Departments of Environmental Health Science (Dr Gershon, Ms Karkashian) and Epidemiology (Dr Comstock, Dr Vlahov), the School of Public Health, and The Department of Internal Medicine, School of Medicine (Dr Badawi), Johns Hopkins University, Baltimore, Md.; Instituto de Salud, Ambiente y Trabajo, Tlalpan, Mexico (Dr Escamilla-Cejudo); the Department of Medicine, University of Maryland School of Medicine, Baltimore, Md. (Dr McDiarmid); and the Department of Infection Control, Holy Cross Hospital, Silver Spring, Md. (Ms Grimes).
Address correspondence to: Robyn R.M. Gershon, MHS, DrPH, The Johns Hopkins University School of Public Health, 615 N Wolfe St, Rm 8503, Baltimore, MD 21205.