Peace Corps Volunteers, Tuberculosis and Causes for Fatalities

Lin Chen
June 2008
Travel Medicine Advisor;Jun2008, Vol. 18 Issue 6, p32
JUNG AND BANKS REPORTED PPD CONVERsions and acute TB cases from the Peace Corps Epidemiological Surveillance System and post-service claims data between 1996 and 2005. PPD conversions to positive occurred at a rate of 1.283 per 1000 Volunteer-months, and acute TB cases occurred at 0.057 per 1000 Volunteer-months (1540 and 68.9 per 100,000 Volunteer-years, respectively). The authors analyzed PPD conversion and acute TB cases based on regions. The highest risk region for PPD conversion is Africa with a rate of 1.467 cases per 1000 Volunteer-months. The European region is second with a rate of 1.442. Asia is third with a rate of 1.364. Central America has a rate of 1.272. The rates for the Caribbean, South America, and the Pacific Islands are 0.994, 0.739, and 0.547 per 1000 Volunteer-months, respectively. For active TB, the African region also has the highest rate at 0.089 cases per 1000 Volunteer-months. The Pacific Islands are second with a rate of 0.071, followed by Central America (0.065), Europe (0.039), the Caribbean (0.021), Asia (0.019), and South America (0.013). The authors also compared their rates to the high-risk countries as identified by the World Health Organization. These are: Bangladesh, Botswana, China, Congo, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Philippines, Russia Far East, Russia Western, South Africa, Tanzania, Thailand, Uganda, Zambia, Zimbabwe. These high-risk countries have a PPD conversion and active TB at rates of 1.436 and 0.084 cases per 1000 Volunteer-months. For individual countries that host Peace Corps Volunteers (PCVs) and whose rates are available, Ethiopia has the highest PPD conversion rate at 3.384 and also the highest active TB rate at 0.677 per 1000 Volunteer-months. Compared to the U.S. population that has a TB rate of 4.8 per 100,000 person-years, the Peace Corps Volunteers have a higher TB rate. However, the PPD conversion rate is lower than data from other studies on travelers, which reported 2.8 per 1000 person-months. The second study on Peace Corps Volunteers reported on fatalities that occurred between 1984 and 2003. Sixty-six deaths occurred during this period, with a death rate of 54.3 deaths per 100,000 Volunteer-years. The major causes were injury (45), homicide (11), medical illness (9), and suicide (1). The death rate is lower than the previous Peace Corps report from 1961 and 1983, where death occurred at 110.4 per 100,000 Volunteer-years. Unintentional injuries included motor vehicle accidents (22; 48.9%), most commonly in automobiles (11; 24.4%), but injuries also occurred in buses, trucks, taxis, and minibus taxis. Only 1 of the automobile deaths occurred during confirmed seat belt use, and 5 had a confirmed lack of seat belt use. There were 2 motorcycle deaths (3%), 6 drownings (13.3%), including 4 in volunteers who knew how to swim. The homicides included 6 women and 5 men, and occurred in Africa (6), Eastern Europe (1), Asia (2), Latin America (2). Among the medical illnesses that led to death, heart disease was the major cause (5), cancer (2), cerebral malaria (1), and sepsis (1). Age group of 25 to 34 had the highest number of deaths (28), although death rates were highest in the 65- to 74-year-old group (185 deaths per 100,000 Volunteer-years). Comparison with prior PCV data found significant decreases, with major declines in motorcycle accidents and medical illness. When compared with U.S. death rates, PCVs have lower death rates probably due to the overall younger age of PCVs. When deaths in only the 20- to 39-year-old age group were compared, there were fewer deaths in PCVs. When compared to U.S. resident overseas deaths (1799 between October 2002 and December 2004), PCVs have a higher proportion of deaths due to injury and lower proportions from homicide and suicide.


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