Epidemiology of a tuberculosis outbreak in a rural Missouri high school
Epidemiology of a tuberculosis outbreak in a rural Missouri high school
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DOI：
10.1542/peds.113.6.e514
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发表时间：
2004-06-01
期刊：
影响因子：
8
通讯作者：
Smith, D
中科院分区：
文献类型：
--
作者：
Phillips, L;Carlile, J;Smith, D
目标。1)通过对密苏里州农村一名高传染性高中生的结核病接触调查，证明即使在低发病率地区也要保持结核病控制计划的重要性，以及2)讨论持续或遏制这种校本暴发的因素。对指标患者--一名15岁的高中生--进行的病例回顾，确定了他的传染性水平和持续时间的估计。对其家庭(n=5)、高中(n=781)和校车(n=67)的接触调查是根据疾病控制和预防中心制定的指南进行的。根据课堂暴露对高中生进行了进一步的分层，并计算了每个风险组的相对风险。病例回顾显示，指标患者在诊断结核病前6个月的胸片上有肺部空洞的证据。在5名家庭接触者中，所有人都被感染，3人(60%)出现活动性结核病。在781名寻求结核病筛查的高中生中，559人(72%)完成了检测，58人(10%)PPD阳性。67名公交车乘客接受了检测，其中7名(19%)PPD呈阳性，1名公交车乘客随后被诊断为活动性疾病。根据教室和公交车接触患者的情况计算风险。PPD阳性的相对危险度为：随患者参加任何一节课(n=25)的相对危险度为3.2，通气量较少的课(n=21)为4.2，与患者一起参加3节课(n=7)以上的PPD的相对危险度为5.7。共有62名学生开始治疗结核病潜伏感染，49人已经完成治疗。其中42名学生通过当地公共卫生机构和高中接受了直接观察治疗。这项调查表明，一例诊断延迟6个月的儿童结核病病例出现了广泛的成人型传播。几项行动促成了这项调查的成功，包括迅速动员公共卫生系统，集中跟踪，以及现场检测和直接观察治疗。儿科医生需要保持对儿童结核病和危险因素的认识，即使在低发病率地区也是如此。及时诊断将降低患者的病情严重程度，并有可能防止广泛的学校传播。公共卫生当局必须维护基础设施，以应对大规模的结核病暴发。
Objectives. 1) Demonstrate the importance of maintaining a tuberculosis ( TB) control program even in low-incidence areas by studying a TB-contact investigation of a highly infectious high school student in rural Missouri, and 2) discuss factors that perpetuated or contained this school-based outbreak.Methods. A case review of the index patient, a 15-year-old high school student, established estimates of his level and duration of infectiousness. Contact investigations of his household (n = 5), high school ( n = 781), and school bus ( n = 67) were administered according to guidelines established by the Centers for Disease Control and Prevention. High school students were stratified further based on classroom exposure, and relative risks were calculated for each risk group.Results. The case review revealed that the index patient had evidence of a pulmonary cavity on chest radiograph 6 months before his TB diagnosis. Of the 5 household contacts, all were infected and 3 ( 60%) had developed active TB disease. Of the 781 high school students sought for TB screening, 559 (72%) completed testing, and 58 (10%) were PPD-positive. Sixty-seven bus riders were sought for testing and 7 (19%) were purified protein derivative (PPD)-positive, with 1 bus rider subsequently diagnosed with active disease.Risks were calculated based on classroom and bus exposure to the patient. The relative risks for a positive PPD were 3.2 for attending any class with the patient ( n = 25), 4.2 for classes with less ventilation ( n = 21), and 5.7 for greater than or equal to 3 classes ( n = 7) with the patient. A total of 62 students started treatment for latent TB infection, and 49 have completed it. Forty-two of these students received directly observed therapy through the local public health agency and the high school.Conclusion. This investigation demonstrated widespread adult-type transmission from a pediatric TB case with a 6-month delay in diagnosis. Several actions contributed to the success of this investigation, including rapidly mobilizing the public health system, centralizing follow-up, and on-site testing and treatment with directly observed therapy. Pediatricians need to maintain awareness of TB and risk factors in children, even in low-incidence areas. Prompt diagnosis would have reduced the severity of illness in the patient and potentially prevented widespread school-based transmission. Public health authorities must maintain an infrastructure to respond to large TB outbreaks.