Extensive Transmission of<i>Mycobacterium tuberculosis</i>from a Child

Curtis, Amy; Ridzon, Renée; Vogel, Ruth H.; McDonough, Stephen; Hargreaves, J.; Ferry, Julie; Valway, Sarah E.; Onorato, Ida M.

doi:10.1056/nejm199911113412002

Cited by 181 publications

(71 citation statements)

References 14 publications

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“…These findings are consistent with other outbreaks during which confined air space promoted transmission, such as those aboard ships, in factories, and in bars. 4,10 Testing the entire high school led to the identifica- NA indicates not applicable. * Two students rode the bus and attended school but were not in class with the index patient.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School

2004

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ABSTRACT. 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 >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 lowincidence 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. Pediatrics 2004; 113:e514 -e519. URL: http://www.pediatrics.org/cgi/ content/full/113/6/e514; tuberculosis disease, latent tuberculosis infection, directly observed therapy, school-based outbreak, contact investigation.

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Section: Discussionmentioning

confidence: 99%

“…In contrast, older children and adolescents with TB can be very effective transmitters. 3,4 The following describes a pediatric TB case in rural Missouri and the subsequent school-based outbreak.…”

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confidence: 99%

Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School

2004

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“…Seven years old age group 1979, 1984/85, 1990, the infection rate was 7.3%, 7.8%, 6.6%.1979, 1990 Children's immune system is not perfect, because children tuberculosis person progress fast, easy development of disseminated TB (tuberculosis of su li sex or tuberculous meningitis) [7]. And children tuberculosis may also have stronger infectivity [8].…”

Section: The Status Quo Of Tuberculosis In Childhood In Chinamentioning

confidence: 99%

The Current Situation of Diagnosis and Treatment of Tuberculosis in Childhood in China

Jiao¹,

Mengrao²

2017

J Pediatr Neurol Med

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“…This educational plan targets providers involved in the diagnosis and management of persons at high risk for TB infection and progression to disease once infected with M. tb, e.g., HIV-infected persons, homeless persons, injection-drug users, nationals of countries with high TB prevalence, prison/jail inmates, and elderly individuals in congregate settings (82). Children of foreign-born individuals in whom TB is often missed should also be included in this category (51,76).…”

Section: The Futurementioning

confidence: 99%

Tuberculosis

Tiruviluamala

Reichman

2002

Annu. Rev. Public Health

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Key Words Mycobacterium tuberculosis, nosocomial infection, DOT, MDR TB, TB vaccines Abstract Tuberculosis is an infectious disease caused by bacteria in the Mycobacterium tuberculosis complex. Of these, the most common species to infect humans is M. tuberculosis. The TB bacillus is an extremely successful human pathogen, infecting two billion persons worldwide; an estimated 2 to 3 million people die from tuberculosis each year. In the United States, TB rates decreased steadily at the rate of 5% per year from 1953 until 1985 when the trend reversed, with the number of TB cases peaking in 1992. Outbreaks of multidrug-resistant TB (MDR TB) were reported, and these cases were documented to be transmitted in nosocomial and congregate settings, including hospitals and prisons. AIDS patients infected with M. tb developed disease rapidly, and case-fatality rates of >80% were noted in those infected with multidrug-resistant M. tb. Intensive intervention, at enormous cost, caused the number of TB cases to decline. This article discusses factors that led to the increase in TB cases, their subsequent decline, and measures needed in the future if TB is to be eliminated in the United States.

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Extensive Transmission ofMycobacterium tuberculosisfrom a Child

Cited by 181 publications

References 14 publications

Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School

Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School

The Current Situation of Diagnosis and Treatment of Tuberculosis in Childhood in China

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