Extensive Transmission of Mycobacterium Tuberculosis Among Children on a School Bus

Neira-Munoz, Edmundo; Smith, J T; Cockcroft, P.M.; Basher, Damian; Abubakar, Ibrahim

doi:10.1097/inf.0b013e31816ff7c5

Cited by 22 publications

(13 citation statements)

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“…The meta-analysis included cohort studies of children who were screened as part of an investigation of a tuberculosis outbreak,11 12 20 21 22 who were referred to hospital as close contacts of index cases,20 21 23 24 25 were household contacts of an infectious adult,13 26 27 28 or were contacts in other settings 29. Four studies were conducted in the United Kingdom, two each in the Gambia and Spain, and a single study in Greece, Italy, Indonesia, Turkey, South Africa, and Cambodia each (table) .…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were conducted in the United Kingdom, two each in the Gambia and Spain, and a single study in Greece, Italy, Indonesia, Turkey, South Africa, and Cambodia each (table) . BCG vaccination status was assessed in included studies by one or a combination of BCG scar,12 13 22 23 24 25 26 27 29 30 confirmed medical records,11 12 21 30 and parental recall of vaccination 21…”

Section: Resultsmentioning

confidence: 99%

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Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

Roy

Eisenhut

Harris

et al. 2014

BMJ

493

330

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Objectives To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children.Design Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. Setting Community congregate settings and households.Inclusion criteria Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. Data extractionStudy results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. ResultsThe primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). Conclusions BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www. crd.york.ac.uk/prospero/). IntroductionBCG vaccine has been the subject of numerous efficacy trials and epidemiological studies conducted over several decades. These trials indicate that BCG has 60-80% protective efficacy against severe forms of tuberculosis in children, particularly meningitis, 1 2 and its efficacy against pulmonary diseases varies geographically.3-5 BCG does not seem to protect against disease when it is given to people already infected or sensitised to environmental mycobacteria, which could explain the geographical variation.6-8 Until recently it was not possible to establish whether the protective effect of BCG vaccination against disease was from its action in preventing acquisition of infection or limited to prevention of progression from infection to clinical disease.The scarcity of evidence on whether the vaccine is effective against Mycobacterium tuberculosis infection was because of limitations of the tuberculin skin test. This test cannot distinguish a positive response caused by M tuberculosis infection from that caused by BCG vaccination or non-tuberculous In this systematic review we examined the evidence for the protective effect of BCG against M tuberculosis infection, as opposed to against disease, in settings where children can be presumed to have been exposed to M tu...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

Roy

Eisenhut

Harris

et al. 2014

BMJ

493

330

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“…It is therefore highly probable that the majority of infection occurs indoors, in buildings other than individual’s own homes. Individual outbreaks of M.tb infection have been linked to a wide range of settings, including public transport [ 8 , 9 ], schools [ 10 ], churches [ 11 , 12 ] and healthcare facilities [ 13 , 14 ]. These kinds of study provide some information on locations where transmission can occur, but as outbreak investigations are typically only undertaken when unusual patterns of disease are noticed, they give little insight into the types of location where transmission is most common.…”

Section: Introductionmentioning

confidence: 99%

Comparison of indoor contact time data in Zambia and Western Cape, South Africa suggests targeting of interventions to reduce Mycobacterium tuberculosis transmission should be informed by local data

et al. 2016

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BackgroundIn high incidence settings, the majority of Mycobacterium tuberculosis (M.tb) transmission occurs outside the household. Little is known about where people’s indoor contacts occur outside the household, and how this differs between different settings. We estimate the number of contact hours that occur between adults and adult/youths and children in different building types in urban areas in Western Cape, South Africa, and Zambia.MethodsData were collected from 3206 adults using a cross-sectional survey, on buildings visited in a 24-h period, including building function, visit duration, and number of adults/youths and children (5–12 years) present. The mean numbers of contact hours per day by building function were calculated.ResultsAdults in Western Cape were more likely to visit workplaces, and less likely to visit shops and churches than adults in Zambia. Adults in Western Cape spent longer per visit in other homes and workplaces than adults in Zambia. More adults/youths were present at visits to shops and churches in Western Cape than in Zambia, and fewer at homes and hairdressers. More children were present at visits to shops in Western Cape than in Zambia, and fewer at schools and hairdressers. Overall numbers of adult/youth indoor contact hours were the same at both sites (35.4 and 37.6 h in Western Cape and Zambia respectively, p = 0.4). Child contact hours were higher in Zambia (16.0 vs 13.7 h, p = 0.03). Adult/youth and child contact hours were highest in workplaces in Western Cape and churches in Zambia. Compared to Zambia, adult contact hours in Western Cape were higher in workplaces (15.2 vs 8.0 h, p = 0.004), and lower in churches (3.7 vs 8.6 h, p = 0.002). Child contact hours were higher in other peoples’ homes (2.8 vs 1.6 h, p = 0.03) and workplaces (4.9 vs 2.1 h, p = 0.003), and lower in churches (2.5 vs 6.2, p = 0.004) and schools (0.4 vs 1.5, p = 0.01).ConclusionsPatterns of indoor contact between adults and adults/youths and children differ between different sites in high M.tb incidence areas. Targeting public buildings with interventions to reduce M.tb transmission (e.g. increasing ventilation or UV irradiation) should be informed by local data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1406-5) contains supplementary material, which is available to authorized users.

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“…TB outbreaks usually occur in people who live in a closed and crowded environment. TB outbreaks have occurred in refugees [10–12], correctional facility [13], long-term care facility [14], schools [15,16] and on a school bus [17] in other countries. TB outbreaks in schools have frequently been reported in China [2, 6, 18–20].…”

Section: Discussionmentioning

confidence: 99%

An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors

Wang

Zhang

et al. 2019

PLoS ONE

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BackgroundIn 2013, a tuberculosis (TB) outbreak occurred in a middle school in Henan province of China. An outbreak survey was carried out in the school.ObjectivesThis study was undertaken to investigate the detection rate of TB cases and those with strong Mantoux positive (SMP), defined as tuberculin skin test (TST) indurations of 15mm or larger and/or blisters, necrosis or lymphangitis, and to identify their risk factors.MethodsThe TST, chest x-ray/radiography, and TB-suspicious symptoms interview were used to screen for TB cases. Their diagnosis was made by sputum smear microscopy, liquid culture, computed tomography (CT), and diagnostic therapy if necessary. We retrospectively analyzed the outbreak survey data of 4082 students and 278 staff in the school. Logistic regression models were used to identify the risk factors associated with SMP and TB disease.ResultsApproximately 3.55% of students and 16.55% of staff were SMP. SMP rate in students was significantly lower than that in staff (p<0.001). 55 TB cases in students and none in staff were identified in the school from February to November, 2013, with a detection rate of 1.35% for students. SMP and TB case detection rates were 20.29% and 41.77%, respectively, in the index class, both significantly higher than that in the other classes (3.26% and 0.55%, respectively; both p<0.001). In the index class, TB case detection rate over the study period in students with SMP was not significantly higher than that with TST indurations of <15mm (38.18% vs 21.43%, p = 0.24), but it was significantly higher in the other classes (7.81% vs 0.18%, p<0.001). Risk factors independently associated with SMP and TB cases shared the following with the index case: same dormitory-floor (adjusted odds ratio (AOR) 5.36, 95% CI 3.02–9.48, p<0.001 for SMP; AOR 2.67; 95% CI 1.03–6.96, p = 0.044 for TB cases), same classroom (AOR 4.01; 95% CI 1.95–8.26, p<0.001 for SMP; AOR 165.08; 95% CI 66.88–407.47, p<0.001 for TB cases), same teaching-floor in different classroom (AOR 5.41; 95% CI 3.02–9.71, p<0.001 for SMP; AOR 11.24; 95% CI 3.71–34.03, p<0.001 for TB cases) and same teaching-building on different floor (AOR 1.81; 95% CI 1.16–2.85, p = 0.009 for SMP; AOR 3.30; 95% CI 1.16–9.42, p = 0.025 for TB cases). The closer the contact was with the index case, the larger the AORs for SMP and TB cases were.ConclusionSame dormitory-floor, same classroom, same teaching-floor and same teaching-building with the index case were all risk factors for both TB infection and disease for students in the outbreak, and the closer the contact was with the index case, the higher the risk was observed. Attention should also be paid to students with TST indurations <15mm, as well as to those with that ≥15mm for the index class in dealing with the outbreak.

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Extensive Transmission of Mycobacterium Tuberculosis Among Children on a School Bus

Cited by 22 publications

References 4 publications

Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis

Comparison of indoor contact time data in Zambia and Western Cape, South Africa suggests targeting of interventions to reduce Mycobacterium tuberculosis transmission should be informed by local data

An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors

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