Risk Factors for Transmission of Mycobacterium tuberculosis in a Primary School Outbreak: Lack of Racial Difference in Susceptibility to Infection

Abstract

Recent data have suggested that there are racial differences in the susceptibility to infection by Mycobacterium tuberculosis. An opportunity to test this suggestion was afforded by an outbreak of tuberculosis in a racially mixed elementary school in St. Louis County, Missouri. A physical education teacher was discovered to have cavitary pulmonary tuberculosis. Of 343 students in the school, 176 (51 percent) were found to be tuberculin skin test positive (> or = 5 mm induration by Mantoux method); 32 children had abnormal chest radiographs. More frequent contact with the physical education teacher was associated with infection (p < 0.001). Black children were no more likely to be infected than were white children (relative risk (RR) = 0.98, 95% confidence interval (CI) 0.78-1.22). However, black children who were tuberculin positive had larger skin reactions than did white children (mean, 18.9 vs. 16.6 mm, p < 0.001) and were more likely to have abnormal chest radiographs (RR = 2.76, 95% CI 1.44-5.27). Among tuberculin-positive children, low body mass index (less than 10th percentile) was associated with active disease (RR = 2.90, 95% CI 1.45-5.80). The analysis of race was unchanged after controlling for sex, body build, and level of contact with the physical education teacher. Widespread tuberculous infection resulted from contact with a highly infectious staff person. Thin body build was a risk factor for active disease. Black children were no more susceptible to infection than were white children, although they more commonly developed radiographic evidence of active disease.

Incidência e fatores de risco para tuberculose em Pelotas, uma cidade do Sul do Brasil

“…Stead e colaboradores 20 , por exemplo, encontraram um risco duas vezes maior para tuberculose em adultos da raça negra do que em adultos da raça branca. No entanto, Hoge e colaboradores 21 , estudando crianças escolares, não encontraram risco mais elevado para tuberculose em crianças de raça negra. A variável observada, no presente estudo, foi cor da pele.…”

Transmissibility of tuberculosis among school contacts: An outbreak investigation in a boarding middle school, China

“…TB outbreaks among school children and college students have been previously documented (1994; Abubakar et al, 2011; Cavanaugh et al, 2012; Filia et al, 2011; Hoge et al, 1994; Quigley, 1997; Ridzon et al, 1997; Shannon et al, 1991; Stein-Zamir et al, 2006). However, there have been few, if any, attempts to estimate the SAR and R in the school setting.…”

“…The government-reported national BCG vaccine coverage of newborns has remained above 90% for most of the years since 1990 (WHO, 2014); however, local coverage rates vary substantially with urban/rural indicator, parental education level, and access to health services as strong predictors, especially in less-developed regions (Ciren et al, 2007; Xie and Dow, 2005). TB outbreaks usually occur in institutional settings and have been reported in kindergartens, primary schools, boarding schools, and colleges (1994; Hoge et al, 1994; Quigley, 1997). Boarding schools are subject to a higher risk of TB outbreaks, where adolescents often cluster under relatively overcrowded conditions (ATS, 2000; Cohn et al, 2000; Oelemann et al, 2007; WHO, 2009a, b).…”

Screening Nonimmigrant Visitors to the United States for Tuberculosis

“…Compared with adults, young children more often have negative sputum smears, they seldom have cavitary disease, they often have little or no cough, and when a cough is present, it is often of insufficient strength to expel aerosolized bacilli effectively. 25 In 5 recently published reports [26][27][28][29][30] of school-based outbreaks of TB, all source patients were adults or adolescents.…”