Tuberculosis Outbreak in an Educational Institution in Henan Province, China

Li, Hui; Liu, Chunfa; Liang, Mengya; Liu, Dongxin; Zhao, Bing; Shi, Jie; Zhao, Yanlin; Ou, Xichao; Zhang, Guolong

doi:10.3389/fpubh.2021.737488

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…First, the proportion of bacteriological evidence in tuberculosis cases is very small, and most of them are clinically diagnosed. Previous studies have shown a low rate of pathogenic positivity in the student population and the bacterial load in children's specimens is low and difficult to collect ( 27 , 28 ). To improve the sensitivity of bacteriological testing, some researchers suggest the use of multiple sampling methods for microbiological diagnosis, including serial collection of biological samples such as gastric aspirates, nasopharyngeal aspirates, sputum, bronchoalveolar lavage, and lymph node aspirates and urine ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

A university-clustered tuberculosis outbreak during the COVID-19 pandemic in eastern China

Zhu

Yu³

et al. 2022

Front. Public Health

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During the COVID-19 pandemic in 2020, a tuberculosis outbreak occurred in a university in eastern China, with 4,488 students and 421 staff on the campus. A 19-year-old student was diagnosed in August 2019. Later, the first round of screening was initiated among close contacts, but no active cases were found. Till September 2020, four rounds of screening were performed. Four rounds of screening were conducted on September 9, November 8, November 22-25 in 2019 and September 2020, with 0, 5, 0 and 43 cases identified, respectively. A total of 66 active tuberculosis were found in the same university, including 4 sputum culture-positive and 7 sputum smear-positive. The total attack rate of active tuberculosis was 1.34% (66/4909). The whole-genome sequencing showed that the isolates belonged to the same L2 sub-specie and were sensitive to all tested antituberculosis drugs. Delay detection, diagnosis and report of cases were the major cause of this university tuberculosis epidemic. More attention should be paid to the asymptomatic students in the index class. After the occurrence of tuberculosis cases in schools, multiple rounds of screening should be carried out, and preventive therapy should be applied in a timely manner.

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Section: Discussionmentioning

confidence: 99%

A university-clustered tuberculosis outbreak during the COVID-19 pandemic in eastern China

Zhu

Yu³

et al. 2022

Front. Public Health

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“…The index case was defined as the first identified TB patient in each school. 17 Close contacts refer to those who have direct contact with index cases, and the first-round screening of close contacts mainly included teachers and students in the same class and dormitory. Systematic TB screening was performed by clinical evaluation, tuberculin skin testing (TST), chest radiography (CXR), and laboratory test for all close contacts.…”

Section: Methodsmentioning

confidence: 99%

“…There were 36 (73.5%) male and 13 (26.5%) female patients. Except for one patient who was a 31-year-old female teacher, the others were all students with a median age of 17 years (IQR [17][18]. Most TB patients (34, 69.4%) were in the 12 th grade.…”

Section: Epidemiological Characteristicsmentioning

confidence: 99%

“… 15 , 16 Recent studies have shown that WGS was applied in TB outbreaks to find the source and determine the transmission route in communities in China. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

“…15,16 Recent studies have shown that WGS was applied in TB outbreaks to find the source and determine the transmission route in communities in China. 17,18 Hunan Province, located in south-central China, is one of the provinces with a high TB burden in China, 9 with an estimated notification of a TB incidence rate of 74 patients per 100,000 population. From 2012 to 2017, 7940 students with TB were notified in Hunan Province, with a registered incidence rate of 13.2 per 100,000 population, suggesting the relative high school tuberculosis epidemic of Hunan Province.…”

Section: Introductionmentioning

confidence: 99%

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Whole-Genome Sequencing and Epidemiological Investigation of Tuberculosis Outbreaks in High Schools in Hunan, China

Xu¹,

Liu²,

Liu³

et al. 2022

IDR

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Background Tuberculosis (TB) seriously threatens individual and public health. Recently, TB outbreaks in schools have been reported more frequently in China and have attracted widespread attention. We reported three TB outbreaks in high schools in Hunan Province, China. Methods When a tuberculosis patient was reported in a school, we carried out field epidemiological investigations, including tuberculin skin testing (TST), chest X-ray (CXR) and laboratory test for all close contacts, and whole-genome sequencing (WGS) analyses to understand the transmission patterns, the causes and the risk factors for the outbreaks, thereby providing a foundation for the control of TB epidemics in schools. Results A total of 49 students with TB patients were identified in the three schools where TB outbreaks occurred, including nine patients in School A, 14 patients in School B, and 26 patients in School C. In Schools A, B and C, the putative attack rates in the classes of the index case were 13.8% (8/58), 7.6% (5/66), and 40.4% (21/52), while the putative attack rates of expanding screening in the school were 0.3% (1/361), 0.2% (9/3955), and 0.2% (5/2080), respectively. Thirteen patients had patient delay, with a median delay interval of 69 days (IQR 30.5–113 days). Twelve patients had a healthcare diagnostic delay with a median delay interval of 32 days (IQR 24–82 days). Phylogenetic analysis of culture-positive patients revealed that most of them shared a small genetic distance (≤12 SNPs), with three separate genetic clusters (including one MDR-TB genomic cluster), indicating the recent transmission of Mycobacterium tuberculosis strains. Conclusion This combination of field investigation and WGS analysis revealed the transmission of three TB outbreaks in schools. Reinforced implementation is needed to improve timely case finding and reduce diagnosis delay in routine TB control in the school population.

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Extreme value analysis of the number of student absences in Jiangsu, China: Based on extreme value theory

Liu,

Yang,

Tian

et al. 2024

PLoS ONE

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Attendance absences have a substantial impact on student’s future physical and mental health as well as academic progress. Numerous personal, familial, and social issues are among the causes of student absences. Any kind of absence from school should be minimized. Extremely high rates of student absences may indicate the abrupt commencement of a serious school health crisis or public health crisis, such as the spread of tuberculosis or COVID-19, which provides school health professionals with an early warning. We take the extreme values in absence data as the object and attempt to apply the extreme value theory (EVT) to describe the distribution of extreme values. This study aims to predict extreme instances of student absences. School health professionals can take preventative measures to reduce future excessive absences, according to the predicted results. Five statistical distributions were applied to individually characterize the extreme values. Our findings suggest that EVT is a useful tool for predicting extreme student absences, thereby aiding preventative measures in public health.

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Tuberculosis Outbreak in an Educational Institution in Henan Province, China

Cited by 7 publications

References 35 publications

A university-clustered tuberculosis outbreak during the COVID-19 pandemic in eastern China

A university-clustered tuberculosis outbreak during the COVID-19 pandemic in eastern China

Whole-Genome Sequencing and Epidemiological Investigation of Tuberculosis Outbreaks in High Schools in Hunan, China

Extreme value analysis of the number of student absences in Jiangsu, China: Based on extreme value theory

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