An outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019
In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019. We defined latent T...
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| description | In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019.
We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates.
Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13-0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case.
Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected. |
| doi_str_mv | 10.1371/journal.pone.0247564 |
| format | Article |
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We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates.
Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13-0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case.
Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0247564</identifier><identifier>PMID: 33626108</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Biology and Life Sciences ; China ; Classrooms ; Consent ; Control ; Disease control ; Disease prevention ; Disease transmission ; Draft (gas flow) ; Drug resistance ; Editing ; Emergency preparedness ; Emergency response ; Epidemics ; Epidemiology ; Ethics ; Health aspects ; High schools ; Infections ; Infectious diseases ; Medical diagnosis ; Medical personnel ; Medical records ; Medicine and Health Sciences ; Middle schools ; Outbreaks ; People and Places ; Physicians ; Prevention ; Public health ; Pulmonary tuberculosis ; Radiography ; Reviews ; Risk analysis ; Risk factors ; Schools ; Secondary schools ; Social Sciences ; Statistics ; Students ; Training ; Tuberculosis ; Ventilation</subject><ispartof>PloS one, 2021-02, Vol.16 (2), p.e0247564-e0247564</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Fang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Fang et al 2021 Fang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-bfbf3b9870931e7e64567151a5efe5e7b02bee4bdabdebae914bbf1a90a645d3</citedby><cites>FETCH-LOGICAL-c692t-bfbf3b9870931e7e64567151a5efe5e7b02bee4bdabdebae914bbf1a90a645d3</cites><orcidid>0000-0002-6067-2488</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904191/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904191/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33626108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Mokrousov, Igor</contributor><creatorcontrib>Fang, Yirong</creatorcontrib><creatorcontrib>Ma, Yan</creatorcontrib><creatorcontrib>Lu, Qiaoling</creatorcontrib><creatorcontrib>Sun, Jiamei</creatorcontrib><creatorcontrib>Pei, Yingxin</creatorcontrib><title>An outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019.
We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates.
Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13-0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case.
Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected.</description><subject>Biology and Life Sciences</subject><subject>China</subject><subject>Classrooms</subject><subject>Consent</subject><subject>Control</subject><subject>Disease control</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Draft (gas flow)</subject><subject>Drug resistance</subject><subject>Editing</subject><subject>Emergency preparedness</subject><subject>Emergency response</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Ethics</subject><subject>Health aspects</subject><subject>High schools</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Medical diagnosis</subject><subject>Medical personnel</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Middle schools</subject><subject>Outbreaks</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Prevention</subject><subject>Public health</subject><subject>Pulmonary tuberculosis</subject><subject>Radiography</subject><subject>Reviews</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Schools</subject><subject>Secondary schools</subject><subject>Social 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outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019</title><author>Fang, Yirong ; Ma, Yan ; Lu, Qiaoling ; Sun, Jiamei ; Pei, Yingxin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-bfbf3b9870931e7e64567151a5efe5e7b02bee4bdabdebae914bbf1a90a645d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biology and Life Sciences</topic><topic>China</topic><topic>Classrooms</topic><topic>Consent</topic><topic>Control</topic><topic>Disease control</topic><topic>Disease prevention</topic><topic>Disease transmission</topic><topic>Draft (gas flow)</topic><topic>Drug resistance</topic><topic>Editing</topic><topic>Emergency preparedness</topic><topic>Emergency response</topic><topic>Epidemics</topic><topic>Epidemiology</topic><topic>Ethics</topic><topic>Health aspects</topic><topic>High schools</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Medical diagnosis</topic><topic>Medical personnel</topic><topic>Medical records</topic><topic>Medicine and Health Sciences</topic><topic>Middle schools</topic><topic>Outbreaks</topic><topic>People and Places</topic><topic>Physicians</topic><topic>Prevention</topic><topic>Public health</topic><topic>Pulmonary tuberculosis</topic><topic>Radiography</topic><topic>Reviews</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Schools</topic><topic>Secondary schools</topic><topic>Social Sciences</topic><topic>Statistics</topic><topic>Students</topic><topic>Training</topic><topic>Tuberculosis</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fang, Yirong</creatorcontrib><creatorcontrib>Ma, Yan</creatorcontrib><creatorcontrib>Lu, Qiaoling</creatorcontrib><creatorcontrib>Sun, Jiamei</creatorcontrib><creatorcontrib>Pei, 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one</jtitle><addtitle>PLoS One</addtitle><date>2021-02-24</date><risdate>2021</risdate><volume>16</volume><issue>2</issue><spage>e0247564</spage><epage>e0247564</epage><pages>e0247564-e0247564</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In October 2016, a senior high school student was diagnosed with sputum-smear positive [SS(+)] pulmonary tuberculosis (TB). We conducted an investigation of an outbreak in the school, including among students and teachers diagnosed with latent TB, who we followed until July 2019.
We defined latent TB infection (LTBI) as a tuberculin skin test (TST) induration of 15mm or larger; probable TB as a chest radiograph indicative of TB plus productive cough/hemoptysis for at least 2 weeks, or TST induration of 15mm or larger; and confirmed TB as two or more positive sputum smears or one positive sputum smear plus a chest radiograph indicative of TB or culture positive with M. tuberculosis. We conducted mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing based on 24 loci in the isolates.
Between October 2016 and July 2019, we identified 52 cases, including nine probable, six confirmed, and 37 LTBI cases. The index case-student had attended school continuously despite having TB symptoms for almost three months before being diagnosed with TB. We obtained three isolates from classmates of the index case in 2016; all had identical MIRU-VNTR alleles with the index case. The LTBI rate was lower among students (7.41%, 30/405) than among teachers (26.92%, 7/26) (rate ratio [RR] = 0.28, 95% confidential interval [CI]: 0.13-0.57). Among the 17 students who had latent TB and refused prophylaxis in October 2016, 23.53% (4/17) became probable/confirmed cases by July 2019. None of the six teachers who also refused prophylaxis became probable or confirmed cases. Of the 176 students who were TST(-) in October 2016, 1.70% (3/176) became probable/confirmed cases, and among the 20 teachers who were TST(-), 1 became a probable case.
Delayed diagnosis of TB in the index patient may have contributed to the start of this outbreak; lack of post-exposure chemoprophylaxis facilitated spread of the outbreak. Post-exposure prophylaxis is strongly recommended for all TST-positive students; TST-negative students exposed to an SS(+) case should be followed up regularly so that prophylaxis can be started if LTBI is detected.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33626108</pmid><doi>10.1371/journal.pone.0247564</doi><tpages>e0247564</tpages><orcidid>https://orcid.org/0000-0002-6067-2488</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Public Library of Science (PLoS) Journals Open Access; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Biology and Life Sciences China Classrooms Consent Control Disease control Disease prevention Disease transmission Draft (gas flow) Drug resistance Editing Emergency preparedness Emergency response Epidemics Epidemiology Ethics Health aspects High schools Infections Infectious diseases Medical diagnosis Medical personnel Medical records Medicine and Health Sciences Middle schools Outbreaks People and Places Physicians Prevention Public health Pulmonary tuberculosis Radiography Reviews Risk analysis Risk factors Schools Secondary schools Social Sciences Statistics Students Training Tuberculosis Ventilation |
| title | An outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019 |
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