An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors
Autoři:
Jiying Xu aff001; Guojie Wang aff002; Yanqiu Zhang aff001; Guolong Zhang aff001; Jin Xing aff001; Lihong Qi aff003; Yan Zhuang aff001; Hejun Zeng aff004; Jianhua Chang aff004
Působiště autorů:
Institute of Tuberculosis Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan province, China
aff001; Department of Medicine, Henan Medical College, Zhengzhou, Henan province, China
aff002; Department of Public Health Science, School of Medicine, University of California, Davis, California, United States of America
aff003; Institute of Tuberculosis Control and Prevention, Hebi Prefecture Center for Disease Control and Prevention, Hebi, China
aff004
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0225042
Souhrn
Background
In 2013, a tuberculosis (TB) outbreak occurred in a middle school in Henan province of China. An outbreak survey was carried out in the school.
Objectives
This 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.
Methods
The 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.
Results
Approximately 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.
Conclusion
Same 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.
Klíčová slova:
Epidemiology – Human mobility – Medical risk factors – Schools – Sputum – Tuberculin – Tuberculosis – Tuberculosis diagnosis and management
Zdroje
1. World Health Organization (WHO). Global tuberculosis report 2018. Geneva, Switzerland: WHO. 2018.
2. Chen W, Xia Y, Li X, Zhou L, Li C, Wan K, et al. A tuberculosis outbreak among senior high school students in China in 2011. J Int Med Res. 2012;40(5):1830–9. doi: 10.1177/030006051204000521 23206464
3. Chen H, Xia Y, Zhang C, Cheng J, Zhang H. Epidemic trends and characteristics of pulmonary tuberculosis in students in China from 2014 to 2018. Chin J Antitubrec. 2019, 41 (6): 662–668
4. Sheng X, Zhuang Y, Xu J, Xing J, Ma L, Wang K, et al. Analysis of the tuberculosis surveillance of students in Henan province. Chinese Journal of school health. 2013; 34(8):971–2,975.
5. Rodríguez P, Díaz-Cabanela D, Díaz M, Fernández-Albalat R, Hernando H. The importance of genotyping of strains for the evaluation and interpretation of 5 school-based epidemic outbreaks of tuberculosis. Arch Bronconeumol. 2007; 43:611–6. doi: 10.1016/s1579-2129(07)60138-4 17983545
6. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=48439. The norm of tuberculosis control in school (2010), Ministry of Health of China.
7. Ministry of Health and China CDC. Guideline of national TB control program. Beijing: The Peking Union Medical College Publishing House, 2008.
8. http://www.doc88.com/p-770457663092.html. Hygiene Professional standards, Peoples Republic of China. 020101.
9. Zhang TH, Cheng SM, Chen W, Hong F, Xu WG, Yang HL, et al. Household close contacts investigation of sputum smear positive pulmonary tuberculosis. Chinese Journal of Antituberculosis, 2010,32 (11): 736–740
10. Schmid D, Fretz R, Kuo H, Rumetshofer R, Meusburger S, Magnet E, et al. An outbreak of multidrug-resistant tuberculosis among refugees in Austria, 2005–2006 Int J Tuberc Lung Dis. 2008; 12(10):1190–5. 18812050
11. Oeltmann J, Varma J, Ortega L, Liu Y, O’Rourke T, Cano M, et al. Multidrug-Resistant Tuberculosis Outbreak among US-bound Hmong Refugees, Thailand, 2005. Emerging Infectious Diseases. 2008;14(11):1715–21 doi: 10.3201/eid1411.071629 18976554
12. Moreau D, Gratrix J, Kunimoto D, Beckon A, Der E, Hansen E, et al. A shelter-associated tuberculosis outbreak: a novel strain introduced through foreign-born populations. Can J Public Health. 2012;103(6):e408–12. 23618017
13. Sosa L, Lobato M, Condren T, Williams M, Hadler J. Outbreak of tuberculosis in a correctional facility: consequences of missed opportunities. Int J Tuberc Lung Dis. 2008;12(6):689–91. 18492339
14. Khalil N, Kryzanowski J, Mercer N, Ellis E, Jamieson F. Tuberculosis outbreak in a long-term care facility. Can J Public Health. 2013 Jan 7;104(1):e28–32. 23618117
15. Faccini M, Codecasa LR, Ciconali G, Cammarata S, Borriello CR, De Gioia C, et al. Tuberculosis outbreak in a primary school, Milan, Italy. Emerg Infect Dis. 2013; 19(3): 485–7. doi: 10.3201/eid1902.120527 23621942
16. Calder L, Rivers J, Hayhurst M, Brown J, Forde A, Gallagher L, et al. A school and community outbreak of tuberculosis in Palmerston North, New Zealand. N Z Med J. 2008 Jul 25;121(1278):50–61. 18670474
17. Neira-Munoz E, Smith J, Cockcroft P, Basher D, Abubakar I. Extensive transmission of Mycobacterium tuberculosis among children on a school bus. Pediatr Infect Dis J. 2008; 27(9):835–7. doi: 10.1097/INF.0b013e31816ff7c5 18679154
18. Fang Y, Zhang L, Tu C, Ye D, Fontaine R, Ma H, et al. Outbreak of Pulmonary Tuberculosis in a Chinese High School, 2009–2010. J Epidemiol. 2013; 23(4):307–12. doi: 10.2188/jea.JE20120216 23774287
19. Lu X, Song Q, Lu Z, Wang C, Zhan J. Preliminary study on school tuberculosis group infection control strategy. Chin J Antituberc. 2012; 34(10):637–41.
20. Song J, Yang S. Analysis on data of 5 tuberculosis outbreaks in school in Rizhao, China, 1997–2006. Prev Med Trib. 2007; 13(9): 843–4.
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PLOS One
2019 Číslo 11
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