title: Tuberculosis outbreak among students in a boarding school.
abstract: Tuberculosis (TB) outbreaks present a public health challenge. Six cases of active TB emerged in a boarding school in Israel during 1 yr. An epidemiological outbreak investigation was performed, followed by implementation of control measures. The investigation included interviews, tuberculin skin test (TST) and chest radiographs of the students. Close contact (n = 155) was defined as being in the same class or dormitory with a patient. Remote contact (n = 246) was defined as being in the school. An epidemiological association was detected among five of the cases and a distinct pattern was found in molecular analysis. TST was performed in 398 (99.2%) students. Repeated (two-step) TST was applied to the close contacts. The degree of contact, country of origin and previous bacille Calmette-Guérin vaccination were significantly associated with TST reactions. Preventive directly observed therapy was completed by 157 (91.3%) students. During 5 yrs follow-up, no additional cases emerged. While investigating a tuberculosis outbreak, the definition of degree of contact is a significant predictor for detecting positive tuberculin test. Immigration from an endemic country, as well as previous bacille Calmette-Guérin vaccination have a major effect on tuberculin skin-test results. The directly observed therapy approach was found to be successful in preventing further morbidity.
authors.affiliation: Jerusalem District Health Office, Ministry of Health and Braun School of Public Health and Community Medicine, Hebrew University, Hadassah Jerusalem, Israel. chen@lbjer.health.gov.il
authors.forename: C
authors.initials: C
authors.lastname: Stein-Zamir
authors.forename: I
authors.initials: I
authors.lastname: Volovik
authors.forename: S
authors.initials: S
authors.lastname: Rishpon
authors.forename: A
authors.initials: A
authors.lastname: Atamna
authors.forename: A
authors.initials: A
authors.lastname: Lavy
authors.forename: D
authors.initials: D
authors.lastname: Weiler-Ravell
mesh_terms: D000293:Adolescent; D000328:Adult; D001500:BCG Vaccine / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods; D023801:Directly Observed Therapy; D004196:Disease Outbreaks / Q000517:prevention & control*; D004641:Emigration and Immigration; D005002:Ethiopia; D006798:Housing; D006801:Humans; D017053:Infection Control / Q000379:methods; D007557:Israel; D012574:Schools; D013334:Students; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics
chemical_list: D001500:BCG Vaccine