title: A school and community outbreak of tuberculosis in Palmerston North, New Zealand.
abstract: OBJECTIVE
  To describe a secondary school outbreak of tuberculosis in Palmerston North, New Zealand in 2006.
  
  
  METHODS
  Case and contact management was conducted by MidCentral District Health Board according to national guidelines.
  
  
  RESULTS
  The index (and source) case was a school student. Delayed diagnosis led to extensive transmission. Contact investigation detected fifteen secondary cases, from six of whom Mycobacterium tuberculosis organism was cultured which was identical to that found in the index case. Latent tuberculosis infection was diagnosed in 235 of 1828 contacts. Following logistic regression, risk of infection was significantly associated with age, exposure setting (household and school vs other settings) and duration of exposure. Large numbers of contacts were infected who had no known contact with the index case, thus indicating probable tertiary transmission from the 7 infectious secondary cases. The secondary healthcare cost of the outbreak was estimated at $279,481. Findings from school tuberculosis (TB) outbreaks since 1990 are summarised.
  
  
  CONCLUSIONS
  This was the largest tuberculosis outbreak described in New Zealand and one of the largest school outbreaks reported in the published literature.
authors.affiliation: Hawke's Bay District Health Board, Napier, New Zealand.
authors.forename: Lester
authors.initials: L
authors.lastname: Calder
authors.forename: Jane
authors.initials: J
authors.lastname: Rivers
authors.forename: Michael
authors.initials: M
authors.lastname: Hayhurst
authors.forename: Jeff
authors.initials: J
authors.lastname: Brown
authors.forename: Andrea
authors.initials: A
authors.lastname: Forde
authors.forename: Lou
authors.initials: L
authors.lastname: Gallagher
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Connor
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009169:Mycobacterium tuberculosis; D009520:New Zealand / Q000453:epidemiology; D012574:Schools; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000635:transmission