title: Lessons learned from earthquake-related tuberculosis exposures in a community shelter, Japan, 2011.
abstract: BACKGROUND
  Refugees and displaced populations after natural disasters have been vulnerable to tuberculosis. We report an active pulmonary tuberculosis case at a shelter and the subsequent contact investigation and review lessons learned from the 2011 Great East Japan Earthquake.
  
  
  METHODS
  The contact investigation was conducted to identify latent tuberculosis infection among a total of 95 contact persons, including 78 evacuees at the shelter, who were exposed to the index tuberculosis patient. The association between exposure time of contacts to a patient with active tuberculosis and results of interferon-γ release assay (IGRA) was also examined.
  
  
  RESULTS
  IGRA was positive in 9 (12.3%) of 73 evacuees at the shelter. Contacts who were exposed to active tuberculosis for more than 25 days were significantly more likely to be IGRA positive, compared with contacts exposed for less than 20 days. All of the 4 evacuees with latent tuberculosis infection who initiated treatment completed the regimen successfully.
  
  
  CONCLUSIONS
  When a disaster strikes and many people are living in shelters, it is essential for health care personnel to first suspect tuberculosis and implement prevention and control in collaboration with referral hospitals and public health centers.
authors.affiliation: Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Respiratory Medicine, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan. Electronic address: kanamori@med.tohoku.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Miyagi Prefectural Government Kesennuma Public Health Center, Kesennuma, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kimura
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: Department of Respiratory Medicine, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan.
authors.forename: Bine
authors.initials: B
authors.lastname: Uchiyama
authors.affiliation: Department of Respiratory Medicine, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hirakata
authors.affiliation: Department of Respiratory Medicine, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Aso
authors.affiliation: Miyagi Prefectural Government Kesennuma Public Health Center, Kesennuma, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kiryu
authors.affiliation: Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kaku
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D055866:Earthquakes; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D059425:Interferon-gamma Release Tests; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D055815:Young Adult
keywords: Contact investigation; Interferon-γ release assay; Natural disaster