title: Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country.
abstract: A contact investigation following a case of infectious tuberculosis (TB) reported in a call centre in Milan (Italy) led to the identification of three additional cases that had occurred in employees of the same workplace during the previous 5 years, one of whom was the probable source case. Thirty-three latent infections were also identified. At the time of diagnosis, the source case, because of fear of stigma related to TB, claimed to be unemployed and a contact investigation was not performed in the workplace. Cases were linked through genotyping of Mycobacterium tuberculosis. TB stigma has been described frequently, mainly in high-incidence settings, and is known to influence health-seeking behaviours and treatment adherence. The findings in this report highlight that TB-associated stigma may also lead to incomplete contact investigations. Little is known about the causes and impact of TB-related stigma in low-incidence countries and this warrants further exploration. Research is also needed to evaluate the effectiveness of specific interviewing techniques and training interventions for staff in reducing feelings of stigma in TB patients. Finally, the outbreak emphasizes the importance of integrating routine contact investigations with genotyping.
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: M
authors.initials: M
authors.lastname: Faccini
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cantoni
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ciconali
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Filipponi
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mainardi
authors.affiliation: University of Milan, Postgraduate School of Public Health,Milan,Italy.
authors.forename: A F
authors.initials: AF
authors.lastname: Marino
authors.affiliation: Prevention Department,Local Health Unit (ASL) Milano,Milan,Italy.
authors.forename: S
authors.initials: S
authors.lastname: Senatore
authors.affiliation: Niguarda Cà Grande Hospital,Milan,Italy.
authors.forename: L R
authors.initials: LR
authors.lastname: Codecasa
authors.affiliation: Niguarda Cà Grande Hospital,Milan,Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ferrarese
authors.affiliation: Niguarda Cà Grande Hospital,Milan,Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gesu
authors.affiliation: Niguarda Cà Grande Hospital,Milan,Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mazzola
authors.affiliation: National Centre for Epidemiology,Surveillance and Health Promotion,Istituto Superiore di Sanità,Rome,Italy.
authors.forename: A
authors.initials: A
authors.lastname: Filia
mesh_terms: D000328:Adult; D016358:Contact Tracing; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D057545:Social Stigma; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000523:psychology* / Q000635:transmission
keywords: Infectious disease control; outbreaks; tuberculosis (TB)