title: A pulmonary tuberculosis outbreak in a long-term care facility.
abstract: In long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identical Mycobacterium tuberculosis genotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.
authors.affiliation: Emergency Department of Taipei City Hospital,Ren-Ai Branch,Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Changhua Health Bureau,Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Hsieh
authors.affiliation: Changhua Health Bureau,Taiwan.
authors.forename: Y-P
authors.initials: YP
authors.lastname: Yeh
authors.affiliation: Reference Laboratory of Mycobacteriology,Centre for Research, Diagnostic and Vaccine Development,Centres for Disease Control,Ministry of Health and Welfare,Taiwan.
authors.forename: R-W
authors.initials: RW
authors.lastname: Jou
authors.affiliation: Division of Infectious Diseases,Department of Internal Medicine,National Taiwan University Hospital,Taipei,Taiwan.
authors.forename: J-T
authors.initials: JT
authors.lastname: Wang
authors.affiliation: Department of Physical Medicine and Rehabilitation,National Taiwan University Hospital,Taipei,Taiwan.
authors.forename: S-L
authors.initials: SL
authors.lastname: Pan
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine,College of Public Health,National Taiwan University,Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Infectious period; LTBI; Mycobacterium tuberculosis; latent period; tuberculosis (TB)