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Lessons learned from continued TB outbreaks in a high school

 Young Kim  ;  Byeong Ki Kim  ;  Hong Jo Choi  ;  Sung Weon Ryu  ;  Eui Sook Kim  ;  Yoon Soo Chang  ;  Hee Jin Kim  ;  Jae Hyung Cha  ;  Je Hyeong Kim  ;  Chol Shin  ;  Seung Heon Lee 
 PLOS ONE, Vol.12(11) : e0188076, 2017-11 
Journal Title
Issue Date
Adolescent ; Contact Tracing ; Disease Outbreaks* ; Female ; Humans ; Male ; Republic of Korea / epidemiology ; Schools* ; Tuberculosis / epidemiology*
We investigated the aftereffects of confirmatory QuantiFERON testing (QFT) added to a positive tuberculin skin test (TST). We reviewed the pre and post course of sequential tuberculosis (TB) outbreaks in a high school where massive 43 active TB cases had been found within one year before delayed contact investigation. And we investigated the TB development in relation to initial TST and QFT during mean follow-up of 3.9 ± 0.9 years. After delayed contact investigation for two subsequent TB outbreaks, 925 contacts were divided into the following 3 groups: TST- (n = 632), TST+/QFT+ (n = 24), TST+/QFT- (n = 258). QFT- was more prevalent than QFT+ in contacts with 10mm ≤ TST <15mm (158, 61.2%) compared with TST ≥15mm (100, 38.8%) among the TST+ reactors (P < 0.001). Among the 258 TST+/QFT- subjects, 256 received no latent TB infection (LTBI) treatment, but 7 contacts developed TB during follow-up. Among these 7 patients, 4 had initial TST ≥15mm and 3 had 10mm ≤ TST <15mm. In conclusion, the delayed contact investigation for LTBI in a high school resulted in continued TB developments. False-negative QFT performed late among the TST+ reactors should not be considered criteria for LTBI treatment. Additionally, the contacts only with TST ≥15mm should be considered for LTBI treatment in congregate settings of intermediate-burden countries.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young(김영)
Chang, Yoon Soo(장윤수) ORCID logo https://orcid.org/0000-0003-3340-4223
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