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Tuberculosis outbreak among students in a boarding school

¹ Jerusalem District Health Office, Ministry of Health and Braun School of Public Health and Community medicine, Hebrew University, Hadassah Jerusalem, ² Hadera Sub-District Health Office, Ministry of Health, and ⁴ Tuberculosis Clinic, Clalit Health Services, Hadera, ³ Haifa District Health Office, Ministry of Health and the Faculty of Welfare and Health Science Haifa University, and ⁶ Division of Respiratory Physiology and Chest Diseases Carmel Medical Center, Haifa, and ⁵ National Mycobacteria Reference Center, Public Health Laboratories, Ministry of Health, Tel Aviv, Israel.

CORRESPONDENCE: C. Stein-Zamir, Jerusalem District Health Office, 86 Jaffa Road, Jerusalem 94341, Israel. Fax: 972 25314861. E-mail: chen{at}lbjer.health.gov.il

Keywords: Boarding school, outbreak, tuberculin skin test, tuberculosis

Received: January 7, 2006
Accepted June 8, 2006

Tuberculosis (TB) outbreaks present a public health challenge. Six cases of active TB emerged in a boarding school in Israel during 1 yr. An epidemiological outbreak investigation was performed, followed by implementation of control measures.

The investigation included interviews, tuberculin skin test (TST) and chest radiographs of the students. Close contact (n = 155) was defined as being in the same class or dormitory with a patient. Remote contact (n = 246) was defined as being in the school.

An epidemiological association was detected among five of the cases and a distinct pattern was found in molecular analysis. TST was performed in 398 (99.2%) students. Repeated (two-step) TST was applied to the close contacts. The degree of contact, country of origin and previous bacille Calmette–Guérin vaccination were significantly associated with TST reactions. Preventive directly observed therapy was completed by 157 (91.3%) students. During 5 yrs follow-up, no additional cases emerged.

While investigating a tuberculosis outbreak, the definition of degree of contact is a significant predictor for detecting positive tuberculin test. Immigration from an endemic country, as well as previous bacille Calmette–Guérin vaccination have a major effect on tuberculin skin-test results. The directly observed therapy approach was found to be successful in preventing further morbidity.