An Outbreak Investigation of Tuberculosis in a nursery, Wang Saphung District, Loei Province, Thailand, 2018
Keywords:
tuberculosis, pulmonary tuberculosis, Mycobacterium tuberculosis, nursery, childrenAbstract
Background: In June 2018, the Bureau of Epidemiology received notification of a tuberculosis cluster among teachers in a nursery, Khok Khamin Subdistrict, Wangsaphung District, Leoi Province, Thailand. We investigated to confirm, determine the magnitude, and contain the outbreak.
Method: We reviewed medical records and interviewed index cases. Active case finding was performed in the nursery, household, and teachers of nurseries in this subdistrict by interviewing and performing Chest X–ray (CXR). Tuberculin Skin Test (TST) was performed to children. Suspected cases were persons reported at least: cough more than 2 weeks, OR cough less than 2 weeks with respiratory symptoms (i.e. difficult breathing, chest pain, and hemoptysis) or constitutional symptoms (i.e. anorexia, weight loss, failure to thrive, fever, night sweats, and fatigue), OR abnormal CXR. Confirmed cases were suspected cases with bacteriological confirmation or positive blood test of Interferon–gamma release assays (IGRAs) OR physician–diagnosed TB. Latent TB infection (LTBI) were persons with normal CXR and/or physician–diagnosed LTBI. Sputum from contacts or gastric wash from children for GeneXpert was tested. Blood samples for IGRAs among adults who had abnormal CXR were tested. An environmental study was done to describe the epidemiological characteristics of the outbreak. The cross– sectional analytic study was done to compare the risk factor of being TB disease among children, using univariate analysis with an odds ratio (OR) and 95%CI.
Results: We found 28 suspected, 11 confirmed (3 adults and 8 children), and 67 LTBI cases. The attack rate of confirmed cases was 9.8% (11/112). All 49 specimens for geneXpert were negative. The IGRAs positive rate was 20% (3/15). Poor ventilation and overcrowding were observed at the nursery. The children who had reactive TST or CXR result with suggestive TB were more likely to be diagnosed as TB (p < 0.001).
Conclusions: A pulmonary tuberculosis outbreak at the nursery occurred during June 2018 with 11 confirmed cases. Although the primary case could not be identified, early detection by CXR among teachers of nurseries, re–arrange the nursery’s environment and isolation of TB cases was done to prevent transmission. Since children are a vulnerable group for developing TB, LTBI identification, and treatment are required.
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