Tuberculosis contact tracing among children and adolescents, Brazil

OBJECTIVE: To detect tuberculosis (TB) disease or infection among contacts of pulmonary TB patients. METHODS: Cross-sectional study in a Primary Healthcare unit in Rio de Janeiro (Brazil) with 184 child and adolescent contacts of pulmonary TB patients between March 1995 and March 1997. Subjects underwent clinical evaluation, chest radiographs, and tuberculin skin tests (TST); sputum smears were performed whenever possible. TB cases found were submitted to treatment and infected patients to chemoprophylaxis. Tuberculin converters, who tested positive for TST eight weeks after an initial negative result, received chemoprophylaxis. RESULTS: The sample included 98 boys and 86 girls; age ranged from 0 to 15 years; 26.9% were malnourished according to the Gomez criteria. Concerning the source of infection, 170 cases (92.4%) had household contacts, of which 66.5% were the child's parents. BCG vaccination was verified in 98.4% of children, and 14.7% of children had been revaccinated. Strong TST reactions were observed in 110/181 children. Seventy-six children (41.3%) were considered as infected by M. tuberculosis and 25 cases (13.6%) of TB were detected, of which seven (28%) were asymptomatic. There was greater occurrence of disease when the contact lived with more than one source of infection (p=0.02). CONCLUSIONS: The detection of TB disease and infection was high in the studied population. Contact control must be emphasized, for it allows for the diagnosis of TB in children who are still asymptomatic, in addition to identifying infected subjects who may profit from chemoprophylaxis.     

Screening of TB contacts by tuberculin skin tests in a low-incidence community by BCG vaccination

A 36-year-old man, an unemployed waiter, a regular patron of two bars living in a Czech city suffered for about a year from disorders caused probably by tuberculosis (TB). When hospitalised, diabetes mellitus and extensive lung TB were diagnosed. TB was found also at the post mortem examination when the patient died one week later. Screening of his contacts by tuberculin skin tests (2TU RT23 W. Tw.80) provided data for analyzing the usefulness of tuberculin tests for monitoring of propagation of TB infection among BCG vaccinated population with high TB prevalence in the A statistically significant difference was found in tuberculin reactivity between 543 contacts and 232 individuals who had not reported contact with, the patient. A skin reaction of 12 mm and more was found in 55.6% contacts while only in 2.6% of those included in the second group. The high tuberculin reactivity was proved in the individuals exposed to massive TB infection. Neither BCG vaccination, nor possible previous contact with TB in the past seemed to influence the actual tuberculin reactivity in the group of non-contacts. Furthermore, it is indicative of the fact that unknown TB sources are rare among the Czech population. The high tuberculin reactivity is suggestive of a fresh infection and justifies the tuberculin testing and the application of chemoprophylaxis.     

Latent Tuberculosis Infection Among Immigrant and Refugee Children Arriving in the United States: 2010

Immigrants and refugees age 2–14 years entering the United States from countries with estimated tuberculosis (TB) incidence rate ≥20 per 100,000 population are screened for TB. Children with TB disease are treated before US arrival. Children with positive tuberculin skin tests (TST), but negative TB evaluation during their pre-immigration examination, are classified with latent TB infection (LTBI) and are recommended for re-evaluation post-arrival. We examined post-immigration TB evaluation and therapy for children arriving with LTBI. We reviewed medical exam data from immigrant children with medical conditions and all refugee children arriving during 2010. Medical examination data were available for 67,334 children. Of these, 8231 (12 %) had LTBI pre-immigration; 5749 (70 %) were re-evaluated for TB post-immigration, and 64 % were retested by TST or IGRA. The pre-immigration LTBI diagnosis was changed for 38 % when retested by TST and for 71 % retested by IGRA. Estimated LTBI therapy initiation and completion rates were 68 and 12 %. In this population, testing with IGRA may limit the number of children targeted for therapy. Increased pre-immigration TB screening with post-immigration follow-up evaluation leading to completion of LTBI therapy should be encouraged to prevent TB reactivation.     

Practices and Policies of Providers Testing School-Aged Children for Tuberculosis,Connecticut, 2008

This study identified current practices and policies related to testing school children for latent tuberculosis infection (LTBI) in Connecticut. A cross-sectional survey was mailed to a random sample of community pediatricians and family practitioners in Connecticut who provide health care services to children aged 4–18 years. The main outcome measure was adherence to national guidelines for tuberculosis (TB) testing of school-aged children. The response rate was 66.3% (345 of 520), 258 of whom provided services to children. Responses showed that 60% (152 of 252) of replying providers read the American Academy of Pediatrics (AAP) published guidelines, and 85% routinely assess children for TB risk before skin testing although only a minority (22%) use a written questionnaire. Of 153 responding providers, 130 (85%) report that schools require formal TB risk assessments at mandated school physical examinations or at school entry. Results also showed providers who read AAP-published guidelines and who are trained in the United States are more likely to follow the national guidelines for TB testing of children. The majority of health care providers reported following AAP-published guidelines for screening school-aged children for LTBI and TB disease; however, an important number of providers still do not follow recommended guidelines. Public health officials should make efforts to increase provider awareness of, and adherence to, guidelines. School districts also should take steps to ensure the appropriate level of testing of children for TB disease and LTBI.     

Results of an extended tuberculosis screening programme among sixth formers in a London school--more questions than answers

Following the death of an unvaccinated 16-year-old school student with isoniazid resistant pulmonary tuberculosis, extended screening of sixth formers took place to identify further cases of tuberculosis and to establish the need for BCG vaccination. Eight hundred and four 16-19 year olds in the school underwent Heaf testing and completed a demographics questionnaire. Forty-nine (5.5%) of these children had a positive Heaf test and were offered a chest radiograph. Four children were diagnosed with pulmonary or mediastinal tuberculosis, none linked to the index case. Fifty-four students (6.7%) with no prior BCG had a Heaf grade 0-1 reaction and were recommended for vaccination. Ninety-one percent of students were from ethnic minority groups and 29% had been born outside the UK. British Thoracic Society recommendations on the management of tuberculin positive cases of this is open to interpretation and we suggest that a more directed and aggressive approach to TB control should be considered in inner city schools with a high proportion of at risk ethnic minority students.     

Preventing tuberculosis among HIV-infected persons: a survey of physicians' knowledge and practices

BACKGROUND: Guidelines exist for screening, diagnosing, and preventing tuberculosis (TB) among HIV-infected persons, but their application and utility are unknown. METHODS: We conducted a survey of knowledge and practices among 1,300 physicians in the San Francisco Bay area to assess their practices towards TB among HIV-infected persons. RESULTS: Of 630 respondents, 350 (56%) provided care for HIV-infected persons. Thirty-four percent of the respondents had seen the most recent guidelines for preventing tuberculosis among HIV-infected persons; 65% routinely provide information to HIV-infected patients about the risks of exposure to Mycobacterium tuberculosis; 39% provide annual tuberculin skin testing (TST) to HIV-infected patients without a history of a positive test; 86% knew that >/=5-mm induration is considered a positive TST result in HIV-infected persons; and 47% provide a 12-month regimen of chemoprophylaxis for HIV-infected persons who have a positive TST but not active tuberculosis. Physician specialty and experience with HIV-infected persons were not strongly correlated; experience was a better predictor of correct knowledge and practices. CONCLUSIONS: Many physicians were not aware of the standards of care for preventing tuberculosis among HIV-infected patients, even in a geographic area with a high prevalence of M. tuberculosis and HIV.     

Contact tracing and population screening for tuberculosis--who should be assessed?

BACKGROUND: The aim of the study was to investigate the relative effectiveness of four strategies in detecting and preventing tuberculosis: contact tracing of smear-positive pulmonary disease, of smear-negative pulmonary disease and of non-pulmonary disease, and screening new entrants. METHODS: An analysis of patient records and a TB database was carried out for an NHS Trust-based tuberculosis service in a socio-economically deprived area. Subjects were contacts of all patients treated for TB between 1997 and 1999. New entrants were screened in 1999. Outcomes measured were numbers of cases of active tuberculosis detected and numbers of those screened given chemoprophylaxis. RESULTS: A total of 643 contacts of 227 cases of active TB were seen, and 322 new entrants to the United Kingdom. The highest proportion of contacts requiring full treatment or chemoprophylaxis were contacts of smear-positive index cases (33 out of 263 contacts; 12.5 per cent). Tracing contacts of those with smear-negative pulmonary tuberculosis (12 out of 156; 7.7 per cent) and non-pulmonary disease (14 out of 277; 6.2 per cent) was significantly more effective in identifying individuals requiring intervention (full treatment or chemoprophylaxis) than routine screening of new entrants (10 out of 322; 3.1 per cent). CONCLUSIONS: Screening for TB of new entrants to the United Kingdom is part of the national programme for control and prevention of TB, whereas tracing contacts of those with smear-negative and non-pulmonary disease is not. This study demonstrates that, in our population, the contact-tracing strategy is more effective than new entrant screening. It is not likely that the contacts have caught their disease from the index case, but rather that in high-incidence areas such as ours such tracing selects extended families or communities at particularly high risk.     

学校为载体的流动人口结核病健康教育模式研究

目的探讨通过民办学校开展流动人口结核病健康教育模式效果。方法随机选取上海市浦东新区2所民办小学,分别以2所学校的学生家长作为对照组和干预组,对干预组采取综合干预措施。干预前后,通过结核病健康知识、信念和行为问卷调查,评估干预效果。结果基线共调查学生家长611人,其中干预组302人,对照组309人;终末评估时,干预组279人,对照组285人。干预后,干预组结核病知识、信念和行为均好于对照组,其中,知晓"肺结核能传染给别人"的比例达到82.1%,知晓"近距离咳嗽喷嚏能传染肺结核"的比例达到72.4%,知晓"咳嗽"、"咳痰"、"咯血(痰中带血)"这3个结核病主要症状的比例分别达到72.0%、59.5%和64.9%;干预组"认为结核病能治好"的比例提高到50.9%,"吐痰用纸包起来"和"咳嗽喷嚏遮挡"的比例分别提高到62.3%和71.8%,与干预前相比,差异均有统计学意义(P<0.05)。结论以民办学校为载体进行流动人口肺结核健康教育模式有效,可以明显提高目标人群结核病防治知识水平。     

2019年北京市朝阳区高中及以下阶段新生入学肺结核筛查结果分析

目的 分析北京市朝阳区高中及以下阶段新生入学肺结核筛查结果,为学校结核病防控工作提供参考依据。 方法 幼儿园、小学、非寄宿制初中新生首先完成肺结核可疑症状问卷调查,有可疑症状者需进行结核菌素皮肤试验（PPD试验）,PPD强阳性或未完成PPD试验者再进一步完成X线胸片检查。高中及寄宿制初中新生均需完成问卷调查和PPD试验,有可疑症状或PPD强阳性或未完成PPD试验者再进行X线胸片检查。 结果 2019年北京市朝阳区550所学校完成了新生肺结核筛查。问卷调查70 835人,有结核病可疑症状者109人,可疑症状率1.54‰,高中（9.36‰）高于幼儿园（0.55‰）、小学（0.63‰）、初中（0.69‰）。PPD试验8 567人,强阳性104人,强阳性率为1.21%,高中组（1.33%）高于幼小初中组（0.64%）,差异有统计学意义（x2=4.72, P =0.03）。X线胸片检查461人,影像学异常9人（全部为高中学生）,其中1名女生诊断为活动性肺结核。 结论 新生入学肺结核筛查工作具有重要意义,应加强高中学生的结核病防控管理工作。     

Tracing patients exposed to health care workers with tuberculosis.

OBJECTIVES: Following an outbreak of tuberculosis (TB) among health care workers at a public hospital, the study was undertaken to (a) locate all exposed patients and administer tuberculin skin tests (TSTs) to them, (b) provide clinical treatment or prophylaxis to infected patients, and (c) ascertain the risk of M. tuberculosis transmission from health care workers to patients. METHODS: The authors identified all patients who had been hospitalized on floors where health care workers with symptomatic TB worked. The staff of the hospital''s outpatient HIV/AIDS clinic notified and evaluated clinic patients who had been hospitalized on those floors. County health department personnel attempted to contact the remaining patients by letter and phone. RESULTS: The authors identified 586 patients hospitalized during the health care worker outbreak, of whom 503 were potentially susceptible. Of these, 172 (34.2%) could be contacted, and 138 (80.2%) completed tuberculin skin testing or other follow-up evaluation. Of 134 who completed testing, 28 (20.9%) had reactive TSTs. In all, 362 patients (72%) were lost to follow-up, including many HIV-positive and homeless patients, who are at high risk of developing active TB once infected with M. tuberculosis. CONCLUSIONS: The reemergence of TB as a public health threat and the emergence of other infectious diseases make it imperative to elicit accurate addresses and contact information from hospitalized patients and to develop better methods of contacting patients after hospital discharge.     

Prevalence of latent tuberculosis infection in German radiologists

Healthcare workers have an increased risk of tuberculosis infection compared with the general population. There have been few attempts to quantify the prevalence of latent tuberculosis infection amongst German healthcare workers, due to inadequacy of the current tuberculin skin test (TST). Therefore, it was our aim to investigate the prevalence of latent tuberculosis in this cohort using a tuberculosis-specific ELISpot (T-SPOT.TB) test and to compare the performance of this test to that of the TST. Ninety-five healthy participants working in departments of radiology were examined by ELISpot, lymphocyte transformation test and TST. For cellular in-vitro tests, tuberculosis-specific peptides and purified protein derivate (PPD) were used as antigens. These tests were combined with a questionnaire on prior tuberculosis exposure. Out of 95 healthcare workers, only one (1%) was defined as positive by T-SPOT.TB, 92 (97%) by PPD-ELISpot, 78 (82%) by PPD-lymphocyte transformation test and 32 (34%) by TST. Multivariate analysis showed that the TST was significantly affected (P<0.0001 and P=0.001, respectively) by foreign birth and prior skin testing. The T-SPOT.TB test results were independent of foreign birth, prior skin testing and prior vaccination against tuberculosis. In contrast to the TST, T-SPOT.TB appears to be an accurate and useful tool to track tuberculosis infection in this at-risk group. With only one of 95 participants having acquired latent tuberculosis, these preliminary results argue for a low incidence of latent tuberculosis in German radiologists.     

学校结核病健康教育效果评价

目的评价学校开展结核病健康教育的效果,为制定学校结核病健康教育规范提供依据。方法对12所学校进行为期6个月的健康教育综合干预,并根据卫生部关于结核病防治宣传的8条核心信息设计问卷,干预前后用同一问卷进行调查,评价干预前后学生结核病知识知晓率变化情况。结果健康教育干预后,学生结核病知识掌握均有显著提高,小学组与初中组知晓率提高了近40%;知识得分不及格比例均有显著下降,小学组、初中组下降幅度大;掌握知识较好的(80分以上)比例大幅增加。对肺结核病人歧视现象也明显减少。结论本次健康教育干预,对学生结核病知识的提高效果明显,应在学校继续加强重大传染病的健康教育。     

Outbreak of tuberculosis at a Newcastle public house: the role and effectiveness of contact screening

We report an outbreak of tuberculosis (TB) that originated in a public house, involving 12 cases. The presumed index case was a regular patron. Initial screening of close contacts identified no further cases. Six cases of TB then presented symptomatically among other regular patrons. Contact screening was extended to include all regular patrons and bar staff. In total, 110 individuals were screened. One case was detected and three children were placed on chemoprophylaxis. Transmission of M. tuberculosis between patrons of a public house may cause community outbreaks of TB. Where cases present outside a close-contact screening program, extended contact screening must be considered.     

Incidence of TB in inmates with latent TB infection: 5-year follow-up

BACKGROUND: Inmates are a high-risk population for tuberculosis (TB) control efforts, including treatment for latent tuberculosis infection (LTBI). Completion of therapy after release has been poor. The goal of this study was to evaluate therapy completion and active disease over 5 years in a cohort of inmates. METHODS: The sample was from a completed randomized trial in 1998-1999 of education or incentive versus usual care to improve therapy completion after release from the San Francisco County Jail. Records from the jail, the County Tuberculosis Clinic, and the California TB Registry were used to measure therapy completion and development of active TB. Analyses were conducted in 2005. RESULTS: Of a total 527 inmates, 31.6% (n=176) completed therapy, of whom 59.7% (n=105) completed it in jail. Compared with the U.S.-born, foreign-born inmates residing in the United States for < or =5 years were less likely to complete the therapy (adjusted odds ratio [AOR]=0.49, 95% confidence interval [CI]=0.28-0.85), and those with more education were more likely to complete the therapy (AOR=1.06, 95% CI=1.01-1.12). Three subjects developed active TB in the 5 years of follow-up, resulting in an annual rate of 108 per 100,000. Compared with California rates, subjects were 59 times as likely to develop active TB (standardized morbidity ratio of 59.2, 95% CI=11.2-145.1). None had completed therapy, none were new immigrants, and two were known to be HIV-positive at diagnosis. CONCLUSIONS: Completion of therapy for LTBI is a challenge, but the active TB seen in this jail cohort emphasizes the importance of continued efforts to address TB risk in this population.     

Radiologic manifestation of pulmonary tuberculosis in children admitted in pediatric ward-Massih Daneshvari Hospital: a 5-year retrospective study

Despite the extensive preventive and therapeutic measures present against tuberculosis (TB), this disease still remains as one of the important causes of mortality and morbidity in the world. Considering the high incidence of TB in children, rareness of its' clinical features and complexity of bacteriologic diagnosis in this age group paraclinical studies, especially radiologic evaluations, is useful for reaching a final diagnosis. This 5 year study was conducted in National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Massih Daneshvari Hospital, Tehran, Iran. This retrospective study was conducted on 70 children (43 (61%) female and 27 (38.5%) male) aged between 5 months to 15 years old during a five year period (from 2001-2006) in pediatric ward. It was performed on children who were confirmed to have TB by various clinical, bacteriologic and radiologic features and tuberculin skin test. We studied the radiologic features of pulmonary TB in these children. Right lung involvement was observed in 65%, left lung 23% and bilateral involvement was detected in 12%. Also middle and superior lobes were the most common lobes affected. The commonest radiographic feature was hilar (mediastinal) lymphadenopathy; 70% detected on chest x-ray (CXR) and 85% on CT scan. Lymph nodes on right side were affected more; 25% were calcified. Also nodular infiltration of lung parenchyma was observed in 35% of CXRS and 61% of CT scans. This was followed by patchy consolidation detected in 25% and 35% of CXRs and CT scans respectively. We also observed that children <3 yr. of age had the highest lymph node involvement but the least parenchymal lesions as compared to older children. It is concluded that primary TB is the most common form of pulmonary TB in children. This could be in the form of hilar lymphadenopathy with or without lung parenchymal involvement. Also radiologic features could provide valuable information in regard to diagnosis, treatment and follow-up of pulmonary TB in children.     

西安市小学入学新生结核病筛查结果分析

目的 了解西安市小学入学新生结核感染及患病情况,为儿童及学校结核病防治工作提供科学依据。方法 分别选择西安市市区和乡镇共7所小学,共筛查小学入学新生2 982名,采用结核菌素(PPD)试验结合胸部X线检查方法。结果 全部新生结核感染率为2.1%(64/2 982);不同性别感染率差异无统计学意义(χ²=3.848,P>0.05)。不同地区感染率差异有统计学意义(χ²=8.896,P<0.05)。PPD试验强阳性者行胸部X线检查,共检出结核患者2例,患病率67/10⁵。结论 重视在校学生结核病筛查,是儿童结核病防治的有效措施。乡镇学生的结核感染率高于市区学生。     

Tuberculosis infection in urban adolescents: results of a school-based testing program.

In 1986-87 a pilot tuberculosis (TB) skin testing program was introduced for seventh and tenth grade students in the Boston (Massachusetts) public schools. The 8.9 percent tuberculin positivity rate in tenth grade students was significantly higher than the 5.1 percent rate found in seventh graders. A majority of those who were skin test positive were born outside the United States. These results suggest that tuberculin testing in an urban school setting may identify a significant number of candidates for TB preventive therapy, particularly among tenth grade students and those who are foreign-born.     

2011年德州市德城区中小学生肺结核防治知识知晓情况调查

[目的]了解德州市德城区中小学生结核病防治知识水平,为开展学校结核病控制工作提供依据。[方法]2011年11～12月,对德城区9所中小学校的部分学生进行调查。[结果]调查1518人,结核病防治知识知晓率为81．52％。其中,96．18％的学生知道肺结核,96．11％知道咳嗽是肺结核的症状之一,89．46％知道咳痰是肺结核的症状之一,96．05％知道肺结核有传染性,67．06％知道咳嗽咳痰3周以上应考虑患了肺结核,72．66％知道所在地有免费检查肺结核的地方,72．53％知道所在地有免费治疗肺结核的地方。结核病防治知识知晓率,男生为80．42％,女生为82．68％（P〉0．05）;小学生为73．94％,初中生为81．54％,高中生为88．44％（P〈0．01）;城区学生为86．04％,农村学生为74．66％（P〈O．01）。[结论]德城区中小学生结核病防治知识知晓率较高,但不够全面。     

Limitations of national guidelines in the management of an outbreak of tuberculosis

National guidelines offer no clear definition of a close (non-household) contact of tuberculosis. The resulting lack of distinction between close and casual contacts may lead to excessive screening in outbreaks of pulmonary tuberculosis in the United Kingdom. Poor compliance with chemoprophylaxis suggests that priority should be given to the follow up of high risk contacts, who should be more clearly defined. A review of the management of a family outbreak of tuberculosis illustrates the problem. Fifty-nine out of 213 non-household contacts screened for infection had grade 3 and 4 Heaf reactions and none developed clinical tuberculosis within one year. Three of the 59 did not attend for chest radiography and a further 11 patients did not attend the outpatients appointment offered. Twenty-three took chemoprophylaxis for three months, 14 did not complete chemoprophylaxis, six (11%) declined it and two were offered x-ray follow up.     

江苏省某技师学院学生结核病核心知识知晓情况调查*

摘 要：目的：了解江苏省盱眙县技师学院在校学生结核病核心知识知晓情况，为开展结核病宣教工作提供科学依 据。 方法：2022年 8—9月，对江苏省盱眙县技师学院 497名在校学生进行问卷调查，了解学生结核病核心知识知晓情况。 结果：学生结核病核心知识总知晓率为55.31%，幼护专业学生的总知晓率最高，为67.99%。结核病传播途径及预防途径的 单一知晓率最高，为86.92%；“结核病何时停止治疗”的单一知晓率最低，为0.60%。89.54%的学生在校内接受过结核病知 识宣传，56.14%的学生在校外接受过知识宣教。28.37%的学生认为应当避免与确诊患者接触，停止一切社交活动；10.26% 的学生认为应避免与已治愈人群接触。结论：学生对于结核病核心知识总知晓率较低，建议对学生加强结核病诊疗、国家优 惠政策以及正确对待结核病等方面知识的宣传。