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PLoS One. 2017 Nov 16;12(11):e0188076. doi: 10.1371/journal.pone.0188076. eCollection 2017.

Lessons learned from continued TB outbreaks in a high school.

Author information

1
Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
2
Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Korea Institute of Tuberculosis, Osong, Republic of Korea.
4
Public Healthcare Center, Ansan, Republic of Korea.
5
Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.

Abstract

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.

PMID:
29145443
PMCID:
PMC5690470
DOI:
10.1371/journal.pone.0188076
[Indexed for MEDLINE]
Free PMC Article

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