Stein-Zamir C, Volovik I, Rishpon S, Atamna A, Lavy A, Weiler-Ravell D
Jerusalem District Health Office, Ministry of Health and Braun School of Public Health and Community Medicine, Hebrew University, Hadassah Jerusalem, Israel.
Eur Respir J. 2006 Nov;28(5):986-91. doi: 10.1183/09031936.06.00002506. Epub 2006 Jun 28.
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.
结核病（TB）疫情对公共卫生构成挑战。以色列一所寄宿学校在1年内出现了6例活动性结核病病例。开展了流行病学疫情调查，随后实施了控制措施。调查包括对学生进行访谈、结核菌素皮肤试验（TST）和胸部X光检查。密切接触者（n = 155）定义为与患者在同一班级或宿舍。远距离接触者（n = 246）定义为在该校上学。在5例病例中检测到流行病学关联，并且在分子分析中发现了一种独特模式。对398名（99.2%）学生进行了TST。对密切接触者采用重复（两步法）TST。接触程度、原籍国和既往卡介苗接种与TST反应显著相关。157名（91.3%）学生完成了预防性直接观察治疗。在5年随访期间，未出现其他病例。在调查结核病疫情时，接触程度的定义是检测结核菌素试验呈阳性的一个重要预测指标。来自结核病流行国家的移民以及既往卡介苗接种对结核菌素皮肤试验结果有重大影响。发现直接观察治疗方法在预防进一步发病方面是成功的。
