Holzschuh Elizabeth Lawlor, Province Stacie, Johnson Krystle, Walls Caitlin, Shemwell Cathy, Martin Gary, Showalter Amy, Dunlay Jennifer, Conyers Andrew, Griffin Phil, Tausz Nancy
MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):387-389. doi: 10.15585/mmwr.mm6614a3.
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis and is spread from person to person through the air. TB can be spread in congregate settings, such as school environments, to varying degrees, based on factors including duration of contact and air ventilation (1); therefore, evaluating potential contacts and exposures can be challenging. In February 2015, a student at a Kansas high school received a diagnosis of active pulmonary TB disease. Screening of 385 (91%) school contacts, four (100%) household contacts, and 19 (90%) social contacts resulted in the identification of 50 persons with latent TB infection. Johnson County Department of Health and Environment (JCDHE) Public Health Emergency Preparedness personnel used their experience with points of distribution logistics to optimize testing clinic layouts and implement the incident command structure. Open communication with students, school staff members, the public, and the media about the investigation from the outset was imperative to reduce rumors and unease that can accompany a large communicable disease investigation. The large number of persons needing treatment for latent TB overwhelmed JCDHE's two TB nurses. As a result, JCDHE developed a policy and procedure to allow persons who met eligibility requirements to complete 12 weekly doses of isoniazid and rifapentine treatment using video directly observed therapy (VDOT) rather than traditional in-person directly observed therapy (DOT). This procedure facilitated treatment compliance and completion; among the eligible 15 persons who chose the 12-week VDOT option, 14 (93%) completed treatment. State and local health departments might consider use of VDOT to monitor treatment of persons with latent TB infection.
结核病（TB）由结核分枝杆菌引起，通过空气在人与人之间传播。结核病可在集体环境中传播，比如学校环境，传播程度因接触时长和空气流通等因素而异（1）；因此，评估潜在接触者和暴露情况可能具有挑战性。2015年2月，堪萨斯州一所高中的一名学生被诊断患有活动性肺结核病。对385名（91%）学校接触者、4名（100%）家庭接触者和19名（90%）社会接触者进行筛查后，发现了50名潜伏性结核感染患者。约翰逊县卫生与环境部（JCDHE）公共卫生应急准备人员利用他们在分发后勤方面的经验，优化检测诊所布局并实施事件指挥结构。从一开始就与学生、学校工作人员、公众和媒体就调查情况进行公开沟通，对于减少大型传染病调查可能伴随的谣言和不安情绪至关重要。大量需要治疗潜伏性结核的人员让JCDHE的两名结核病护士应接不暇。因此，JCDHE制定了一项政策和程序，允许符合资格要求的人员使用视频直接观察疗法（VDOT）而非传统的当面直接观察疗法（DOT），完成12周的异烟肼和利福喷汀治疗。这一程序促进了治疗的依从性和完成情况；在选择12周VDOT方案的15名符合条件的人员中，14名（93%）完成了治疗。州和地方卫生部门可考虑使用VDOT来监测潜伏性结核感染患者的治疗情况。
