 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Post-publication Peer Reviews to:
|
|
![[Read P3R]](/icons/misc/sectionDOWN.gif){kind=icon}
Additional Lessons About Tuberculosis
|
|
|||
|
Josiah F. Wedgwood, Pediatrician National Institute of Allergy and Infectious Diseases
Send letter to journal:
JWedgwood{at}niaid.nih.gov Josiah F. Wedgwood
|
Phillips, Carlile and Smith are to be commended for their description of the “Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School” (Pediatrics 2004; 113:e514-e519) which serves as useful reminder of the importance of public health measures necessary for preventing the spread of tuberculosis. The data they present contains some disturbing implications which the authors have not discussed: * Approximately 135 students never completed testing. While there may be some comfort in the information that none of 87 “highest risk” students who did not complete testing in September 2001 but were later tested were positive, the risk of a positive test in the untested group appears to be about 10%. While the reported 5-year risk of developing tuberculosis in untreated LTBI is 2.4% (1), if disease should occur in members of this group, diagnosis is likely to be delayed. Continued effort to find and test these individuals should be made, but such efforts require appropriate resources. * 33 of 453 (7.3%) tested students who did not share a class with the index case had a positive PPD. This is certainly consistent with reports of transmission of TB during a long airplane ride. (2) However, few pediatricians would identify attending a school, but not a class, where a student had active tuberculosis as a reason for screening. This is a circumstance where alerting pediatricians and other pediatric health care providers might be helpful. To be effective such an alert would need to identify the school involved – an invasion of privacy which needs to be balanced against public health concerns. The AAP Committee on Infectious Diseases may also wish to modify their Recommendations for Pediatric Screening for TB in light of these findings and similar past reports (3,4,5). * At least 8 of 87 faculty had a positive PPD. This implies that faculty, including faculty without obvious contact with an infectious student, are at risk. While the total number of school faculty tested is not mentioned, the difference between the numbers in Table 1 and Table 2 (77) suggest that 10 faculty may not have been tested. The state and legislature need to consider whether it is appropriate for TB-exposed school faculty to continue having contact with students without testing. Josiah Wedgwood MD PhD Division of Allergy Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, MD* * For identification purposes only. The views are solely those of the author. 1. Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999; 3:847-850. 2. Kenyon T, Valway S, Ihle W, Onorato I, Castro K. Transmission of multidrug-resistant mycobacterium tuberculosis during a long airplane flight. N Engl J Med 1996; 324; 15: 933-8. 3. Sacks JJ, Brenner ER, Breeden DC, Anders HM, Parker RL. Epidemiology of a tuberculosis outbreak in a South Carolina junior high school. Am J Public Health 1985; 75:361-365. 4. Curtis AB, Ridzon R, Vogel R, McDonough S, Hargreaves J, Ferry J, Valway S, Onorato IM. Extensive Transmission of Mycobacterium tuberculosis from a Child. N Engl J Med 1999; 341:1491-1495. 5. Sepkowitz KA. How contagious is tuberculosis? Clin Infect Dis 1996; 23:954-962. Conflict of Interest:None declared |
|||
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2008 American Academy of Pediatrics. All rights reserved. |
||
|
||
P3Rs: