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Factors contributing to the cause of a community outbreak of tuberculosis

Y G Doyle1, P Graves, C Rayner

  • 1St George's Hospital NHS Trust, London. yvonne.doyle@selondon.nhs.uk

Journal of Public Health (Oxford, England)
|July 31, 2004
PubMed

Insights

A nursery teacher

Area of Science:

  • Public Health
  • Infectious Disease Epidemiology

Background:

  • A pulmonary tuberculosis (TB) diagnosis in a nursery teacher initiated a large-scale screening.
  • The teacher had multiple healthcare contacts over 18 months prior to diagnosis.
  • Latent and active factors contributed to delayed diagnosis.

Purpose of the Study:

  • To investigate the systemic failures in diagnosing pulmonary tuberculosis.
  • To understand how these failures led to disease transmission within a community setting.
  • To identify widespread system errors that could be replicated elsewhere.

Main Methods:

  • Retrospective analysis of patient and healthcare system interactions.
  • Contact tracing and screening of 282 individuals.
  • Review of diagnostic delays and contributing factors.

Main Results:

  • 67 individuals contracted tuberculosis following exposure to the index case.
  • Multiple, poorly coordinated events within the healthcare system contributed to diagnostic delays.
  • Systemic failures were identified as a key factor in disease transmission.

Conclusions:

  • The healthcare system failed to diagnose pulmonary tuberculosis promptly in the index case.
  • These systemic failures resulted in significant disease transmission to contacts.
  • Widespread system errors pose a risk for similar occurrences in other settings.

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