Tuberculosis outbreak in a German daycare center

Young children who are exposed to people with infectious tuberculosis (TB) have an increased risk of developing TB disease following infection. The risk of infection and disease progression can be minimized by prompt identification of TB-exposed individuals and initiation of prophylactic or preventive treatment.

We report on a TB outbreak in a daycare center in Berlin, Germany following a delayed diagnosis of cavitary pulmonary TB in a childhood educator. We describe contact investigation, diagnostic, prophylactic, preventive and therapeutic measures in 62 TB-exposed children (median age 3.9 years), including 30 with prolonged TB exposure.

The initial examination took place 5-16 days after the index patient was diagnosed with TB. Ten of the 30 children with intensive contact became infected, six (median age 2.7 years) developed pulmonary TB. Three of these children had a concurrent influenza infection, which may have contributed to disease progression. No child without prolonged exposure to the index patient developed disease.

Early diagnosis of TB in adult patients, especially those with persistent cough, is crucial to prevent TB in vulnerable infants. Close collaboration between public health departments and specialized facilities is essential for the effective control of TB outbreaks.