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Tuberculosis in a day-care center, Kentucky, 1993
C R Driver1, J S Jones, L Cavitt
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insights
Tuberculosis (TB) screening in a daycare identified two new childhood TB cases. Further investigation revealed four additional children with TB skin test conversions, but the infection source remained unidentified.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- A tuberculosis (TB) diagnosis in a 33-month-old child in a daycare necessitated an investigation into potential transmission.
- Limited community TB cases in the preceding three years complicated source identification.
Purpose of the Study:
- To identify the source of TB infection in a daycare setting.
- To screen close contacts, daycare children, and staff for TB.
Main Methods:
- Tuberculin skin tests (TST) were administered to 164 children and staff.
- TB registry and medical records were reviewed.
- Two known community TB cases were investigated for epidemiological links.
Main Results:
- Two children were diagnosed with TB, exhibiting TSTs >= 10 mm.
- Four additional children showed TST conversions (TSTs >= 5 mm) between December 1993 and March 1994.
- No TB cases were found among daycare staff or parents.
Conclusions:
- The source of TB infection for the affected children could not be definitively identified.
- Possible explanations include an undetected case within the daycare or community, or false positive TST results due to low TB prevalence.
Abstract:
In November, 1993, a 33-month-old child in a day-care center was diagnosed with tuberculosis (TB). To identify her source of infection, close contacts, other day-care children and staff were screened by tuberculin skin test (TST). TB registry and medical/laboratory records were reviewed. The only 2 community TB cases reported in the past 3 years were investigated. Of 164 children 2 were diagnosed with TB; their TSTs were > or = 10 mm but no specimens were obtained. Six children had TSTs > or = 5 mm. Of these 4 had TST conversions between December, 1993, and March, 1994. There were no additional positive TST children in June, 1994. No TB case was identified among staff or parents. A possible epidemiologic link with the index case was found for 1 community case. No source of infection was found for the other children. Possible explanations for not finding a source are: an as yet unidentified case in the day-care center or community; or false positive TST results in children related to low community prevalence of TB infection.