{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T21:55:06Z","timestamp":1775080506688,"version":"3.50.1"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,6,1]]},"abstract":"<jats:p>Objectives. 1) Demonstrate the importance of maintaining a tuberculosis (TB) control program even in low-incidence areas by studying a TB-contact investigation of a highly infectious high school student in rural Missouri, and 2) discuss factors that perpetuated or contained this school-based outbreak.<\/jats:p>\n               <jats:p>Methods. A case review of the index patient, a 15-year-old high school student, established estimates of his level and duration of infectiousness. Contact investigations of his household (n = 5), high school (n = 781), and school bus (n = 67) were administered according to guidelines established by the Centers for Disease Control and Prevention. High school students were stratified further based on classroom exposure, and relative risks were calculated for each risk group.<\/jats:p>\n               <jats:p>Results. The case review revealed that the index patient had evidence of a pulmonary cavity on chest radiograph 6 months before his TB diagnosis. Of the 5 household contacts, all were infected and 3 (60%) had developed active TB disease. Of the 781 high school students sought for TB screening, 559 (72%) completed testing, and 58 (10%) were PPD-positive. Sixty-seven bus riders were sought for testing and 7 (19%) were purified protein derivative (PPD)-positive, with 1 bus rider subsequently diagnosed with active disease.<\/jats:p>\n               <jats:p>Risks were calculated based on classroom and bus exposure to the patient. The relative risks for a positive PPD were 3.2 for attending any class with the patient (n = 25), 4.2 for classes with less ventilation (n = 21), and 5.7 for \u22653 classes (n = 7) with the patient. A total of 62 students started treatment for latent TB infection, and 49 have completed it. Forty-two of these students received directly observed therapy through the local public health agency and the high school.<\/jats:p>\n               <jats:p>Conclusion. This investigation demonstrated widespread adult-type transmission from a pediatric TB case with a 6-month delay in diagnosis. Several actions contributed to the success of this investigation, including rapidly mobilizing the public health system, centralizing follow-up, and on-site testing and treatment with directly observed therapy. Pediatricians need to maintain awareness of TB and risk factors in children, even in low-incidence areas. Prompt diagnosis would have reduced the severity of illness in the patient and potentially prevented widespread school-based transmission. Public health authorities must maintain an infrastructure to respond to large TB outbreaks.<\/jats:p>","DOI":"10.1542\/peds.113.6.e514","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"e514-e519","source":"Crossref","is-referenced-by-count":60,"title":["Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School"],"prefix":"10.1542","volume":"113","author":[{"given":"Lynelle","family":"Phillips","sequence":"first","affiliation":[{"name":"Disease Investigation, Missouri Department of Health and Senior Services, Jefferson City, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Carlile","sequence":"additional","affiliation":[{"name":"Cox Health, Springfield, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Smith","sequence":"additional","affiliation":[{"name":"Disease Investigation, Missouri Department of Health and Senior Services, Jefferson City, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2004,6,1]]},"reference":[{"key":"2021121006341029700_R1","unstructured":"Jereb J. Progressing toward tuberculosis elimination in low-incidence areas of the United States: recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep.2002;51(RR-05):1\u201316"},{"key":"2021121006341029700_R2","unstructured":"Missouri Department of Health and Senior Services. Communicable disease quarterly reports 2002. Available at: www.dhss.state.mo.us\/ehcdp\/ComDisRpts.htm. Accessed April 21, 2004"},{"key":"2021121006341029700_R3","unstructured":"Centers for Disease Control and Prevention. Self-Study Module on TB: Contact Investigations for TB. Atlanta, GA: US Department of Health and Human Services; 1999"},{"key":"2021121006341029700_R4","doi-asserted-by":"crossref","unstructured":"Curtis AB, Ridzon R, Vogel R, et al. Extensive transmission of Mycobacterium tuberculosis from a child. N Engl J Med.1999;341:1491\u20131495","DOI":"10.1056\/NEJM199911113412002"},{"key":"2021121006341029700_R5","doi-asserted-by":"crossref","unstructured":"Dicker RC. Analyzing and Interpreting Data. In: Gregg MB, ed. Field Epidemiology. 2nd Ed. New York, NY: Oxford University Press; 2002:144\u2013153","DOI":"10.1093\/oso\/9780190933692.003.0008"},{"key":"2021121006341029700_R6","doi-asserted-by":"crossref","unstructured":"Raffalli J, Sepkowitz KA, Armstrong D. Community-based outbreaks of tuberculosis. Arch Intern Med.1996;156:1053\u20131060","DOI":"10.1001\/archinte.156.10.1053"},{"key":"2021121006341029700_R7","unstructured":"Committee on Infectious Diseases. Report of the Committee on Infectious Diseases: Red Book 2000. 5th ed. Elk Grove, IL: American Academy of Pediatrics; 2000:597"},{"key":"2021121006341029700_R8","doi-asserted-by":"crossref","unstructured":"Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society\/Centers for Disease Control and Prevention\/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med.2003;167:603\u2013662","DOI":"10.1164\/rccm.167.4.603"},{"key":"2021121006341029700_R9","doi-asserted-by":"crossref","unstructured":"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\u2013365","DOI":"10.2105\/AJPH.75.4.361"},{"key":"2021121006341029700_R10","doi-asserted-by":"crossref","unstructured":"Sepkowitz KA. How contagious is tuberculosis?Clin Infect Dis.1996;23:954\u2013962","DOI":"10.1093\/clinids\/23.5.954"},{"key":"2021121006341029700_R11","doi-asserted-by":"crossref","unstructured":"Reichler MR, Reeves R, Bur S, et al. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA.2002;287:991\u2013995","DOI":"10.1001\/jama.287.8.991"},{"key":"2021121006341029700_R12","unstructured":"Edwards D. Analysis of latent TBI registry for non-metro Missouri [abstract]. Presented at: the International Union Against Tuberculosis and Lung Disease, North America Region Annual Meeting; March 12, 2001; Chicago, IL"},{"key":"2021121006341029700_R13","unstructured":"Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know. 4th ed. Atlanta, GA: Centers for Disease Control and Prevention; 2000"},{"key":"2021121006341029700_R14","unstructured":"Libbus MK, Phillips LM, Benjakul W. Assessment of TB knowledge and practice among Missouri public health nurses. Program listing of the 130th Annual Meeting of the American Public Health Association, November 9\u201313, 2002 (abstracts). Available at: http:\/\/apha.confex.com\/apha\/130am\/techprogram. Accessed April 21, 2004"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/6\/e514\/1004096\/zpe0060400e514.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/6\/e514\/1004096\/zpe0060400e514.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T15:06:40Z","timestamp":1639148800000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/113\/6\/e514\/64399\/Epidemiology-of-a-Tuberculosis-Outbreak-in-a-Rural"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,6,1]]},"references-count":14,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2004,6,1]]},"published-print":{"date-parts":[[2004,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.113.6.e514","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,6,1]]}}}