{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:00:07Z","timestamp":1788188407651,"version":"build-2803163510"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Tuberculosis (TB) outbreaks in confined settings such as schools pose significant public health challenges due to the potential for rapid transmission among closely interacting individuals. In December 2018, a senior high school student in Shenzhen City, China, was diagnosed with etiological positive TB, prompting an investigation that extended until November 2024. This study aimed to analyze the outbreak\u2019s characteristics, identify its causes, and provide insights for timely identification and management of similar clusters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The confirmed, clinically diagnosed, and suspected cases of TB were identified according to the \u201cTuberculosis diagnosis WS288-2017\u201d criteria. Epidemiological investigations of TB cases included close contact screening via symptom assessment, TST, and chest radiography. Moderately TST-positive contacts underwent IGRA confirmation for preventive therapy eligibility, while MIRU-VNTR genotyping of culture-positive isolates delineated transmission networks. The Chi-square test or Fisher\u2019s exact test was employed to analyze changes in TST positivity rates and differences in TB incidence rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of six TB cases were detected in the high school, with five screenings conducted over the study period. Misdiagnosis caused a near-three-month delay from symptom onset to confirmed TB in the index case. Among the five newly diagnosed patients, four were in the same class as the index case, and one was in an adjacent class. These two classes are located on the middle horizontal line of the \u201cB\u201d-shaped teaching building. For the indicated case\u2019s class, the positive rate of TST in the second screening (35.85, 95% CI: 23.49\u201319.25%) was significantly higher than in the first screening (8.93, 95% CI: 3.33\u201320.37%) (\u03c7<jats:sup>2<\/jats:sup>\u202f=\u202f11.493, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). MIRU-VNTR genotyping of four clinical isolates identified concordant non-Beijing strains with matching profiles at 11\/12 loci (excluding VNTR3232), demonstrating a single transmission chain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This outbreak was a cluster epidemic driven by misdiagnosis, poor ventilation, and insufficient routine prevention measures. Establishing long-term close-contact monitoring and secondary screening is crucial for identifying infections missed during the initial window period, thereby mitigating the spread of TB in similar settings and improving outbreak management strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1655711","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:15Z","timestamp":1756964115000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The role of expanded close contact screening in the tuberculosis outbreak at a school in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Liai","family":"Peng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzhou","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangxiang","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingbin","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongguang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxia","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref1","volume-title":"Global Tuberculosis Report 2024","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1093\/infdis\/jiv025","article-title":"Genomic epidemiology of multidrug-resistant Mycobacterium Tuberculosis during transcontinental spread","volume":"212","author":"Coscolla","year":"2015","journal-title":"J Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1093\/infdis\/jiae619","article-title":"Protracted tuberculosis outbreak in a Pasifika diaspora in Western Sydney, Australia: the importance of community engagement","volume":"231","author":"Koirala","year":"2025","journal-title":"J Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3390\/tropicalmed9020029","article-title":"The challenges of tuberculosis management beyond professional competence: insights from tuberculosis outbreaks among Ethiopian immigrants in Israel","volume":"9","author":"Bishara","year":"2024","journal-title":"Trop Med Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"309","DOI":"10.15585\/mmwr.mm7212a3","article-title":"Tuberculosis outbreak in a state prison system - Washington, 2021-2022","volume":"72","author":"Stalter","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"taac121","DOI":"10.1093\/jtm\/taac121","article-title":"Outbreak of tuberculosis in internet cafes amongst young internal migrants without fixed abode in Shanghai, China, 2018-2019","volume":"30","author":"Lu","year":"2023","journal-title":"J Travel Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"287","DOI":"10.4103\/ijmy.ijmy_111_22","article-title":"Analysis of a tuberculosis outbreak in an office: Hokkaido, Japan, 2019-2020","volume":"11","author":"Nitta","year":"2022","journal-title":"Int J Mycobacteriol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1365983","DOI":"10.3389\/fpubh.2024.1365983","article-title":"Epidemiological characteristics and influencing factors of tuberculosis aggregation in schools in Wuhan, China during 2017-2022","volume":"12","author":"Zhang","year":"2024","journal-title":"Front Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5365\/wpsar.2020.11.3.005","article-title":"Tuberculosis outbreaks in schools: experiences from the Western Pacific region","volume":"12","author":"Rahevar","year":"2021","journal-title":"Western Pac Surveill Response J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e0225042","DOI":"10.1371\/journal.pone.0225042","article-title":"An outbreak of tuberculosis in a middle School in Henan, China: epidemiology and risk factors","volume":"14","author":"Xu","year":"2019","journal-title":"PLoS One"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"768","DOI":"10.19982\/j.issn.1000-6621.20220200","article-title":"Analysis on the epidemic situation of pulmonary tuberculosis in schools in China from 2004 to 2021","volume":"44","author":"Chen","year":"2022","journal-title":"Chin J Antituberc."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3969\/j.issn.1000-6621.2021.02.002","article-title":"The analysis of national tuberculosis reported incidence and mortality, 2015-2019","volume":"43","author":"Wang","year":"2021","journal-title":"Chin J Antituberc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e64286","DOI":"10.2196\/64286","article-title":"Epidemiological characteristics and spatiotemporal clustering of pulmonary tuberculosis among students in Southwest China from 2016 to 2022: analysis of population-based surveillance data","volume":"10","author":"Kong","year":"2024","journal-title":"JMIR Public Health Surveill"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"34","DOI":"10.46234\/ccdcw2021.009","article-title":"Guidelines for the prevention and control of tuberculosis in schools: recommendations from China CDC","volume":"3","author":"Xia","year":"2021","journal-title":"China CDC Wkly"},{"key":"ref15","first-page":"58","article-title":"Tuberculosis in schools and requirements for prevention and control in China","volume-title":"China CDC Wkly","author":"Chen","year":"2021"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"20472","DOI":"10.1038\/s41598-024-71720-9","article-title":"Analysis of the epidemiological characteristics and influencing factors of tuberculosis among students in a large province of China, 2008-2018","volume":"14","author":"Yu","year":"2024","journal-title":"Sci Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1186\/s12879-024-10221-6","article-title":"Transmissibility and control of tuberculosis in school outbreaks: a Modeling study based on four outbreaks in China","volume":"24","author":"Liu","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"90","DOI":"10.3325\/cmj.2021.62.90","article-title":"Tuberculosis in schools: an outbreak in northeastern Italy and some key health protection interventions","volume":"62","author":"Cegolon","year":"2021","journal-title":"Croat Med J"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4415\/ANN_19_01_10","article-title":"Tuberculosis outbreak in a grammar school, Serbia, 2016","volume":"55","author":"Ilic","year":"2019","journal-title":"Ann Ist Super Sanita"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3855\/jidc.10952","article-title":"Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study","volume":"13","author":"Stosic","year":"2019","journal-title":"J Infect Dev Ctries"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"243","DOI":"10.3969\/j.issn.1000-6621.2018.03.005","article-title":"Interpretation of clinical diagnosed pulmonary tuberculosis case in new national diagnostic standard on pulmonary tuberculosis","volume":"40","author":"Gao","year":"2018","journal-title":"Chin J Antituberc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"191","DOI":"10.19871\/j.cnki.xfcrbzz.2018.03.018","volume":"3","year":"2018","journal-title":"Emerg. Infect. Dis"},{"key":"ref23","year":"2017"},{"key":"ref24","year":"2016"},{"key":"ref25","first-page":"18","volume-title":"Laboratory test procedures for tuberculosis","author":"Zhao","year":"2015"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"506","DOI":"10.3969\/j.issn.1000-6621.2017.05.018","article-title":"Analysis of tuberculosis aggregation epidemic in a senior high school in Shanghai using molecular epidemiology method","volume":"39","author":"Li","year":"2017","journal-title":"Chin J Antituberc"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1292762","DOI":"10.3389\/fpubh.2023.1292762","article-title":"The role of Xpert Mtb\/Rif using bronchoalveolar lavage fluid in active screening: insights from a tuberculosis outbreak in a junior School in Eastern China","volume":"11","author":"Wu","year":"2023","journal-title":"Front Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"10010","DOI":"10.7189\/jogh.12.10010","article-title":"A systematic review of clinical, epidemiological and demographic predictors of tuberculosis in children with pneumonia","volume":"12","author":"Kazi","year":"2022","journal-title":"J Glob Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.jped.2023.10.009","article-title":"Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review","volume":"100","author":"Russo","year":"2024","journal-title":"J Pediatr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"52","DOI":"10.51866\/oa.595","article-title":"Characteristics of smear-positive pulmonary tuberculosis with Normal chest radiographic findings during a tuberculosis outbreak in Northeast Malaysia: a cross-sectional study","volume":"19","author":"Mohd Redhuan","year":"2024","journal-title":"Malays Fam Physician"},{"key":"ref31","year":"2020"},{"key":"ref32","volume-title":"(2021) A cross-sectional study on \"over diagnosis\" of smear-negative tuberculosis in 15districts in Yunnan Province and analysis of influencing factors [dissertation\/master's thesis]","author":"Ye","year":"2021"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1830","DOI":"10.1177\/030006051204000521","article-title":"A tuberculosis outbreak among senior high school students in China in 2011","volume":"40","author":"Chen","year":"2012","journal-title":"J Int Med Res"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1136355","DOI":"10.3389\/fpubh.2023.1136355","article-title":"Ltbi-negative close contacts of tuberculosis are more likely to develop the disease: enlightenment and lessons from a cluster outbreak","volume":"11","author":"Du","year":"2023","journal-title":"Front Public Health"},{"key":"ref35","first-page":"89","article-title":"Epidemiological investigation and management of a tuberculosis cluster epidemic in a school","volume-title":"J Tuberculosis Lung Disease","author":"Li","year":"2020"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e1002152","DOI":"10.1371\/journal.pmed.1002152","article-title":"The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling","volume":"13","author":"Houben","year":"2016","journal-title":"PLoS Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1016\/j.ijid.2020.02.034","article-title":"Management of Latent Tuberculosis Infection in China: exploring solutions suitable for high-burden countries","volume":"92","author":"Cui","year":"2020","journal-title":"Int J Infect Dis"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e0247564","DOI":"10.1371\/journal.pone.0247564","article-title":"An outbreak of pulmonary tuberculosis and a follow-up investigation of latent tuberculosis in a high school in an eastern city in China, 2016-2019","volume":"16","author":"Fang","year":"2021","journal-title":"PLoS One"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.3967\/bes2024.150","article-title":"Barriers to the acceptance of tuberculosis preventive treatment: a multicenter cross-sectional study in China","volume":"37","author":"Ren","year":"2024","journal-title":"Biomed Environ Sci"},{"key":"ref40","year":"2023"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e0182185","DOI":"10.1371\/journal.pone.0182185","article-title":"Child contact Management in High Tuberculosis Burden Countries: a mixed-methods systematic review","volume":"12","author":"Szkwarko","year":"2017","journal-title":"PLoS One"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1093\/jpids\/piac070","article-title":"Testing and scaling interventions to improve the tuberculosis infection care Cascade","volume":"11","author":"Campbell","year":"2022","journal-title":"J Pediatric Infect Dis Soc"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e004836","DOI":"10.1136\/bmjgh-2020-004836","article-title":"A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking","volume":"6","author":"Campbell","year":"2021","journal-title":"BMJ Glob Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1655711\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:21Z","timestamp":1756964121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1655711\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":43,"alternative-id":["10.3389\/fpubh.2025.1655711"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1655711","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]},"article-number":"1655711"}}