This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (40)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

John Raffalli; Kent A. Sepkowitz; Donald Armstrong

Arch Intern Med. 1996;156(10):1053-1060.

Abstract
Numerous recent reports have detailed outbreaks of tuberculosis in hospitals and other congregate settings. The characteristics of such settings, including high concentrations of infectious patients and immunocompromised hosts, the potential for sustained daily contact for weeks and often months, and improper precautions taken for protection, make them well suited for tuberculosis transmission. However, community-based outbreaks, which are the source of much public concern, have not been reviewed since 1964, when 109 community outbreaks were examined. Since few of the characteristics of institutional settings are present in the community, the lessons learned may not be applicable to community-based out-breaks. Furthermore, recent studies with analysis by restriction fragment length polymorphisms have documented unexpectedly high rates of primary disease in certain urban communities, suggesting that our understanding of community-based transmission may be incomplete. We reviewed all reported community-based outbreaks of tuberculosis occurring in the last 30 years to assess the basis of our current understanding of community-based transmission. More than 70 out-breaks were identified, with schools being the most common site. In most, a delay in diagnosis, sustained contact with the index case, inadequate ventilation, or overcrowding was contributory. We conclude that community-based outbreaks of tuberculosis continue to occur and that well-established risks contribute to most outbreaks. Many outbreaks can be prevented or limited by attention to basic infection control principles.

(Arch Intern Med. 1996;156:1053-1060)

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

T Cell-Based Tracking of Multidrug Resistant Tuberculosis Infection after Brief Exposure
Richeldi et al.
Am. J. Respir. Crit. Care Med. 2004;170:288-295.
ABSTRACT | FULL TEXT  

Epidemiology of a Tuberculosis Outbreak in a Rural Missouri High School
Phillips et al.
Pediatrics 2004;113:e514-e519.
ABSTRACT | FULL TEXT  

Transmission and Prevention of Occupational Infections in Orthopaedic Surgeons
Wong and Leung
JBJS 2004;86:1065-1076.
ABSTRACT | FULL TEXT  

Cough-generated Aerosols of Mycobacterium tuberculosis: A New Method to Study Infectiousness
Fennelly et al.
Am. J. Respir. Crit. Care Med. 2004;169:604-609.
ABSTRACT | FULL TEXT  

Screening Nonimmigrant Visitors to the United States for Tuberculosis: Report of the Council on Scientific Affairs
Tan et al.
Arch Intern Med 2001;161:334-340.
ABSTRACT | FULL TEXT  

Spread of Mycobacterium tuberculosis in a Community Implementing Recommended Elements of Tuberculosis Control
Chin et al.
JAMA 2000;283:2968-2974.
ABSTRACT | FULL TEXT  

Extensive Transmission of Mycobacterium tuberculosis from a Child
Curtis et al.
NEJM 1999;341:1491-1495.
ABSTRACT | FULL TEXT  

Tuberculosis: 11. Nosocomial disease
Schwartzman and Menzies
CMAJ 1999;161:1271-1277.
FULL TEXT  

Pulmonary tuberculosis in Harare, Zimbabwe: analysis by spoligotyping
Heyderman et al.
Thorax 1998;53:346-350.
ABSTRACT | FULL TEXT