Abstract
BackgroundIn recent years, tuberculosis outbreaks in schools have occurred more frequently in China than in other parts of the world, and have posed a public health threat to students and their families. This systematic review aimed to understand the epidemiological characteristics of tuberculosis (TB) outbreaks and analyze the factors associated with TB outbreaks in schools in China.MethodsWe conducted this systematic review following the standard procedures of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The meta-analysis was performed with STATA using a random effects model.ResultsWe included 107 studies involving 1795 student patients with TB in mainland China. The results of the systematic analysis indicated that TB outbreaks were more frequently reported in senior middle schools and in Eastern China. The outbreaks mainly occurred during the winter and spring, and the median outbreak duration was 4 months. The meta-analysis showed that the total attack rate and the class attack rate of tuberculosis outbreaks among students were 4.60% (95% CI 3.80 to 5.70%) and 22.70% (95% CI 19.20 to 27.00%), respectively. Subgroup analysis showed that outbreaks that occurred at universities or colleges had a relatively higher attack rate than those occurred in senior middle schools. The prevalence of latent tuberculosis infection (LTBI) among close contacts was 23.70% (95% CI 19.50 to 28.90%). The median case-finding interval was 2 months, and 47.40% of the index cases had a case-finding delay.ConclusionThe results of our review indicated that school TB outbreaks were reported most frequently in senior middle schools in China. The attack rates of outbreaks at universities or colleges were higher than those in senior middle schools. The TB outbreaks in schools usually occurred over prolonged periods. The case-finding delay in the index cases must be reduced to prevent transmission in classes and schools. Effective surveillance and screening of presumptive TB cases in schools should be strengthened to reduce outbreaks in schools.
Highlights
In recent years, tuberculosis outbreaks in schools have occurred more frequently in China than in other parts of the world, and have posed a public health threat to students and their families
66 (61.70%) outbreaks occurred at senior middle schools and involved 1100 patients; universities or colleges followed, with 29 (29.00%) outbreaks involving 587 patients
In terms of geographical distribution, there were 78 (72.90%) outbreaks involving 1207 patients reported in the eastern provinces of China while 13 (12.10%) outbreaks occurred in central provinces
Summary
Tuberculosis outbreaks in schools have occurred more frequently in China than in other parts of the world, and have posed a public health threat to students and their families. China is one of 30 countries with the heaviest burden of tuberculosis patients, and it has the third highest number of cases [3, 4]. The top five provinces had the highest TB incidence rates among school students, including Tibet(79.95/100,000), Qinghai(59.09/100, 000), Guizhou(36.54/100,000), Chongqing(33.06/100,000) and Xinjiang(26.08/100,000) [7, 8], which are mainly western regions of china. School TB outbreaks, refer to 3 or more cases with an epidemiological link at the same school within 2 years [9, 10]. According to a study investigating an outbreak in a training school in Shanxi Province, the prevalence of TB was 15.70%, which was a serious clustered outbreak that lead to an irreversible impact on students [12]. The outbreak caused a substantial social impact, especially on students and their families. Once tuberculosis spreads widely among students, it causes great panic among classes and schools and even affects social stability
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