Researchers have reported initial findings from an outbreak of tuberculosis in children at a primary school in England. The presumed index case was a 9-year-old boy who had been symptomatic with cough and fatigue since January, 2007, and who had initially received a diagnosis of asthma. 189 children were subsequently eligible for screening, 121 (64%) of whom had latent infection and required chemoprophylaxis. The overall attack rate in the school was 43% (81 of 189), with 17 requiring chemotherapy. Attack rates were similar across all ethnic groups. Marian McEvoy (Health Protection Unit, Bedfordshire,UK) told TLID: "These findings are unprecedented because the first case was a young child who was sputum smear negative. Normally tuberculosis in this context is transmitted by adults and is thought to be infectious in individuals who are sputum smear positive". Current guidelines do not recommend screening the class of a pupil diagnosed with tuberculosis unless they have sputum smear-positive tuberculosis. "Investigations are still ongoing. We have subsequently discovered a second child with positive gastric washings", said McEvoy. "It is too early to tell whether the findings will have implications for UK screening policy", she added.
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