Tuberculosis Outbreak in a Primary School, Milan, Italy

The Study

Conclusions

References

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Suggested Citation

Marino Faccini, Luigi Ruffo Codecasa, Giorgio Ciconali, Serafina Cammarata, Catia Rosanna Borriello, Costanza De Gioia, Alessandro Za, Andrea Filippo Marino, Valentina Vighi

, Maurizio Ferrarese, Giovanni Gesu, Ester Mazzola, and Silvana Castaldi

Author affiliations: Author affiliations: Prevention Department ASL Milano, Milan, Italy (M. Faccini, G. Ciconali, S. Cammarata, C.R. Borriello, C. De Gioia); Azienda Ospedaliera Ospedale Niguarda Cà Granda, Milan (L.R. Codecasa, M. Ferrarese, G. Gesu, E. Mazzola); University of Milan Postgraduate School of Public Health, Milan (A. Za, A.F. Marino, V. Vighi, S. Castaldi); Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Milan (S. Castaldi)

Abstract

Investigation of an outbreak of tuberculosis (TB) in a primary school in Milan, Italy, found 15 schoolchildren had active TB disease and 173 had latent TB infection. TB was also identified in 2 homeless men near the school. Diagnostic delay, particularly in the index case-patient, contributed to the transmission of infection.

Italy has a low incidence of tuberculosis (TB); in 2008, incidence of notified cases was 7.6/100,000 population (1). However, higher incidence rates have been reported in some areas. In 2009, in the northern Italy region of Lombardy, incidence of notified cases was 11.7/100,000 population; 58% of cases were in non-Italian nationals (www.dgsan.lombardia.it/malinf/2009/report_sintesi_2009.pdf

). Incidence in children 0–14 years of age was 3.38/100,000 (n = 47 cases). In 2009 in Milan, the largest urban area of Lombardy (1.6 million inhabitants), the incidence was 20.44/100,000 population (www.asl.milano.it/user/download.aspx?FILE=OBJ06171.PDF&TIPO=FLE&NOME=report_prevenzione_2011).
In industrialized countries, such as Italy, TB is increasingly associated with specific population subgroups: immigrants from countries with high endemicity (2,5,6), ethnic minorities (2), refugees, and the homeless (2,4). The control of TB in Italy relies on timely diagnosis and adequate treatment of TB cases, screening of persons in at-risk groups and those in close contact with active TB case-patients, and vaccination of at-risk health care workers and children who live in close contact with a reported TB case-patient (2,3). Factors that influence the effectiveness of TB surveillance and control include lack of prioritization of TB within the health service, difficulties faced by foreign citizens in accessing health care, lack of coordination by a reference center, and diagnostic delay (7). One study found that that median diagnostic delay, health care delay, and total delay for TB patients in Italy were 7, 36, and 65 days, respectively (8). We investigated an outbreak of TB infection identified in 2010 among children in a primary school in Milan.