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Has transmission occured in the school?

  • Is transmission likely to have occured in the school, and is further transmission likely?
  • Will you take further action at this stage and if so what?

Take some time to think through your answers before checking them.

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Feedback for Exercise 1

Is transmission likely to have occurred in the school, and is further transmission likely?

Six culture-confirmed cases in a class strongly suggests transmission.

The likelihood of transmission increases when a person has active pulmonary TB. The infectiousness of the index case (Mrs Y) was likely to be high, smear positive individuals are considered to be infectious to any close contact (children in Mrs Y’s class and her household contacts, plus any close prolonged contacts outside of work).

The setting in a secondary school means that Mrs Y spent many hours over the past months with the students in her classes so the likelihood that the children were exposed to coughing is high.

Although seven cases identified at the same time in a UK school is highly suggestive of an outbreak it is not certain that every case in the cluster is part of the same chain of transmission, especially if the school is in a high incidence area or the ethnic mix of the school is associated with a high risk e.g. many students or staff who have recently arrived from or frequently travel to areas where TB incidence is high.

The six students taught by Mrs Y are not smear-positive so are less likely to be infectious. This does not rule out the possibility of further transmission especially to household contacts.

Will you take further action at this stage and if so what?

All cases should be started on treatment.

Contact tracing and screening around the six newly identified cases among school students should begin.

Communication with the school, parents and local community should be coordinated, there is likely to be media interest.

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