Microepidemias de tuberculosis en centros escolares. ¿Cómo seleccionar los contactos?

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"tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "470" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María del Carmen Álvarez-Castillo, Sara Cano Escudero, José Antonio Taveira Jiménez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "del Carmen Álvarez-Castillo" "email" => array:1 [ 0 => "carmen.alvarez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Sara" "apellidos" => "Cano Escudero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Taveira Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Epidemiología, Servicio de Salud Pública del Área 7, Instituto de Salud Pública, Comunidad de Madrid, Madrid, España" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España" "etiqueta" => "b" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: María del Carmen Álvarez-Castillo. Sección de Epidemiología. Servicio de Salud Pública del Área 7. Maudes, 32. 28003 Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Microepidemics of tuberculosis in schools. How should we select contacts?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-09-27" "fechaAceptado" => "2007-02-05" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13909" "palabras" => array:4 [ 0 => "Epidemiología" 1 => "Tuberculosis" 2 => "Estudio de contactos" 3 => "Microepidemias" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13910" "palabras" => array:4 [ 0 => "Epidemiology" 1 => "Tuberculosis" 2 => "Contact Investigations" 3 => "Microepidemics" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivosLa aparición de microepidemias de tuberculosis indica una transmisión de Mycobacterium tuberculosis. Se describe una microepidemia en un centro escolar donde se observó un alto porcentaje de infectados y de enfermos a partir de un caso fuente de baja capacidad infectante. MétodosSe realizó un estudio de contactos a 423 alumnos de un colegio, ante la aparición de un caso de tuberculosis en una profesora con escasa sintomatología y poco tiempo de exposición en el centro. Estudio transversal donde se calcula la prevalencia de enfermedad y de infección tuberculosa en el centro escolar. ResultadosSe hallaron diferencias estadísticamente significativas en la distribución de casos positivos en la primera prueba de tuberculina por ciclo escolar, y se encontraron más alumnos positivos en educación secundaria (18,4%) que en primaria (6,1%). La incidencia de conversores tuberculínicos fue del 5,7%. La prevalencia de infección por nivel educativo fue del 10% en educación primaria y del 23,4% en educación secundaria. El riesgo de infección en alumnos de educación secundaria fue más del doble que los de primaria (odds ratio=2,4; intervalo de confianza del 95%, 1,5-3,5). Aparecieron 6 casos de tuberculosis en los alumnos. ConclusiónEl alto porcentaje de conversiones en la segunda prueba de la tuberculina indica la existencia de transmisión en el colegio. Esta investigación refuerza la idea de llevar a cabo un amplio estudio de contactos en centros escolares ante la detección de un caso de tuberculis, sea bacilífero o no." ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundOutbreaks of microepidemics of tuberculosis indicate the existence of Mycobacterium tuberculosis transmission. We describe a microepidemic in a school in which an index case with low infective capacity gave rise to a high percentage of tuberculosis infection and disease in the center. MethodsContact investigation was performed in 423 pupils of a school after a recently arrived teacher with few symptoms was diagnosed with tuberculosis. A cross-sectional study was carried out to calculate the prevalence of tuberculosis infection and disease in the school center. ResultsStatistically significant differences were found in the distribution of positive results in the first tuberculosis skin test for primary and secondary students, with more positive results in secondary school pupils (18.4%) than in primary school pupils (6.1%). The incidence of skin tuberculosis test converters was 5.7%. The prevalence of infection by educational level was 10% in primary education and 23.4% in secondary education. The risk of infection in secondary school pupils was more than twice that in primary school pupils (OR=2.4; 95% CI, 1.5-3.5). There were 6 new cases of tuberculosis in pupils. 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