Diagnostic delay as main contributing factor to a large outbreak of tuberculosis in a university

Abstract Objective To describe the epidemiological characteristics of a large tuberculosis outbreak in the university environment and the main risk factors associated with it. Method A descriptive analysis of the data collected from sick individuals and their contacts was made. For the contact tracing, the guidelines established in the Tuberculosis Program of the Autonomous Community of the Basque Country were followed. Six of the outbreak strains were sent to the National Centre of Microbiology for molecular typing. Results The total number of cases of the outbreak was 11. The rate of tuberculosis infection in the classroom of the index case, including the sick individuals, was 88.1% (59 infected and only 8 uninfected). The diagnostic delay of the index case was 260 days, and in the other 8 symptomatic cases it ranged between 10 and 70 days. The pattern obtained by the 2 genotyping techniques was identical in the 6 strains studied. Conclusions The long diagnostic delay of the authentic index case, which was diagnosed in the contact tracing, and the poor ventilation conditions of the classroom, determined the high number of secondary cases associated with this outbreak.