Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study

  • Maja B Stosic Department of HIV, hepatitis, STDs and TB, Public Health Institute of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
  • Dragana Plavsa Department of Epidemiological Surveillance, Public Health Institute of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
  • Nikoletta Mavroeidi Child and Adolescent Centre, Athens, Greece
  • Dragana Jovanovic University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
  • Violeta Vucinic University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
  • Goran Stevanovic Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • Lidija Sagic Municipality Institute for Tuberculosis and Lung Diseases, Belgrade, Serbia
  • Sefadil Spahic District Public Health Institute, Novi Pazar, Serbia
  • Uros Rakic Department of Epidemiological Surveillance, Public Health Institute of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
  • Anita Grgurevic Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Keywords: tuberculosis, outbreak, retrospective cohort study, high school, Serbia

Abstract

Introduction: Between February and November 2016, 17 tuberculosis (TB) cases were identified among high school students in Novi Pazar, Serbia. The objectives of our study were to describe the outbreak, to identify potential risk factors and to evaluate the applied control measures.

Methodology: The outbreak was described by time, person and place. A retrospective cohort study was conducted. Attack rates, unadjusted relative risks (RR) and 95% confidence intervals (CI) were calculated. Multiple log-binomial regression analysis was performed to calculate adjusted RR.

Results: Sixteen of the total 17 cases occurred among grade 3 students, AR 5.5%. Previous TB family history, (RR = 5.29; 95% CI = 1.63-17.12), spending time with a known TB case at school (RR = 5.38; 95% CI = 1.48-19.55) and exposure to secondhand smoke (RR = 3.37; 95% CI = 1.11-10.29) were all significantly and independently associated with the occurrence of TB.

Conclusions: Delayed diagnosis and reporting resulted in delayed initiation of the contact investigation and non-identification of latent TB cases probably favored the occurrence of this outbreak in a low incidence country. Public health authorities should consider revising the existing guidelines, promoting inter-sectorial collaboration and increasing awareness of public health professionals.

Author Biographies

Nikoletta Mavroeidi, Child and Adolescent Centre, Athens, Greece

Mediterranean Program for Intervention Epidemiology Training- MediPIET

Dragana Jovanovic, University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia

University Hospital of Pulmonology, Clinical Center of Serbia, Koste Todorovica 26, 11000 Belgrade

Violeta Vucinic, University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia

University Hospital of Pulmonology, Clinical Center of Serbia, Koste Todorovica 26, 11000 Belgrade

Goran Stevanovic, Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia

University Hospital of Infectious Diseases, Clinical Center of Serbia, Bulevar Oslobodjenja 16, 11000 Belgrade

Lidija Sagic, Municipality Institute for Tuberculosis and Lung Diseases, Belgrade, Serbia

Municipality Institute for Tuberculosis and Lung Diseases, 11000 Belgrade

Sefadil Spahic, District Public Health Institute, Novi Pazar, Serbia

District Public Health Institute, Novi Pazar, Serbia, 36300 Novi Pazar

Anita Grgurevic, Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, 11000, Belgrade, Serbia.

Published
2019-02-28
How to Cite
1.
Stosic M, Plavsa D, Mavroeidi N, Jovanovic D, Vucinic V, Stevanovic G, Sagic L, Spahic S, Rakic U, Grgurevic A (2019) Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study. J Infect Dev Ctries 13:101-110. doi: https://doi.org/10.3855/jidc.10952
Section
Outbreak