Investigation of Tuberculosis Clusters in a Long-Term Psychiatric Institution in Eastern Taiwan, 2012-2016

Investigation of Tuberculosis Clusters in a Long-Term Psychiatric Institution in Eastern Taiwan, 2012-2016

During April 17-August 14, 2014, eight cases of tuberculosis (TB) were notified (seven confirmed; one excluded) in a long-term psychiatric institution in eastern Taiwan. Six cases were living in the same ward, with identified epidemiologic links, and two confirmed cases were infected with the same genotype. The outbreak had been confirmed. As of August 2016, 302 TB cases in the institution had been reported; 22 were confirmed, and 1,609 contacts were monitored. The completion rates of four times of contact tracing were 99.2%, 92.8%, 95.5% and 94.9%, respectively. From the surveillance database we also identified 10 confirmed TB cases in the same institution between 2012 and 2013. After all, among these 32 confirmed cases, 10 had clustered genotypes (A group: 3; B group: 5; and C group: 2), 16 had separate genotypes and 6 had no culture results. Based on the recommendations from three expert meetings, the institution recruited two infection control specialists, implemented symptom surveillance and reporting, improved transfer records, ensured isolation for TB patients, improved the environment ventilation, and strengthened contact tracing every six months. From April 2015 to August 2016, no TB cases of the same genotype had been identified in the institution. Long-term psychiatric institutions must pay attention to the quality of infection control, maintain adequate human resources, and cooperate with public health authorities in order to lower risks of TB clusters.