Tuberculosis outbreaks in schools: Experiences from the Western Pacific Region.

Reports of tuberculosis (TB) outbreaks among schoolchildren have increased in recent years in countries across the Western Pacific Region. Cases from China, Japan, Mongolia and the Republic of Korea were studied to derive lessons from the challenges and responses to TB outbreaks in schools. Despite differences in the TB burden and outbreak preparedness, the four countries reported similar challenges. These included delayed diagnosis of index cases, lack of experienced health professionals and sustained financial support, and difficulty in responding to intensified media and community attention. Early detection of outbreaks, established resource mobilization networks, coordination among stakeholders and proactive communication were highlights of successful outbreak responses. These principles could be adapted to each context for responses to future TB outbreaks in schools.

Investigation of a mumps outbreak in Mongolia, January to April 2011.

INTRODUCTION: The Gurvantes district in Omnogovi Province reported a suspected mumps outbreak to the Mongolia Ministry of Health in March 2011. An outbreak investigation team was established to verify the diagnosis and to determine the magnitude of the outbreak. METHODS: The descriptive study comprised retrospective investigation of local hospital medical records and surveillance data, and interviews with school teachers, doctors, probable cases and their close contacts. The World Health Organization standard case definition was used to define mumps cases. Clinical specimens were collected for laboratory confirmation. RESULTS: There were 153 cases, none under two years of age, with the five- to 14-years-old age group having the highest rates. There was no difference by sex (P = 0.12). A single index case appeared to be the source of the outbreak, and there were four outbreak waves. Of the 129 cases with information on epidemiological links, 94 (72.3%) were linked to other cases at a kindergarten or school, 17 (13%) were from secondary spread of family members, two (1.5%) were from secondary spread of other relatives, and 16 had no established links. Eight cases (5.2%) were confirmed through laboratory investigation. CONCLUSION: This was the first high-magnitude mumps outbreak since the introduction of the measles-mumps-rubella vaccine in Mongolia in September 2009. There were no cases among vaccinated children; cases were seen among older children and adults not eligible for the vaccine. This suggests that immunity to mumps is still low in Mongolia. Future outbreaks may occur among this unvaccinated population.