Tuberculosis outbreak in a pre-primary and primary school in Barcelona, Spain

Background: In June 2022, a case of non-bacillary pulmonary tuberculosis (TB) was reported in a 10-year-old girl attending a primary school in Barcelona. A second pediatric case from the same school was identified in October 2022, prompting the declaration of a TB outbreak and the initiation of an epidemiological investigation. Methods: Contact tracing was conducted using the concentric circles approach, targeting household contacts, classmates, and school staff. Tuberculin skin tests were administered and read 72 h later. Whole genome sequencing of Mycobacterium tuberculosis isolates was performed to identify potential source cases and transmission chains. Results: Among 218 individuals screened, 30 TB infections and 4 TB disease cases were diagnosed. The highest prevalence occurred in grades EP4 and EP5 (ages 9-10), with a significantly higher risk compared to other grades. No adult cases linked to the school were identified. Later, a genomic cluster of 15 cases was detected across Catalonia, suggesting a super-spreading event. However, no direct epidemiological link to the school was established. Conclusions: This outbreak highlights the challenges of TB detection in pediatric populations and the importance of genomic surveillance in tracing transmission. Despite extensive investigation, the source remains unidentified, underscoring the complexity of TB dynamics in urban settings.

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Publication Details

Journal
Frontiers in Public Health
Published
2026-04-01
DOI
https://doi.org/10.3389/fpubh.2026.1789425
Primary Topic
Tuberculosis Research and Epidemiology
Type
article
Field-Weighted Citation Impact
0.00

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article

Tuberculosis outbreak in a pre-primary and primary school in Barcelona, Spain

Père-Joan Cardona, Elisa Martró, María Espiau, Maria-Luiza de Souza-Galvão et al.
Frontiers in Public Health
Tuberculosis Research and Epidemiology
article

Tuberculosis outbreak in a pre-primary and primary school in Barcelona, Spain

Père-Joan Cardona, Elisa Martró, María Espiau, Maria-Luiza de Souza-Galvão, Pere Simón, David Panisello Yagüe, Rosa Mercè Vileu Vallverdu, Antoni E. Bordoy, C. Rius, Helena Martínez Alguacil, Claudia Broto, Joan Pau Millet, Elisa Lara, Raquel Prieto-García, Laura Gavaldà Mestre, Mar López Espinilla, Antoni Soriano-Arandes, C Taroncher Domingo, Verónica Saludes, Ma Angeles Jiménez-Fuentes, Poppy J. Hesketh-Best, Elisabet Sicart Torres
article en

Abstract

Background: In June 2022, a case of non-bacillary pulmonary tuberculosis (TB) was reported in a 10-year-old girl attending a primary school in Barcelona. A second pediatric case from the same school was identified in October 2022, prompting the declaration of a TB outbreak and the initiation of an epidemiological investigation. Methods: Contact tracing was conducted using the concentric circles approach, targeting household contacts, classmates, and school staff. Tuberculin skin tests were administered and read 72 h later. Whole genome sequencing of Mycobacterium tuberculosis isolates was performed to identify potential source cases and transmission chains. Results: Among 218 individuals screened, 30 TB infections and 4 TB disease cases were diagnosed. The highest prevalence occurred in grades EP4 and EP5 (ages 9-10), with a significantly higher risk compared to other grades. No adult cases linked to the school were identified. Later, a genomic cluster of 15 cases was detected across Catalonia, suggesting a super-spreading event. However, no direct epidemiological link to the school was established. Conclusions: This outbreak highlights the challenges of TB detection in pediatric populations and the importance of genomic surveillance in tracing transmission. Despite extensive investigation, the source remains unidentified, underscoring the complexity of TB dynamics in urban settings.

Frontiers in Public HealthVol. 14
Universitat Autònoma de Barcelona (ES), Generalitat de Catalunya (ES), Universitat Pompeu Fabra (ES), Instituto de Salud Carlos III (ES), Hospital de Sant Pau (ES), Departamento de Epidemiología (GT), Departament de Salut (ES), Vall d'Hebron Institut de Recerca (ES), Agència de Salut Pública de Catalunya (ES), Vall d'Hebron Hospital Universitari (ES), Hospital Universitari Germans Trias i Pujol (ES), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Agencia de Salud Pública de Barcelona (ES), Medical Research Network (US)
Centres de Recerca de Catalunya, Public Health Agency, Generalitat de Catalunya
Good health and well-being
Openalex Percentile: Top 29%
Tuberculosis Research and Epidemiology
DOIOpen Access PDFOpenAlex
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