Objective To investigate the outcomes of the ESAT6-CFP10 skin test (EC-ST) among close contacts of pulmonary tuberculosis (PTB) patients in school settings and to identify factors associated with positive EC-ST results, and to provide a theoretical basis for PTB prevention and control strategies in schools.

Methods From January 2024 to March 2025, EC-ST screening and a questionnaire survey were conducted among close contacts of school-diagnosed PTB patients in Jiangning District, Nanjing City. Univariate and multivariate generalized estimating equations (GEE) models were employed to explore potential factors associated with positive EC-ST results among school-based close contacts.

Results Based on 40 confirmed PTB cases, a total of 1,860 close contacts within schools who had been exposed to these cases were screened. EC-ST results identified 55 individuals with positive reactions, resulting in a positivity rate of 2.96%. The positivity rates varied significantly among different age groups, occupations, and screening frequencies (P < 0.05). Multivariate GEE analysis revealed that obesity was a protective factor for positive EC-ST result among close contacts in school settings [OR=0.74, 95%CI (0.56, 0.98),P=0.037], absence of Bacillus Calmette-Guérin (BCG) vaccination scar [OR=1.29, 95%CI (1.12, 1.49),P< 0.001], and no previous history of tuberculosis/latent tuberculosis infection [OR=1.48, 95%CI (1.09, 2.01),P=0.012] were risk factors for positive EC-ST result among close contacts in school settings.

Conclusion Schools should enhance the monitoring and management of PTB infection by implementing timely screening measures for close contacts of confirmed cases. Particular attention should be given to high-risk groups, including individuals with underweight and absence of BCG vaccination scar. Early detection ofMycobacterium tuberculosis infections and active PTB cases is essential for effective prevention of transmission within schools.

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