STOP TB USA – Do you know of colleagues, policy makers, friends in the press, or other acquaintances who believe tuberculosis is no longer a problem? Please share the following reports by forwarding this email, and invite them to join the mailing list by simply clicking the Subscribe button.

All reports below occurred in just the past three months (October – December, 2013), and although they are not all the TB reports and articles, many of these reports describe problems that present significant challenges for health departments.

As usual, feedback as to the format is always welcome at: setkind@stoptbusa.org.


ALABAMA

“State officials, ASU probing tuberculosis case”, WDEF News 12, October 9, 2103

MONTGOMERY, Ala. (AP) — Officials at Alabama State University and the state Department of Public Health say they’re investigating a case of pulmonary tuberculosis at the school. Assistant state health officer for disease control and prevention Mary McIntyre says the ADPH is working closely with the university to administer precautionary testing, investigation and control. Health officials say they’ve been identifying students and faculty who may have come into close contact with the student and officials have emailed about 600 students and faculty to tell them how and where they can be tested. The university requires all students to show documentation before beginning classes to prove they’ve tested negative for TB. Officials say the student presented documentation before the 2013 fall semester.


ARIZONA

“Passengers Advised to Get Tuberculosis Tests After Plane Lands” , Jim Avila, ABC News, December 2, 2013 (NOTE: There are 58 other related news articles/reports)

PHOENIX: Passengers aboard a US Airways flight said they were told to get tuberculosis tests after they landed in a Phoenix airport over the weekend because of an ill passenger on board. The passengers aboard US Airways Flight 2846 from Austin to Phoenix Saturday night say the plane was swarmed by paramedics and police on landing, who advised that everyone on board should get a tuberculosis test and follow up with the Centers for Disease Control and Prevention.

A Phoenix-area woman told ABC News affiliate KNXV-TV her husband and 10-year-old daughter were on the flight when paramedics and police removed a man who reportedly had tuberculosis. “As we were taxiing, a stewardess came down the aisle,” passenger Dean Davidson said. “She had a mask and she instructed the gentleman to put a mask on.” “The fireman said he has tuberculosis, he’s contagious, you must see your physicians immediately and you must be tested in three months’ time,” Davidson added.

US Airways confirmed to ABC News that the crew of Flight 2846 received notice from the Transportation Security Administration about midway through the flight that a passenger’s boarding status had changed because of a medical condition. “The warning that came from the CDC did not occur until after the flight had departed so the passenger did not have a red flag in their reservation system or any warning there,” airline spokesman Bill McGlashen told ABC News.

US Airways could not confirm what the medical condition was, but the 74 passengers and crew members on board were met by the Phoenix Fire Department at the at Sky Harbor Airport and were given information following the removal of the passenger who had the medical condition. “Passengers were provided some information about what had occurred. And we are following up the situation with the CDC and monitoring it with them,” McGlashen said. Maricopa County Dept. of Public Health Spokesperson Jeanene Fowler said they were notified by the airport in Phoenix of an unconfirmed case of tuberculosis. Tuberculosis, a bacterial infection of the lungs, is contagious and sometimes deadly. But the CCD tells ABC News even if the passenger has tuberculosis, “exposure to other passengers would be unlikely.” “We believe there is very low risk of anyone being exposed to tuberculosis,” Fowler said.


CALIFORNIA

“Community leaders say the nationwide shortage of Tuberculosis Tests may have a big impact locally” Carlos Correa, ABC News , October 17, 2013

BAKERSFIELD: The shortage of Tuberculosis Tests nationwide is causing concern tonight.  Organizations like The Mission of Kern County depend on those vaccines to prevent an outbreak from turning into an epidemic. The Centers for Disease Control and Prevention announced the shortage in the spring, which continues to be a big concern for service groups that test for the bacteria almost every day.

Dennis, 20, is thankful to be staying at the Mission of Kern County. “I needed a place to stay,” he said. Like all residents he’s required to be tested for Tuberculosis, a bacteria that usually attacks the lungs. “At first, I was kind of scared because I don’t like needles, but it’s easy,” he said.

Leaders with the Mission say they get close to three hundred people a night and with a TB test shortage that could spell big problems. “If you have an outbreak of TB, it could be an epidemic in a community, which can turn into a large city and affect your population,” said Carlos Balbovinos, executive director of the Mission of Kern County. The cost for each test $34, which Mission leaders say adds up fast.

“The community, I mean it would be great if they would rally around it because we need to have those kind of services especially TB.  TB is something that, a lot of times people don’t think about the epidemic of something like that,” he said. TB testing at the Mission helps residents acquire jobs and even pursue educational opportunities which all require people to be tested. “We have men that are coming in from the gutter, literally.  Some of them have been on the street five, ten, some even twenty years and the health conditions that they have been living in is often very questionable,” said Joe Raddatz, homeless intervention services director. Health experts are counting on the TB tests to be readily available by next month.

Student tests positive for tuberculosis at Vista Murrieta High”, Matt Stevens, Times, November 1, 2013 (NOTE: There are 3 more related news articles/reports)

RIVERSIDE COUNTY: Riverside County health officials are working with the Murrieta Valley Unified School District to identify students and staff who may have been exposed to a high school student with an active case of tuberculosis. The Vista Murrieta High School student, who was not identified, has not been in school since last week and will not return “until it is safe to do so,” according to a statement posted on the district’s website. The student is being treated and is expected to make a full recovery, the district said.  And although health officials stressed that the risk of transmission is very low, Vista Murrieta Principal Mick Wager notified all parents of the situation via a phone message on Thursday, the district said. Parent Deanne Hazel told KCAL-TV that she received a call and email from the district “and I thought, ‘Great.’ “

Students and staff who are identified as being at risk will receive an email notice and phone call from the school, as well as a letter from the Riverside County Department of Public Health in the coming days. Officials are recommending that anyone who receives the notice be screened at a clinic being planned at the school. Those who do not receive a notice are not at risk. “While the risk of infection is slight, it is important that those who are notified take the time to get tested,” Riverside County Public Health Officer Cameron Kaiser said in a news release. “It will provide peace of mind for those who are concerned about being exposed or begin the next step in the evaluation process.”

Indio High student diagnosed with tuberculosis, Brett Kelman, The Desert Sun, December 3, 2013 (NOTE: There are 3 more related news articles/reports)

INDIO: An Indio High School student has been diagnosed with active tuberculosis, so the school will host a free screening clinic for classmates and staff who may have been exposed to the infectious disease. The student, who was not identified by authorities, attended Indio High from September until mid-November, but is not currently at the school. The student is expected to make a full recovery, according to a news release from the Riverside County Department of Public Health.

Since the diagnosis, the health department has sent written notices to students and school staff that may have been exposed to the infected teenager. Anyone who received a notice can get a free tuberculosis screening at a clinic held at the school during December. The clinic is only open to people who received an exposure notice from county health officials, so the date was not released to the public. The notices were mailed before the holiday weekend. If you have not received a notice by now, it is almost certain you are not considered an exposure risk, said Barbara Cole, chief of the Department of Public Health Disease Control Branch.

Cole said tuberculosis is spread when people share air in tight quarters on a regular basis, so simply passing a student in the hall or chatting by the lockers is unlikely to spread the infection. Students and teachers would be much more likely to be exposed to the disease if they shared a classroom with the infected student on a daily basis. But even if classmates are exposed, most people who contract tuberculosis never move past a dormant stage, when the disease is never contagious or harmful.

The tuberculosis screening offered at the school only takes a few minutes, said Dr. Cameron Kaiser, the county’s public health officer for Riverside County. Parents of students who were not identified as being potentially exposed can still take their children to be screened by their family physician or at the Indio Family Care Center, 47-923 Oasis St. “It is a simple process and can provide peace of mind,” Kaiser said in the news release.

Tuberculosis is uncommon, but not unprecedented, in Coachella Valley schools. In 2010, six students at Colonel Mitchell Paige Middle School tested positive for dormant infections. A College of the Desert student was diagnosed with active tuberculosis in March.

“California high school to be tested for tuberculosis”, Michael Martinez, CNN, December 21, 2013 (NOTE: There are 22 other related news articles/reports)

INDIO: All 1,800 students and staff at a southern California high school will be screened for tuberculosis Friday after 45 students tested positive for possible exposure, authorities said. The Riverside County Department of Public Health and state officials have determined there is a possibility of exposure to other Indio High School students, though “the risk of transmission appears to be moderately low,” according to a letter to parents on the school’s website. Officials said there is one active case of tuberculosis and they do not fear an outbreak.

“The entire school is being tested out of an abundance of caution,” Riverside County Public Health Officer Dr. Cameron Kaiser

Students will have to return to school in Indio, California, on Monday to have the test results evaluated, the letter says. Without verification of a current TB testing and results, students won’t be allowed to return to school after the holiday break, on January 6, the school said. County health officials expanded the testing to the entire school “after results of an initial screening were higher than expected,” spokesman Jose Arballo Jr. said in a statement. Officials tested 131 students on Monday, and 45 of them tested positive to possible exposure to the illness, he said.

“Someone who is exposed does not necessarily have active tuberculosis, a condition that must be confirmed with more tests,” Arballo said. “On Thursday, follow up X-rays identified five students who require further examination.”

“Two tuberculosis cases do not make an outbreak”, J.P. Crumrine, IDYLLWILD Town Crier, December 13, 2013

The Riverside County Department of Public Health has announced the detection of two cases of active tuberculosis in nearby high schools. In late October, one case was diagnosed in Vista Murrieta High School. A second case was diagnosed in an Indio High School student in November. While unusual, the two cases are unrelated, said Barbara Cole, DPH director of Disease Control. In 2012, one case of high school TB appeared in Riverside County out of a total 56 active cases — down from 68 in 2011, according to Cole. A total of 36 cases were found in people older than 44 years.

The numbers have been dropping since the mid-2000s. In 2007 and 2008, the number of identified cases in Riverside County was 80 and 79, respectively. The county’s current rate of cases, 2.5 per 100,000 population, is significantly lower than the U.S average of 3.2 and the California average of 5.8, which happened to be an all-time low in California.


COLORADO

“High compliance rate in Longmont High School TB treatment”, Victoria A.F. Camron, Longmont Times-Call,October 8, 2013

LONGMONT: The percentage of Longmont High School students, staff and teachers completing treatment for latent tuberculosis in 2012 far exceeded state and national rates, according to a Centers for Disease Control report released before the federal government shut down.

“I never really thought we’d get over 90 percent. I was very impressed with that,” Dr. Randall Reves, director of the Denver Metro TB Control Program, said Tuesday. A treatment-completion rate of 90 percent is ideal, he said, to prevent future outbreaks.

As of July, no one connected with the school had been diagnosed with tuberculosis, according to the report, which was written by Reves and others associated with the incident. At Longmont High, 96 percent of those diagnosed with latent tuberculosis — which is not contagious — completed the drug regimens they began, according to the CDC report. Three patients began and completed a nine-month treatment of isoniazid ; 88 of 91 people who started a four-month daily treatment of rifampin completed it; and 61 of 65 patients who took a weekly treatment of isoniazid and rifapentine completed that 12-week regimen. Across Colorado, the completion rate for patients taking isoniazid daily for nine months is 73 percent; the rate is 68 percent for the United States as a whole.

“I do think the shorter regimens made a huge difference,” Reves said.

The school’s tuberculosis crisis began in January 2012, when Reves announced that a student was diagnosed with TB during the winter break. Public health officials immediately tested the student’s teachers and those students with whom he shared two or more classes. Because an unexpectedly high percentage of that group — 53 percent — was found to have latent TB, testing expanded to students who shared one class with the patient. Of those 140 students, 36 were diagnosed with latent TB, so Reves and his team decided to test all the students, teachers and staff in the school. One person tested positive for active tuberculosis, but the disease was caught before it had become infectious, Reves said.

In March 2012, Reves reported that 144 of the 1,071 tested were diagnosed with latent tuberculosis. However, the final results, according to Reves, show that 1,249 people connected to Longmont High were tested, with 162 testing positive for latent TB. Completing the treatment for latent TB is key to prevent it from becoming the active, or contagious, form of the disease, Reves said.

“We really had very good collaboration with the school,” Reves said.

Students and faculty who opted for the once-a-week for 12 weeks medications received their doses at school, where public health officials observed the patients take the medicine. Longmont High officials set up a private location, away from the health office, for teachers and students to receive their medication, principal Rick Olsen said.

“We provided a safe place at school for students and staff to receive treatment,” Olsen said. “It wasn’t something that was in public view or obvious.”

The use of 12 weekly doses of isoniazid and rifapentine at Longmont High was “one of the earliest reported after the controlled clinical trials,” according to the report. The regimen became available shortly before the incident at Longmont High, and as it began, public health officials weren’t sure the medication would be available, Reves said.


FLORIDA

“Two Andrew Jackson High students infected with tuberculosis”, Derek Gilliam& Denise Smith Amos, Florida Times Union, November 7, 2013 (NOTE: There are 6 more related articles/reports)

JACKSONVILLE: About 100 students and six staff members at Andrew Jackson High School are being tested for tuberculosis after two students were infected with the disease, the county health department announced Thursday night. One of the infected students was hospitalized with active tuberculosis, launching the health department’s investigation. That student has since been released from the hospital. Both students were treated. Parents and students at the high school were notified Thursday afternoon. Duval Schools Superintendent Nikolai Vitti told the Times-Union Thursday evening the school will remain open and scheduled activities will not be canceled. Meanwhile, testing of students began Thursday and will likely continue Friday, he said, adding that he hopes to learn results by the end of the day.

It’s unclear exactly how and when the two students fell ill or when school and health officials first knew it. The students had apparently been misdiagnosed at first, Vitti said, and rumors surfaced Wednesday that it might be tuberculosis. However, school officials couldn’t notify anyone until it was confirmed by the health department Thursday, Vitti said. The school sent home letters to parents about the tuberculosis cases and testing and broadcast it over its automated phone system to students’ families.

“We appreciate the speed in which the school district and our health department came together to respond to these cases,” said Kelli Wells, director of the Florida Department of Health in Duval County, said in a written statement. “These initial steps are an important part of the public health process to ensure the health and safety of the students and staff of Andrew Jackson Senior High.”

There also will be an informational meeting at 5 p.m. Thursday at the high school for parents to ask questions. Representatives from the health department will field some of the questions, the news release said. “We’re trying to be transparent and to let parents know where we stand,” Vitti said. “At this point we’re awaiting further information.”

In April 2012, the U.S. Centers for Disease Control issued a report about a tuberculosis outbreak among Jacksonville’s homeless population. Health officials tested more than 4,000 people, and almost 500 people tested positive. At least 14 people have died since the strain was identified in Jacksonville in 2008. News of the 2012 outbreak generated discussion about how the health department notified the public. Several top health department officials, including department director Robert Harmon, resigned or retired after questions were raised about why information wasn’t released to the public sooner about the outbreak. Individuals who worked closely with the homeless were notified about the outbreak, but there wasn’t a public announcement until news reports made it public.

“Tuberculosis case investigation at Ocoee High School” Fox 35 news, November 14, 2013 (NOTE: There are 5 more related articles/reports)

ORLANDO: The Florida Department of Health in Orange County (DOH-Orange) is currently involved in the contact investigation of one case of active Tuberculosis (TB) of an Ocoee High School student. School officials, as well as families of attending students, are being notified and are participating in the investigation. Approximately 130 students and staff from the school have been identified for testing. Those individuals exposed are being medically evaluated and will be offered therapy, if found infected. The investigation was initiated following the recent hospitalization, and release, of a student with active TB. “The school district and our health department came together quickly to respond to this case,” said Dr. Kevin M. Sherin, Director of the Florida Department of Health in Orange County. “The health and safety of the students and staff is our top priority and our work with local school officials is an important part of the public health process.”

“Student at Seminole High School in Sanford contracts tuberculosis”, Justin Warmoth, WKMG, November 15, 2013 (NOTE: There are 3 more related articles/reports)

SANFORD, Fla.: A student at Seminole High School in Sanford has been identified as having an active case of tuberculosis, also known as TB. According to health officials, this is an isolated case, but parents say they’re still going to be taking extra precautions.

“It’s always concerning when you’re talking about a communicable disease that can impact other people, and I think TB is one of those,” said parent Phillip Miller. Miller, along with other parents of students that go to Seminole High School, will soon be getting alerted that a ninth grade student was recently diagnosed with an active case of tuberculosis. Health officials said that approximately 125 students and staff that came in contact with the student will be tested to make sure they weren’t

Dr. Swannie Jett with the Department of Health for Seminole County said that male student found out he had TB this past weekend and hasn’t been to school in over a month. “Once a person becomes active, we provide prophylaxes and we will verify if it is working after two to four weeks,” said Jett.

The case comes a day after health officials announced that an Ocoee High School student has tuberculosis. Health officials say the two incidents are not connected, but parents are still worried about the recent findings. “Any type of disease that you can contract through exposure becomes a concern for the whole community as well, not just the school system,” said Miller. Seminole County health officials said this is the fifth case of tuberculosis they’ve had this year. They want to stress to parents that every case has been very isolated and TB is not on the rise.

“Two tuberculosis cases investigated at Florida Blue”, Jacksonville News , December 25, 2013

JACKSONVILLE, Fla. — The Duval County Health Department says they are working with health care provider Florida Blue, after two of their Southside workers tested positive for tuberculosis. Health Department officials tell Action News a routine contact investigation is underway to figure exactly who the two workers have recently come in contact with. Charles Griggs of the Duval County Health Department stresses there is no immediate threat to any Florida Blue employees. We reached out to the health insurance giant, and they provided the following response: “We are working with the DOH to offer TB screening to employees. We will also be hosting a company meeting with the DOH to address employee questions and concerns.” Officials say somewhere in the neighborhood of 50 cases were reported to the health department this year, a drop of more than 30 percent from 2012.


GEORGIA

“Tuberculosis testing at Glenn Hills High School”,WRDW-TV , News 12 First at Five, October 24, 2013 (NOTE: There are 3 more related articles/reports)

AUGUSTA, Ga. (WRDW) — There’s been some question to whether a particular Glenn Hills High student does in fact have tuberculosis. Today, we learned we’ll have to wait a little longer for an answer. News 12 asked if he or she tested positive for TB. Emmitt Walker with the Richmond County Board of Health replied, “That has not been confirmed yet.” It could take a few more weeks before we know for sure.

“As we speak they’re trying to grow a culture. We’re probably looking at another three to four weeks before we know definitively if the student is positive for TB,” he explained. What we do know, earlier this month a Glenn Hills High student began to show symptoms of tuberculosis.

“We simply erred on the side of caution. We decided to go ahead and remove the student from the school and put the student on meds,” Walker said.

News 12 obtained a copy of the letter the school’s principal sent home to parents last week. It urges parents to “get their kids tested ASAP!!” Today a student at the school said he stayed home today partly because of the contagious disease. “I don’t even like them to be around me . I ain’t even trying to get stuff like that,” he said.

Today the high school offered skin tests for all those who had direct and sustained close contact with the student in question, but health officials insist it’s not as scary as it sounds. “Not at all, not at all. I realize that tuberculosis or the name causes fear and panic, but there’s no need,” insisted Walker. “Even if a person has had contact with this student, this disease is treatable.” Another student says she has her own way of dealing with the illness at school. “I just stay away from every student I see coughing,” she said.

All those that were tested at the high school today should find out their results this coming Thursday.

“Testing finds no tuberculosis at A.R. Johnson”, Tracey McManus,Augusta Chronicle, October 30, 2013

No tuberculosis cases have been identified at A.R. Johnson Health Science and Engineering Magnet School in the first two weeks of testing, according to the Richmond County Health Department. Department spokesman Emmitt L. Walker said 240 students and faculty members have been tested for the disease since Oct. 11, when a student there tested positive for the bacteria during routine TB testing required for clinical work study. The case made A.R. Johnson the third school in less than a year to undergo campus wide testing for tuberculosis. In September, at least 11 people at Glenn Hills High School tested positive for TB bacteria out of the 119 students and faculty members initially tested after a student showed signs of the disease to a doctor.

In October 2012, 578 people at Butler High School were tested for TB after a student also showed signs of the disease. Of those, 136 tested positive for the bacteria, and three later were confirmed to have the disease.

Walker said testing at A.R. Johnson will be completed by Friday.

According to the Georgia Department of Public Health’s media relations manager, Nancy Nydam, tuberculosis is not a common illness in Georgia. The TB rate is around three cases per 100,000 persons, with more than half of the confirmed cases reported in the Atlanta area. Between 2007 and 2010, the most recent period for which data are available, there were 20 confirmed TB cases in Richmond County, five in Columbia County and 919 in the state, according to the Department of Health database.


ILLINOIS

“With new law, TB funds can be converted to other public health services”, J Bourque, Morris daily Herald,December 14, 2013

MORRIS – It has been several years since the last tuberculosis outbreak in Grundy County, but the county will still be collecting $42,000 from taxpayers in fiscal 2014 for a tuberculosis services fund that has its own levy. “That levy has probably been around since tuberculosis started,” said Heidi Miller, Grundy County’s land use director and interim administrator. “It’s been in there [the budget] for quite a long time.”

Typically, the money would be restricted for funding tuberculosis services only, but thanks to changes in Illinois law, the county’s tuberculosis funds will not go to waste. Funds from a tuberculosis levy can be converted to fund other public health services if the county does not have an existing tuberculosis board or sanitarium but has an established board of health, according to the Illinois Department of Public Health. Under this law, the tuberculosis levy can amount to no more than $0.075 for every $100 of assessed property value. Grundy County meets these requirements and can therefore convert the tuberculosis levy into an added source of revenue for the county health department.

“Usually, we transfer $40,000 from that fund. This year, we will transfer about $90,000” Grundy County Board Chairman Ron Severson said. “With this legislation, we could transfer all of the money if we really wanted to, with the understanding that if there were a TB outbreak, the cost would come out of the general fund.”

At the end of fiscal 2013 – or Nov. 30 – the county had roughly $125,000 in the tuberculosis fund. By the end of fiscal 2014, the county expects to have $64,015. Severson said the county took a larger portion of the money this year because county finances have been tight. “No one wanted the county to operate at deficit so we did everything we could to keep a balanced budget,” Severson said.

Judy Bailey, director of nursing for the Grundy County Health Department, said while the county does treat cases of latent tuberculosis infections, the county has not seen a tuberculosis outbreak in years. People with latent TB do not feel sick and don’t have any symptoms, according to the Centers for Disease Control and Prevention. They are infected but do not have TB disease and the only sign of an infection is a positive reaction to the tuberculin skin test or TB blood test. They are not infectious and cannot spread TB to others, according to the CDC. The county has only treated two cases of latent infections this year. “It’s been a very long time since we’ve had an outbreak. There is a very low risk for TB in Grundy,” Bailey said.

IDPH Spokeswoman Melaney Arnold said the state doesn’t keep track of how many counties in Illinois still have a tuberculosis levy. “We don’t keep those records, but I would say that typically, our health departments do not have a TB levy,” Arnold said. Severson said the county’s board of health opted to keep money in the fund as a precaution, but he added that the county will most likely transfer more money from the fund now that it can be used for other public health services.


KANSAS

“Tuberculosis Case Confirmed in Johnson County ”, InfoZine , November 07, 2013

JOHNSON COUNTY: Health Officials have confirmed that the individual had previously been a patient at Overland Park Regional Medical Center (OPRMC). Through an ongoing investigation, JCDHE has determined that this situation has potentially affected a limited number of OPRMC staff and patients and believes the risk of transmission is extremely low. OPRMC is cooperating fully and transparently with public health officials’ efforts and following best practice guidelines to effectively address the investigation.

“A thorough contact investigation began immediately to determine anyone who may have been exposed to the patient,” says John Romito, MD, chief medical officer, Overland Park Regional Medical Center. “People, including staff and patients, who need to undergo testing in the next week have already been contacted.” “The risk of transmission is very low,” says Phil Griffin, BBA, CPM, KDHE tuberculosis controller. “TB testing is being conducted as a standard precautionary measure.”

The patient is in isolation and responding well to treatment.


MINNESOTA

“Melrose turkey plant worker tests positive for tuberculosis”,ASSOCIATED PRESS, November 21, 2013 (NOTE: There is one other related article/report)

MELROSE: A worker at a Jennie-O Turkey Store plant in central Minnesota has tested positive for tuberculosis. A spokesman for Jennie-O’s parent company, Hormel Foods Corp., says the Stearns County Public Health Department informed the Melrose plant on Monday that a worker had tested positive for TB. Hormel says that TB is a health issue and is not a risk to food safety.

The spokesman says Austin-based Hormel has identified nine people who work in the same department as candidates for being the worker who tested positive. A letter with the names of those employees was sent to Stearns County Public Health on Wednesday. Jennie-O will continue working with the Health Department.


NEW YORK CITY

“St. Luke’s-Roosevelt Hospital Confirms Employee Tested Positive For Tuberculosis”,CBS New York, October 31, 2013 (NOTE: There are 4 more related articles/reports)

NEW YORK CITY: A Manhattan hospital has been notifying former maternity ward patients that they may have been exposed to tuberculosis after an employee tested positive for the disease. All patients and staff members who may have been exposed to the disease have been contacted, St. Luke’s-Roosevelt Hospital said in a statement. Hospital officials said they immediately contacted the city’s health department to develop a plan to contact all patients that may have been exposed.

“We understand that patients may have concerns, and we want to assure everyone that we are taking swift and comprehensive steps to address the situation,” the statement said. “If you were recently a patient at Roosevelt Hospital and have not been notified, then you were not in contact with the infected staff member.” St. Luke’s-Roosevelt said the employee had previously been tested for TB, and that the person’s health survey suggested no problems. The hospital stresses that few people exposed to the disease actually become infected.

According to the New York City Bureau of Tuberculosis Control, in 2012, the number of confirmed TB cases in the city dropped to 651 — the lowest number since the disease became reportable in 1897. The hospital has provided patients with options and locations for evaluation and testing. All testing and follow-up procedures not covered by insurance will be reimbursed by the hospital.


NEVADA

“Hospital TB exposure under investigation in Nevada” Elizabeth Landau, CNN, October 8, 2013 (NOTE: There are 64 other related articles/reports)

A young mother who gave birth to premature twins had the bacterial infection, according to the Southern Nevada Health District. The woman died, as did both her babies, at least one of them from tuberculosis. Southern Nevada Health District officials believe the mother contracted tuberculosis from eating unpasteurized dairy products from Mexico, although there is no proof of this, said Dr. Joseph Iser, the health district’s chief health officer.

The mother could have exposed at least one of the infants to tuberculosis while in the neonatal intensive care unit at Summerlin Hospital, but Iser and his colleagues believe it is more likely the infection was transmitted at or around the time of birth. One of the infants died in June and was buried before the bacterial infection was suspected. The mother was transferred to a hospital in a different state, while the surviving baby stayed in the NICU at Summerlin. The mother died of tuberculosis in July.

“We were informed of her death of tuberculosis, and immediately we contacted (Summerlin) hospital,” Iser said. “The hospital immediately put the surviving twin into isolation to prevent transmission. The hospital did the right things once they knew that tuberculosis was a possibility.” The second twin died of tuberculosis in August.

An initial investigation of hospital employees who might have been exposed, as well as close contacts of the mother, revealed two cases of active tuberculosis: one in a hospital staff member and one in a family member. Both of them are receiving treatment, Iser said. An additional 24 people were found to have latent tuberculosis, which means that the bacteria are in the body but don’t cause symptoms and are not contagious. About 5% to 10% of people with a latent infection will develop active tuberculosis disease at some point in their lives, according to the Centers for Disease Control and Prevention. The heath district has offered treatment to these 24 people with latent cases.

The Nevada investigation has been broadened to look for others who may have come in contact with the dangerous bacteria. The families of about 140 infants who could have been exposed are being asked to be tested. These babies could have been exposed between May 11 and August 8, according to CNN affiliate KTNV. “I really don’t expect to find any more cases at all,” Iser said. “But again, we’re testing and offering to test all of these infants and their parents now.”

The health district is not certain whether the infant who had confirmed tuberculosis had spread the bacteria, or if it was the mother when she visited the NICU. “In infants this young, they often don’t have symptoms, and they often aren’t very infectious,” Iser said.

Babies who have had exposure to someone with an active case of the infection would have a small risk of contracting the infection themselves, but the health district recommends tuberculosis testing for those babies and parents, Southern Nevada Health District said in a statement. Parents of the babies in the NICU received a letter in August from the health district that described the investigation and its early results. Anyone who was visiting other parts of the hospital at the same time, such as “going through the lobby, going up to visit their relatives in pediatrics or the adult wing of the hospital, would not have been exposed to tuberculosis,” Iser said. “We will contact those people at risk who we identified through hospital records,” Iser said.

“Dozens Test Positive For Tuberculosis After Exposure at Hospital Neonatal Unit”, Sydney Lupkin, ABC NEWS, December 24, 2013 (NOTE: There are 11 other related articles/reports)

Fifty-nine people have tested positive for tuberculosis after being exposed at a Nevada hospital neonatal intensive care unit, according to a report issued by the Southern Nevada Health District. Dr. Christopher Ohl, an infectious disease expert at Wake Forest Baptist Medical Center, said an outbreak this large tied to a hospital is “extremely unusual.”

“Unfortunately, this situation is a hospital epidemiologist’s worst nightmare as neonates are highly susceptible to contracting TB and their infections can progress quite rapidly,” he said.

A mother and her newborn twins died of tuberculosis at Summerlin Hospital over the summer, prompting an investigation by the Southern Nevada Health District. Hospital staff didn’t realize the infected woman had tuberculosis until after she and one of the twins died and they performed an autopsy, according to KTNV, ABC’s Las Vegas affiliate. The other twin was in the NICU being treated without being under quarantine. The second twin also tested positive for tuberculosis and died in August, health department spokeswoman Stephanie Bethel told ABCNews.com. Letters went out to hundreds of patients in August, but after hospital employees tested positive for the disease, officials started calling families to get tested immediately this fall. They feared about 140 infants had been exposed between May and August. Although many of these infants have not undergone all the tests necessary to rule out active or latent tuberculosis, most of them tested negative for the disease. Some test results were inconclusive, and seven infants are currently on preventive treatment, however.

Of the 977 people exposed, two had active tuberculosis infections, 59 had latent infections –meaning they had the bacterium but weren’t sick – and 181 had incomplete evaluations, according to the report.

“Tuberculosis case diagnosed at Henderson high school” , Kim Powell, KTNV.com, November13, 2013 (NOTE: There are 10 more related articles/reports)

HENDERSON: A individual at a Henderson high school has tested positive for active tuberculosis. The Southern Nevada Health District is now planning on testing other students and staff to make sure it has not spread. The principal of Coronado High School sent out a letter to parents via email Tuesday night, notifying parents that someone at the school has tested positive for active pulmonary tuberculosis, according to SNHD. Students will be sent home with a hard copy of the letter on Wednesday.

In the letter, we learn that, “The case is isolated in nature and the individual has not been on campus recently. Outside of the one confirmed case, no students or staff has shown any signs or symptoms of TB.” The SNHD is now identifying students and staff who had close contact with the infected person, they will have to undergo mandatory testing. Students cannot be tested without consent, so parents will be sent permission slips to fill out. Testing will happen during school hours next Tuesday, Nov. 19 through Thursday, Nov. 21. There is no charge associated with the testing.

The SNHD told Action News they get about 70-80 cases of TB each year in the Valley, and it can be treated with antibiotics.


NORTH CAROLINA

“Wayne Farms Employee Suspected Of Active Tuberculosis”, WFMY News2, December 4, 2013   (NOTE: There are 2 more related article/report)

SURRY COUNTY: The Surry County Health Department says a Wayne Farms employee is suspected of having an active case of Tuberculosis. According to the health department, the person lives in Guilford County and has already been isolated. About 250 Wayne Farms employees who might have been in contact with the employee had evaluations. They will have additional screenings through the middle of January. The health department says even though active Tuberculosis cases are contagious, this case does not affect the food produced at Wayne Farms. According to its website, Wayne Farms is the fifth largest “vertically integrated poultry producer in the U.S.”


NORTH DAKOTA

“TB outbreak appears to be over in Grand Forks, still costly”, Charley Haley, Grand Forks Herald, (NOTE: There is one more related article/report)

The tuberculosis outbreak that led to 27 confirmed cases of the disease in Grand Forks this past year has simmered down, with health officials hoping that patients will be out of treatment this spring. Terri Keehr, registered nurse and TB program manager at Grand Forks Public Health, said there are 11 patients still in treatment and none of them are considered contagious.

“The case management is going very well,” she said. Patients still in treatment are taking medication every day, whether it’s by going to the Public Health office each day or by having a nurse bring medication to them if they lack transportation.

The outbreak, which largely started about 13 months ago, had some patients in isolation, with nurses even bringing them food to keep from spreading the disease. “We have not had anyone in isolation for a long time,” Keehr said Tuesday. Some of the 11 patients still in treatment should be finished in the next couple of months, and Keehr said she expects all of the patients’ treatment to be complete by early spring.

Although known TB patients are out of treatment, that doesn’t mean the disease has been wiped out of Grand Forks, Keehr said. “There may be people out there that we haven’t found yet,” she said. “We hope that’s not the case, but we can’t say there’s no risk.”

Extra costs

Efforts to treat and contain TB in the past year have cost more than $100,000. On Monday, the Grand Forks City Council approved a reimbursement of $55,532 from the North Dakota Department of Health. Added to previous reimbursements, Grand Forks has received about $143,000 from the state for TB management. Keehr said those dollars go toward all aspects of treatment, from paying nurses for working additional hours to providing medication. The outbreak has also caused a strain on Public Health employees, Keehr said. Public Health has several other programs that it’d had to continue while caring for the influx of TB patients, Keehr said. “We’ve had to reallocate some job responsibilities in the department,” to meet all of the needs, she said.


OHIO

“Health officials find no active TB cases”, WHIO.com, October 10, 2013

Dayton & Montgomery County found no active cases of tuberculosis among customers of Galaxy Nail Spa in Miami Twp., who potentially were exposed to the bacteria by a salon technician who tested positive for the disease. The nail technician tested positive for an active form of the bacterial infection in July.

Public health officials first tested 226 customers for the active form of the bacteria in August, and they were re-tested recently at follow-up clinics in Miami Twp. The follow-up tests were necessary because it can take between two and 10 weeks for people infected with the bacteria to develop a response to the skin test. Health officials found no active cases of the disease, but two people tested positive for the infection.

“All that means is that they have been exposed at some point in their life to TB, so the body has reacted to the TB test,” said Bill Wharton, spokesman for Public Health – Dayton & Montgomery County. “The fact that they are infected does not mean they are an active case of TB –an active case of TB would be someone who can spread TB to someone else.”

Anyone who was a customer of the Galaxy Nail Spa and made multiple visits between March 1 and Aug. 15 can still receive free testing. They can visit the tuberculosis clinic at the Reibold Building, Fifth Floor, 117 South Main St. in Dayton. People with other questions about testing information can call 937-225-4550. There are no active tuberculosis cases associated with the Galaxy Nail Spa. Health officials said customers should not hesitate to revisit and patronize the business.


PENNSYLVANIA

“Erie County’s TB cases might be on decline”, David Bruce, Erie Times-News,December 29, 2013

Erie County’s nearly three-year rise in active tuberculosis cases might be ending. Only five cases of the disease have been reported in the county through the first 11 months of 2013, compared to 12 cases during the same period in 2012. “It’s good news,” said Sue Carlson, R.N., nursing supervisor for communicable diseases for the Erie County Department of Health. “Tuberculosis a serious illness and it can spread so easily.”


TEXAS

“Tuberculosis Scare At Another Irving School”, Stephanie Lucero, CBS Dallas/Fort Worth, October 21, 2013 (NOTE: There are 4 more related news articles/reports)

IRVING: A high school in Irving is on high alert after a student tested positive for tuberculosis. Now, the Irving Independent School District and Dallas County Health and Human Services are hosting an informational meeting to answer questions for anyone who is concerned about the situation. The meeting will be held at 6:30 p.m. on Monday evening at Macarthur High School in Irving. School district and health department officials will be on hand to offer information about tuberculosis and talk about the current plan going forward. The meeting is intended for parents, students, staff members and community members.

“It’s really just educational,” said Irving ISD spokesperson Lesley Weaver, “helping people understand how TB is contracted and just, I think, to calm fears, to let everybody know that we don’t think there is an epidemic or we don’t have a problem of TB.”

Tuberculosis testing will begin at the campus on Tuesday. Health officials have recommended testing for about 80 students and employees who may have come in close contact with the student who has already tested positive. The testing is free. Meanwhile, everybody on campus Monday is receiving a handout that features information about tuberculosis, how it is spread and which medications are available to help treat the illness. Health officials are not releasing information about the student who has tuberculosis, except to say that they believe the student acquired it while out of state, and he or she is currently being treated.

This all comes on the heels of a similar scare at another high school in Irving. Last month, more than 130 students and staff members were tested for tuberculosis at Nimitz High School. Those individuals shared a classroom last spring with a student who had tuberculosis. During that round of testing, another five students came up positive for skin exposure to tuberculosis. Dallas County health officials said that the two cases are completely separate, not linked in any way. But they are concerned that the illness continues to be an issue within the community. That is why they have called for the Monday meeting, to educate people about tuberculosis and answer any questions.

“It’s good that the community is taking part in trying to fix the problem,” said student Christopher Ceballos, “keep it from spreading.”


UTAH

“Jail running short of tuberculosis serum”, Daily Herald , November, 2013

SALT LAKE CITY — A national shortage of a skin test serum for tuberculosis has officials at the Salt Lake County jail hoarding their supplies. The jail says it will run out of the test serum Tubersol if it continues a policy of screening all incoming prisoners. Instead, jail officials announced a new policy Wednesday of not repeating a test on any offender who had the test within a year. Jail officials say they have less than an eight-week supply of the skin test serum.


VIRGINIA

“2nd VCU Student Tests Positive for Tuberculosis”,WRIC.com, October 2, 2013 (NOTE: There are 7 more related articles/reports)

RICHMOND, Va. (AP) – A second case of tuberculosis has been confirmed at Virginia Commonwealth University. The university says a student tested positive for tuberculosis during a routine screening.
Media outlets report that the university announced the second case in an email sent Tuesday night to faculty, staff and students. The first case was reported last week. Provost and senior vice president Beverly J. Warren says in the email that state health officials determined the two cases aren’t related.
Warren says the Virginia Department of Health believes the risk to the general VCU community is small.

“Health centers experiencing statewide shortage of tuberculosis skin test”, Lucy Bustamante, 13News Now,WVEC.com, October 8, 2013

NEWPORT NEWS: Judith Harold traveled to her local health center in Newport News Tuesday and was upset to find out the tuberculosis skin test PPD that she needs isn’t available. The tuberculosis skin test is used to determine if someone has developed an immune response to the bacterium that causes tuberculosis.

“I am very disappointed that the PPD shot isn’t available,” Harold said.  “It lets us know if we have tuberculosis and it’s a requirement that our company, Serenity, a home health care company, requires because we care for special needs adults.”

State Epidemiologist Dr. David Trump says the shortage is due to the same manufacturing problem that’s gone on for months now. “The manufacturers aren’t able to produce a sufficient quantity to meet the need.  There was an expectation that it would become available later this year,” Dr. Trump said.
Trump says there’s also a short supply of Pentacel and HIB.  Pentacel offers protection from diphtheria, tetanus, pertussis, poliomyelitis and influenza type B.   HIB offers protection against influenza type B. So far, providers in Virginia are keeping it in stock.

“Last month we provided guidance to all physicians to what the alternatives are,” says Dr. Trump, who has instructed physicians to do blood work until the TB test come back into stock. The health department wants to emphasize these shortages are not due to the shutdown. The CDC has furloughed 68 employees and while it’s flu prevention campaigns have been halted, they say the vaccine supply isn’t impacted.

“Community meeting answers questions about recent tuberculosis case”, Rachel Lucas, WSLS, November 25, 2013 (NOTE: There are 6 more related articles/reports)

At a community meeting tonight, parents are left with question and concerns, after finding out tuberculosis has hit William Fleming high school. Some are so fearful they sat in the meeting with medical masks covering their faces. Margarita Martinez and Calvin Edmonds only took the masks off for an interview. “I was a little upset because i just find whenever there something going on, we find out after the fact,” said Martinez.

The health department notified the school system Friday when one student tested positive. These two parents told WSLS that finding out three days later isn’t acceptable.  Now they’re worried for their teenage daughters, especially since it could take up to ten weeks to identify those who are at risk.

“I kind of think that they are sugar coating it,” Martinez said. I mean it’s tuberculosis.”

 School Superintendent Dr. Rita Bishop says parents shouldn’t be alarmed. She says years ago, her son Gordon tested positive for tuberculosis at the age of two. She says he was successfully treated without spreading the disease.

The school will be conducting TB tests for anyone who is at risk of being infected. Those students and teachers will be identified during the Health Departments investigation. Eventually all of those people who wish to be tested will be, free of charge. So for the next 10 weeks, all parents can do is encourage their children to wash their hands often, and keep on the lookout for flu like symptoms while the investigation unfolds.


GUAM

“DOE worker dies of TB: Untalan students, staff to be tested next Friday”, Pacific daily News, November 15, 2013 (NOTE: There are 2 more related news articles/reports)

Untalan Middle School teacher, who tested positive for active tuberculosis, died from the disease on Saturday, the island’s medical examiner, Dr. Aurelio Espinola, confirmed yesterday morning. The teacher was diagnosed with TB last week, officials said. “The person was feeling ill, went to the hospital and was diagnosed there,” said James Gillan, Department of Public Health and Social Services director. Officials with Public Health met with Untalan Middle staff and are scheduled to meet with school staff again on Monday.

According to Guam Department of Education Deputy Superintendent Robb Malay, DOE and Public Health are launching an investigation to identify those who were in contact with the teacher. Gillan said this is standard procedure for any reports of active TB or positive readings for PPD skin tests. Those who were exposed to the teacher will be screened for TB using a purified protein derivative, or PPD, skin test, which will take 48 to 72 hours to read. Malay said they’ve identified about 110 individuals who need to be tested. According to a Public Health press release, those who were identified as exposed to TB will be given free PPD tests at the school on Nov. 22.

Dr. Felix Cabrera, an internal medicine physician at IHP Medical Group and associate medical director of Guam Memorial Hospital, said passing contact isn’t considered high-risk. “When we look at exposure, we look at those who were most in contact with the individual with TB,” Cabrera said.

Malay said faculty and staff are required to be tested each year. The teacher had tested negative for TB when she first submitted her documents in June or July. While Guam law requires students receive a PPD skin test when they enter the school system, this past summer, Public Health didn’t have enough of the PPD solution to screen students, Pacific Daily News files state. Gillan said the PPD shortage is a concern and in light of the shortage, the requirement to test all students is unnecessary.

“We feel we’re overusing it in the mass school screenings,” Gillan said. “It’s a waste of a valuable tool.” He said some tests return false negatives, and throughout the year, students and staff can come into contact with TB. Instead, Gillan would like to screen students when someone is identified as having active TB.

According to Cabrera, there are 63 active cases of TB per 100,000 people on Guam, compared to the United States’ four cases per 100,000. “Put into perspective, there are about 170,000 people on island. That means 120 people could have active TB on Guam,” Cabrera said. Cabrera said active TB could require months of treatment. “Once you are diagnosed with active TB, you have to hit and hit it hard with numerous anti-TB medications all at the same time,” Cabrera said.

Pacific Daily News files dating back through the 1970s do not report of any TB deaths on island. However, there is frequent reference to Guam’s high incidence of TB.


CANADA

TORONTO

“Officials confirm second case of tuberculosis in Toronto high schools ”, James Armstrong, Global News (NOTE: There are 3 more related news articles/reports)

TORONTO – There is another confirmed case of tuberculosis at a Toronto high school. A spokesperson for the Toronto Catholic District School Board confirmed to Global News Wednesday that there is a case of tuberculosis at Chaminade College School. The school, at 490 Queens Drive near Jane Street and Lawrence Avenue, was made aware of the diagnosis on Tuesday at 4 p.m. As a result, the school instituted its ‘Infection Control Protocol,’ according to Corrado Maltese, a Safety Manager with the TCDSB. The protocol includes additional cleaning and disinfecting of items such as door handles in common areas. The unidentified person who contracted TB is recovering at home. The school has remained open and classes are continuing.

The diagnosis is the second time in a month that a Toronto high school student has been diagnosed with tuberculosis. In September, an unidentified person at Scarborough’s Mary Ward Catholic Secondary School was diagnosed with the disease.  The school’s population in that case was deemed to be at a “very low risk of exposure.”

NEW BRUNSWICK

“Tuberculosis fears have health officials fielding calls”, CBC news.ca, October, 2013 (NOTE: There are 3 more related news articles/reports)

The Vitalité Health Network has been busy fielding calls from people in the Moncton area who are worried they may have been exposed to tuberculosis. Earlier this week, health officials said they wanted to contact people who had visited certain areas of the Dr.-Georges-L.-Dumont University Hospital Centre prior to a university student being positively diagnosed with a potentially highly contagious type of TB.

The response has been higher than expected, said Vitalité spokesman Luc Foulem. “People who didn’t quite understand where the patient was, they just thought, ‘I was at the hospital, I’m calling,’ not necessarily understanding exactly where they were in the hospital and not picking up on the fact that OK, this is really specific to 3C and to the emergency department at specified dates,” he said. Officials have been able to ease the fears of some people by explaining the risk of contact, said Foulem.

“The area where the contagion can potentially happen is if you are in an environment where there’s no air circulation whatsoever for at least 45 minutes to an hour. So anything below that, the possibility for someone to contract [the infection] is minimal at best,” he said. Foulem says names are still being collected in case any kind of testing is required.

“The earliest possible time where you can actually do an effective test is after eight weeks because it takes that long for the possibility of the virus to, for lack of a better term, to implant itself.”

Dr. Gabriel Girouard, a microbiologist and infectious disease specialist, has said about 100 people may have been exposed at the hospital, including medical and paramedical staff members, patients and visitors.

The patient, a business student at the University of Moncton, was admitted to hospital on Sept. 10. Isolation measures were put in place once the diagnosis of laryngeal tuberculosis was confirmed on Sept. 17, Girouard said. The public was notified on Sept. 23. The patient is responding to treatment and improving, Foulem said.

Meanwhile, University of Moncton officials are also trying to reassure students and staff that their risk of developing TB is also low because exposure was limited. The infected student attended only four classes for one week before being hospitalized, they have said. A list of students, professors and other staff at the university who may have been in contact with the patient is being compiled. It is not yet clear how the patient contracted the disease.

NORTH WEST TERRITORIES

“Active TB case found in Colville Lake, N.W.T.”, CBCnews.ca , October 11, 2013

One person from Colville Lake is being treated in hospital for an active case of tuberculosis, say N.W.T. health officials. Dr. Kami Kandola, the N.W.T.’s deputy chief public health officer, says the single case is not being considered an outbreak. Kandola says it’s considered an outbreak only if there are two or more cases of TB that originated from one case. She says TB is treated in both the Inuvik and Yellowknife hospitals, though she couldn’t say where this case is being treated. She also says health officials will test anyone who may have come in contact with the person. Kandola says people are sometimes afraid of the disease.

“People who developed TB back in the ’40s and ’50s, typically they were sent out of their communities. And so there is, among the elders, a certain sense of fear and anxiety,” she said. Kandola says active cases of contagious TB are relatively uncommon in the N.W.T. She says it’s more common to find cases of what’s known as latent TB, which is not contagious and does not require a hospital stay.


MEXICO

“Tijuana leads Mexico in tuberculosis cases: On average, 1000 diagnosed each year”, San Diego Reader, Bob McPhail, December 2, 2013

Dr. Rafael Laniado Laborín, head of the multi-drug-resistant tuberculosis clinic at Hospital General de Tijuana, recently told El Mexicano that the clinic diagnoses an average of 1000 TB cases a year, leading Mexico in the number of tuberculosis cases reported annually.

“A thousand cases a year, that’s a lot of cases,” Laniado told the newspaper. He attributed the large number to high levels of migration into Tijuana and to a better system at the hospital of detecting the illness. TB, said the doctor, is associated with poverty, which explains why most pharmaceutical companies have little interest in developing new drugs to treat the illness. Nonetheless, Laniado told the newspaper, there is a single drug that is effective in curing TB as long as patients are diagnosed early and given adequate treatment early on.

“If you have a cough, phlegm, weight loss, trouble breathing, and a fever, you need to see your doctor so he can examine you and eliminate tuberculosis as the cause,” El Mexicano quoted him as saying.

According to health officials, 234 cases of tuberculosis were reported in San Diego County in 2012, and, as of November 1, 130 cases have been reported in 20

StopTBUSA was formerly known as the U.S. National Coalition for Elimination of Tuberculosis (NCET). Please pass this information on to your colleagues who are interested in TB elimination.

©2014 StopTBUSA

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