Published Date: 2005-06-16 23:50:00
Subject: PRO/EDR> Tuberculosis, hospital exposures - USA (MA)
Archive Number: 20050616.1702
TUBERCULOSIS, HOSPITAL EXPOSURES - USA (MASSACHUSETTS)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu, 16 Jun 2005
From: ProMED-mail <email@example.com>
Source: The Boston Channel [edited]
About 1600 Patients, Health Care Workers Exposed To TB
State health officials are investigating a tuberculosis scare that affects
several Boston area hospitals. NewsCenter 5's Jack Harper reported that a
surgical intern who's worked at 4 local hospitals has the disease and
hundreds of people may have been exposed.
"We are here today (16 Jun 2005) because the Boston Public Health
Commission has diagnosed a case of active tuberculosis (TB) in a health
care worker who worked at 4 hospitals," said Dr. John Rich, of The Boston
Public Health Commission.
The female intern, who is now on leave and undergoing treatment, worked at
4 Massachusetts hospitals including West Roxbury Veterans Affairs Hospital,
Cape Cod Hospital, Boston Medical Center, and Brockton Hospital. Those
hospitals are in the process of assessing who should be tested at those
facilities. "We would estimate that approximately 1600 people might have
had contact with the infected health care worker. That is a large number
and most of those individuals will not have any infection related to this
at all," said Rich.
Experts said there is no threat to the general public. "From a physician's
standpoint, the statement I would like to make at the beginning is that TB
is a very treatable disease and a relatively small percentage of people
exposed to the bacterium will actually contract the disease," said Dr.
Keith Lewis, of Boston Medical Center.
"We are working together to ensure that every person for whom there was any
risk of exposure or infection is contacted and has the appropriate testing
and referral that is necessary to reassure them," said Rich. Health
officials are trying to get in touch with all of the patients who have had
surgery recently, e-mailing them, calling them, and sending them letters,
urging them to come to the hospitals as soon as possible for free testing.
TB is a disease that usually attacks the lungs, and is caused by bacteria
that can be released into the air by an infected person who coughs or
sneezes. Antituberculosis agents usually are effective in treating the
disease. Once the leading cause of death in the USA, TB has re-emerged as
a serious health problem. In 2004, there were 284 cases of tuberculosis in
Massachusetts -- a 9 percent increase from the year before.
The biggest problem, experts said, is the active form can be passed from
person to person, although the CDC said quite a bit of exposure to an
infected person is needed. On average, people have a 50 percent chance of
becoming infected if they spend 8 hours a day for 6 months with an infected
person. Complicating matters more is that not everyone who gets infected
with tuberculosis will know it. The bacteria can lie dormant for years,
without causing symptoms. Symptoms of the disease include coughing, fever,
loss of appetite, night sweats, and feeling extreme fatigue.
[Although the CDC data on transmissibility is often stated, most clinicians
have seen transmission with a much more minimal exposure. Overall, the
risk of acquisition of TB is generally defined not as the number of
secondary cases of active TB -- since activity may not be seen until years
later (see below) -- but rather the number of contacts who become
tuberculin skin test convertors. The risk of skin test conversion is
related to whether the index case has positive sputum acid-fast bacillus
(AFB) smears, the amount of cough, and the degree of direct contact.
Of those contacts who become tuberculin skin test reactive, about 10
percent of the total will eventually develop active tuberculosis, usually
pulmonary disease. Half of these, about 5 percent, will have active
disease in the first 2 years and the other half, sometime during the rest
of their lives.
If, however, the contacts are profoundly immunocompromised such as
HIV-infected individuals, the risk of active TB is closer to 10 percent per
year as opposed to 10 percent per lifetime.
In general, health care workers are screened for latent tuberculosis
infection at the time of the beginning of employment. The posting does not
provide information on whether the intern was tuberculin skin test reactive
upon admission, whether her chest radiograph was initially abnormal or not,
or how long symptoms were present prior to diagnosis. - Mod.LL]