This is a guest blog from STOP TB advocacy officer, based at RESULTS, David Bryden.
TB anywhere is TB everywhere – including in rural South Carolina, in the USA. Today the Wall Street Journal printed an article on what can happen when there is a person with contagious TB working in a school setting. In this case, there was a delay in getting the patient into care and providing testing of children and adults who were exposed. As ACTION documented in its Children and TB brief, tuberculosis among children has been neglected and treatment options are inadequate. TB expert Dr. Randall Reves says that it is only a matter of time before there is a case of drug resistant TB in a school in the US. All the more reason to redouble our efforts globally to educate about TB.
Read the full article at the Wall Street Journal website and share widely on social media -- An abbreviated version is also below!
Response to TB Outbreak in South Carolina Raises Questions
Health Officials Scramble to Explain Delays in Notification and Testing at Rural School
South Carolina health officials are under fire for a delayed response to a tuberculosis outbreak at a rural elementary school in which hundreds of people were exposed to the contagious airborne disease, including 465 children who weren't tested until nearly three months after local nurses discovered the outbreak.
Some 53 of those children were infected with TB, including 10 who were diagnosed with an active form of the disease, meaning they had symptoms of TB that require lengthy drug treatment to cure. A person who is infected but doesn't have an active form of the disease still requires some treatment, usually just one drug.
All told, 1,526 adults and children have been tested, 106 were infected, and 12 developed active TB, according to state officials.
Several employees of the state Department of Health and Environmental Control were either fired or suspended; those fired include three nurses and the head of the state's TB unit. The nurses have each filed lawsuits against the state seeking lost wages and other damages.
DHEC Director Catherine Templeton said this week in multiple statements that her department had botched the probe, waiting until late May to notify parents after local nurses discovered the possible outbreak at Ninety Six Primary School in rural Greenwood County in early March.
The local DHEC nurses became concerned after a visibly ill school custodian went to the hospital and tested positive for TB. The hospital on March 8 notified the local health department nurses, who began an investigation by visiting the janitor at home and contacting supervisors in Columbia, according to court filings.
The nurses tested some school staff and asked several times for permission from state health department administrators to begin informing parents and administering TB tests to children and other staff, but it wasn't granted, according to their lawyer and correspondence in court filings.
Ms. Templeton, the director, learned of the outbreak during an unrelated site visit to Greenwood County in late May and started an immediate investigation, according to a spokesman. The state later called in the Centers for Disease Control and Prevention, which said it sent two epidemiologists who spent about a week earlier this month assisting with the investigation.
In a statement Thursday, Ms. Templeton laid much of the blame at the feet of the three local nurses, who she says didn't follow procedures and didn't do enough to grab their supervisors' attention in a crisis. "The investigation did not begin in a timely manner, the public-health protocols were ignored, and the conclusions from the investigation were nonsensical," Ms. Templeton said. She added that the nurses "could have obtained the authority they needed to properly conduct the investigation by contacting me."
State officials said the children with active TB weren't infectious. But children infected with TB have to be treated and watched carefully, TB experts say. They may have more subtle symptoms, or become infected in other parts of the body aside from the lungs. Young children are also particularly at risk of developing active TB if infected, TB experts say.
"Sometimes the attitude with a TB outbreak is to circle the wagons and not alarm the public," said David Bryden, Stop TB Advocacy Officer at Results, an anti-poverty organization that is active in TB issues. But, he added, "the community at large becomes vulnerable. It's a contagious infection and with children, TB can quickly develop into active disease.