There are very few things that set me ablaze quite like overly dramatic journalism or people chewing loudly with their mouths open. As a recovering journalist and longtime health policy and communications junkie, I shake my fist heavenward when I see articles with poorly chosen graphics like this recent Huffington Post piece on the Tuberculosis (TB) outbreak at a Kansas city-area high school.

I’m about to become a stepmother and after a few years working on maternal and perinatal health policy and implementation, I know the last thing a parent wants to see in relation to an infectious disease affecting children is an outbreak slideshow beginning with “The Bubonic Plague.” It’s essentially the fire-and-brimstone promise of certain death, and frankly, it sits in opposition to what is a managed and benign situation.

If you went to school in the 70s and 80s you likely remember getting TB “shots.” Yes I know, even in ye olden days, we cared/we were crazy enough about infectious disease and vaccinations enough to protect ourselves without protest (clutches pearls). But those TB shots weren’t vaccinations, they were actually harmless skin tests to see if we’d ever been exposed to Mycobacterium tuberculosis (the bacteria that causes TB) and were carrying it in a latent (read: dormant or inactive) form. These shots offered no protection, they were diagnostic, not protective.

After 72 hours, if a test was positive and it was determined that the patient hadn’t gotten a TB vaccine in another country that would cause a false positive, there was an intervention plan to stop it from progressing into a full-blown disease. Which is to say, most Americans like myself have been walking around blissfully unprotected from TB, and some may even carry it latently without knowing it. And frankly, that’s ok. Latency in this case means the body has isolated and cocooned the bacteria well enough via a healthy immune response that it hasn’t progressed into the actual disease, which is a slow-moving bacterial infection.

What spurred the recent testing in Olathe, Kansas was a singular student who presented with an active infection and actual symptoms – coughing, fever, and fatigue. In its earliest stages, TB isn’t always the movie-inspired hacking, choking, bleeding lungs disease we might imagine, so it’s no surprise that this student did not get in to a doctor sooner. While Tuberculosis is certainly a highly fatal disease when left both active and untreated, according to the CDC, a majority of people who have been exposed remain in the latent stage and never actually develop the disease as this student did.

This recent TB scare is a good reminder for why this shouldn’t trouble most parents. Tuberculosis is spread through the air via coughing, breathing, singing, etc., not by physical contact, and it typically takes extended exposure to a symptomatically infectious person to spread (unlike the measles). Of the nearly 350 individuals who had contact with the sick student, only 27 so far have tested positive for exposure, and many more have not been tested or alerted since the school’s currently out on spring break. Now nearly two weeks since the first sign of a TB case, and Johnson County officials, where Olathe is located, are now switching from mailed notices to phone calls to initiate preventative testing in the rest of that population. It says something about the urgency at which any of us should be considering this scenario.

Which is why the word “outbreak” is a bit of misnomer here. Only one person actually has Tuberculosis, and the 27 others have only tested positive for exposure to it. The student in question has already been isolated and will be cleared for contagiousness within a few weeks, and cured in the coming months. The rest are only positive for latent TB, but are not contagious, and do not feel sick. These individuals will take an up to 9-month course of antibiotics to insure that they’re never infectious, and that the dormant bacteria never develop into the full-blown disease.

If you are wondering why we don’t vaccinate for Tuberculosis, as other countries do with the BCG shot (bacille Calmette-Guerin) – to sum it up, it’s simply not the threat it once was, exposure is treatable, and the disease is curable. And of course, if you have concerns about your own child and a possible exposure, ask your pediatrician if the TB skin test is advisable.


 

Resources
KCTV 5 News. State: 27 at Olathe High School Tested Positive for Tuberculosis Infection. Updated March 18, 2015. Retrieved March 18, 2015.

Centers for Disease Control and Prevention. Tuberculosis (TB)9. Last updated December 16, 2014. Retrieved March 18, 2015.

Almendrala, Anna. Tuberculosis Outbreak at Kansas High School Infects 27. The Huffington Post. March 18, 2015. Retrieved March 18, 2015.

Johnson County, Kansas. Case of Active Tuberculosis Identified at Olathe Northwest High School. Released March 4, 2015. Retrieved March 18, 2015.

Olathe Public Schools. Tuberculosis Information. Retrieved March 18, 2015.

Centers for Disease Control and Prevention (CDC). Core curriculum on tuberculosis: what the clinician should know. Retrieved March 18, 2015.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health