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Spokane, Washington  Est. May 19, 1883

Tuberculosis exposure at day care prompts ‘urgent’ testing for 500 children

By Justine McDaniel Washington Post

Tuberculosis testing for hundreds of children in Omaha, Nebraska, began Saturday, after a large group of infants, toddlers and other children was potentially exposed to infection through a drop-in day care program.

More than 500 children need to be tested within the next week, local health officials said, and younger ones will be given preventive drugs. It’s an unusually large tuberculosis exposure of children, who are more vulnerable to the disease and can become sick quickly.

“This is an urgent situation,” Justin Frederick, deputy health director in Douglas County, Nebraska, told reporters this week. The health department was preparing to declare a public health emergency.

Tuberculosis, which can be fatal, can cause meningitis in children and affect organs outside the respiratory system. Such severe illness can generally be prevented by early treatment but can develop rapidly in infants and toddlers, Douglas County Health Director Lindsay Huse told the Washington Post, leading local health officials and Children’s Nebraska pediatric hospital to move quickly to administer testing over the weekend.

“The important thing is keeping the really severe illness from developing in the younger children,” Huse said. “We wanted to ensure we were able to get kiddos in as soon as humanly possible.”

The children were potentially exposed at a YMCA day care program where parents can leave kids while using the gym or facilities. Because people can have symptoms for weeks without realizing they are seriously ill, health officials alerted everyone who came into contact with the patient from May through October. The two factors created a large pool of potential exposure.

Health officials should have a clear picture of whether children were infected and if more people need to be tested by the week of Nov. 20, when all tests results should be complete. Results for the younger children should be known by Tuesday or Wednesday. If others were sick, that could balloon into a larger number of exposures.

People get tuberculosis in the United States every year – 8,300 cases were reported in 2022 – but health officials in Nebraska said the exposure was out of the ordinary for its scope and threat to children.

“It’s really critical that we move rapidly,” Frederick told reporters after a public meeting with parents Thursday. “If this was a situation with a lot of adults, we would probably be handling this a little bit differently; we’d have a little bit more time. Knowing that it’s children … we’re taking it very serious.”

The United States has worked toward eliminating tuberculosis and no longer vaccinates people against it, but it remains in circulation. The number of reported cases dropped during the height of the pandemic but rose again last year.

Symptoms include a long-running cough, chest pain, fatigue, fever and night sweats. Tuberculosis is transmitted through coughing, sneezing, speaking and singing. It isn’t passed through surfaces, handshakes or sharing drinks or food, according to the Centers for Disease Control and Prevention.

It’s not as easy to catch as the coronavirus or a cold, Huse said, but people can contract it by spending time in an enclosed space with someone contagious.

Up to 13 million Americans may have latent TB, meaning they have inactive tuberculosis without sickness but could eventually develop active disease. The person who tested positive in Nebraska may have developed the disease that way, Huse said; public health workers are still investigating the case.

The patient is doing well, isolating and being monitored during treatment, health officials said. They did not say whether the person was a child or an adult. Their symptoms began in late August, but the person wasn’t tested for TB until this week.

The county health department learned about the confirmed case Tuesday and began working with the YMCA to comb attendance records and notify families of potential exposure. Most families have been reached by the health department, Huse said, and none has reported concerning symptoms indicative of possible infections so far.

“We’re casting a wide net and ensuring that we’re testing anyone who could have been exposed,” Huse said.

Children 4 and under who were exposed within the past 10 weeks were being tested at the children’s hospital over the weekend and given treatment to prevent them from developing tuberculosis, Frederick said. Children who are over 5 or were exposed more than 10 weeks ago will be offered tests at a county clinic Wednesday, Thursday and Friday.

Huse estimated there were about 250 children in the first group and 300 in the second. Children who were exposed within the past 10 weeks will also need to be tested a second time 10 weeks after their first test, she said.

Huse said health officials are hoping for negative test results but are prepared to handle cases if they arise.

“It could certainly grow. We are cautiously optimistic that it won’t have gotten that far yet,” she said.