As patient notifications of potential exposures to infectious disease go, it doesn’t get much worse than telling parents their newborn baby may be in danger.
That’s the situation Santa Clara Valley Medical Center in San Jose, CA, finds itself in, having recently notified patients by phone and letter that some 350 infants and their mothers may have been exposed to a healthcare worker with active tuberculosis between mid-August 2015 and mid-November 2015.
Now on leave for treatment, the employee worked in the newborn nursery in the hospital’s Mother & Infant Care Center.
“While the risk of infection is low, the consequences of a tuberculosis infection in infants can be severe,” Stephen Harris, MD, Chair of Pediatrics at Santa Clara Valley said in a statement. “That’s why we decided to do widespread testing and start preventative treatments for these infants as soon as possible.”
The hospital is doing both diagnostic testing and preventive daily treatments of isoniazid on the infants, which are being monitored closely for any signs of active infection with Mycobacterium tuberculosis. Elements of risk include that the newborn immune system is not fully developed and may not respond to testing. Thus X-rays and preventive treatment will be done, and of course clinicians will act quickly if there is any sign of reduced susceptibility of the TB strain to the first line drug administered.
All patients, visitors, and employees who were potentially exposed to the infected worker have been identified.
“The employee underwent her annual tuberculosis test in September 2015,” the hospital stated. “The screening was negative and the employee did not show symptoms at any time. Her physician discovered her TB when she underwent evaluation for an unrelated medical condition. Even before the hospital received a confirmed diagnosis, the employee was placed on leave.”
Q&A FOR PATIENTS
The hospital posted frequently asked questions for patients, parents and others possibly exposed. IPs may want to consider something similar if they ever find themselves in a similar situation. Some of the questions include the following:
What is Tuberculosis (TB) and how is it spread?Tuberculosis is an infectious disease that usually affects the lungs but can affect any part of the body. It is caused by a very small bacteria that lives in the lungs of an infected person and gets into the air when the infected person breathes or coughs, making it possible for others to potentially inhale it.
How could I have been exposed? A person can be exposed if there is a shared breathing space with a person who has the infection in their lungs. Usually, a person has to be in close contact with someone with active TB for a long period of time to become infected; however, some people do become infected after shorter periods of contact.
How will I know if I have been infected with the TB bacteria? A blood sample is taken to test if you have the TB bacteria in your body.
What are the symptoms of TB?It depends on where the TB bacteria begin to grow, but most often the TB bacteria infect the lungs. The following are the most common symptoms in adults:
-
a cough that lasts three weeks or longer;
-
pain in the chest;
-
coughing up blood or phlegm;
-
weakness;
-
weight loss;
-
chills;
-
fever, sweating at night.
Will everyone who gets infected develop these symptoms?No, sometimes the infection lives inside your body but your immune system will stop the TB bacteria from multiplying. In this case, you would not have any symptoms. Because some people will not show symptoms, it is important that anyone who was potentially exposed gets tested.
What if I have a positive test for TB infection? A positive test result does not mean you have TB disease. Your doctor may decide to do other tests such as a chest X-ray and a test of your sputum (phlegm). You will also likely be asked about any symptoms you may be experiencing. Based on the demographics of Santa Clara Valley Medical Center, approximately 1 in 5 patients already have a positive test for TB and were exposed in the past. Your doctor will review your tests and determine how to proceed. People who test positive may be prescribed medication. Your physician will decide if medication is appropriate for you.
If I have a positive test for TB, will my family be affected by this? If you have developed the disease and have symptoms, then there is a risk your family may be affected. If you do not have symptoms, your family will likely not be affected. The County Public Health Department will assist with any necessary follow-up for your family after you have been tested.
If someone stayed with me in the hospital while I was in Mother-Infant Care Center, are they at risk for exposure to TB disease? We are screening all patients who may have had contact with the TB-infected individual. Generally, a healthy person who stayed with you in the hospital has very little risk of getting TB. If that person is concerned or has a condition that weakens their immune system, they should contact his/her primary care provider after you get the results of your TB test.
