Community health officials gave an overview of tuberculosis contact tracing practices and dispelled false information about the disease at a webinar Tuesday, a day after AU announced that an undergraduate student residing on campus tested positive for TB.
What is TB and how is it treated?
Vice President of Campus Life and Inclusive Excellence Fanta Aw, who moderated the panel, asked health officials to provide a “TB 101” for viewers because she said she has been “hearing a lot of rumors that [she was] kind of concerned about” regarding the community’s risk level at this point.
Jason Beverley, the TB nurse supervisor at the D.C. Department of Health, said that TB is a bacterial infection that typically affects the lungs. It is spread through airborne contact with individuals who suffer from active cases.
He said that while common symptoms of active cases include a cough with bloody sputum, fever, weight loss, night sweats and profound fatigue, many TB infections are “latent.” These latent cases are asymptomatic and not contagious.
According to Beverley, one in three people has been exposed to latent TB while about five to 10 percent develop active symptoms later in life, often due to age or immunocompromised status.
Beverley and Dr. Amanuel Rosario, an infectious disease specialist at the DCDOH, emphasized that both active and latent cases are treatable with medication regimens typically consisting of a combination of four pills.
While treatment for active infections typically ranges from six to nine months, patients with latent cases can still receive weekly medication administration once a week for three months to prevent active disease in the future, they said.
Are students and faculty at the University required to be vaccinated against TB?
TB vaccination is not standard in the United States because the disease is not endemic here, said Student Health Center Medical Director Dr. David Reitman. Vaccination against TB is not required to attend classes at the University.
Rosario said that while a TB vaccine does exist, it is primarily offered in countries where its rates are higher. It is administered mostly to people with underdeveloped immune systems, like infants and children, to limit the severity of infection should it occur.
Reitman said that there has been some confusion within the community over the abbreviation “TD” representing a vaccine on some individuals’ medical records — this is to denote the date of the tetanus vaccination, not tuberculosis.
Reitman added that sometimes individuals might see the word “tuberculosis” listed on their medical records with a date written next to it. He said that this is the denotation used when a test is administered, not when a vaccine is given.
Who should get tested for TB now?
Beverley said that the organization’s contact tracing team is in the process of notifying close contacts of the patient. While he could not provide an exact time frame for when contact tracing will be completed, he said that DCDOH officials are working “as quickly as [they] can” to notify every potential contact.
Individuals who have had the most prolonged contact with the patient will be notified first, and then the contact tracing team will continue to reach out to more distant contacts as they learn more about the case.
Reitman said that the Student Health Center has a sufficient number of test kits for some symptomatic community members, but not enough for asymptomatic individuals who have not been identified by contact tracing.
Beverley defined “prolonged exposure” to TB as four to eight hours a week spent in small, poorly ventilated indoor areas with an infected person while unmasked. Contacts to who this criterion applies will be notified by the D.C. Department of Health via phone, email or a letter to their home address.
Rosario said that the decreased rates of influenza and the common cold observed this season indicate that mask-wearing is generally helpful at curbing the spread of airborne upper respiratory infections, so current University COVID-19 guidelines reduce the risk of prolonged exposure to TB.
Aw said that the University’s implementation of upgraded HVAC filters in its buildings in response to the coronavirus pandemic will help with ensuring appropriate classroom ventilation.
“By and large, we are taking the information that we get from the index case themselves and the information that’s being provided by the University,” Beverley said.
According to Aw, if an individual has not received official notification from the DCDOH at this point, they likely “have not been deemed the closest of contacts.”
The DCDOH is also working with the University to determine a location on campus where it can set up a testing site, according to Beverley.
Rosario said that blood tests will be administered as opposed to skin tests because they do not require individuals to come back two days later for a test reading and are less likely to produce false positives. Turnaround time for these results is typically three to five days after testing.
Those identified as close contacts of the patient will be given an initial blood test. Regardless of whether or not they test positive, a follow-up test will be conducted in eight to ten weeks due to TB’s four to 10 week incubation period.
Because many community members are expected to be off-campus for the winter holidays eight weeks from now, Beverley said that close contacts will likely be followed up with once they return to the district.
Typically, the DCDOH will remain in touch with positive patients until the completion of their treatment, which usually takes six to 12 months.
Individuals with a latent infection will not have to quarantine at any point in their treatment. In the unlikely event that somebody is diagnosed with an active case, they will be permitted to resume normal activities once they are no longer infectious.
I haven’t been contacted by the DCDOH, but I feel sick. What should I do?
Health officials encouraged students not to immediately assume they are infected with TB if they experience symptoms such as cough or fever.
“If students are waking up in the morning with a cough, the first thing they need to do is get a COVID test,” Reitman said.
Reitman added that even more TB-specific symptoms like night sweats and fatigue are often associated with other illnesses, like mononucleosis or influenza.
Leanne Wright, AU’s associate director of environmental health and safety, said that students should be “proactive in their care” and get COVID-19 tests within a day of developing respiratory symptoms.
As students prepare to return home for the Thanksgiving holiday, Beverley encouraged anybody who suffers from a cough to “wear a mask and limit activity” even though it is more likely to be the result of COVID-19 or another upper respiratory infection than TB.
What can the University tell me about the undergraduate patient?
Officials underscored the importance of patient confidentiality at the webinar, saying that they would not be offering any personal information about the student who tested positive for TB.
This includes how the student might have contracted TB, any underlying conditions that might have made them more susceptible or their whereabouts, including the residence hall that they live in.
“We are required to keep patient confidentiality as an utmost priority,” Reitman said. “Our students expect that of us and legally they are entitled to that.”
Beverley acknowledged that it can be “frustrating for people who are concerned about their welfare” when public health officials are asking for information regarding potential patient contacts and not providing any additional details to the community members they reach out to.
Reitman asked that parents not direct this frustration toward the University or the public health officials heading up the contact tracing effort, saying that if their student contracted a communicable disease, the team would exercise the same level of care to avoid breaching their student’s medical privacy.
While neither the University nor local health officials will be releasing any personally identifiable information about the patient, Rosario said the community should feel confident in the contact tracing team’s ability to mitigate the infection rate as much as possible.
“Whoever needs to know who is at risk will be informed and all the important tests will be done,” Rosario said.
