Health Alert
TUBERCULOSIS UPDATE

Summary

Following the March 13, 2014, announcement that two former inmates of Howard R. Young Correctional Institution (HRYCI) were diagnosed with active TB disease, the Division of Public Health (DPH) and Department of Correction (DOC) have been working closely together to respond to the situation. DPH is offering free screenings and treatment to former inmates who may have been exposed to TB while at the correctional facility.

Recommendations

This Alert is to inform you that DPH, in collaboration with DOC, has identified possible contacts among former inmates that have been released into the community, and are actively reaching out to these individuals to set up appointments at DPH clinics for TB testing.

As a result of this activity, you may receive calls from the public and patients with questions about TB, and from some of the affected individuals who may have questions about testing. DPH may also reach out to you for help in tracking down some the individuals if they are your patients.

Should any patients identify themselves as former correctional inmates seeking TB testing based on possible exposure, DPH asks that you alert us at the TB Elimination Program at (302) 744-1050 and request that the patient call the same number to schedule a screening. This will allow DPH to monitor the situation and ensure that all former inmate testing results are documented as part of the HRYCI response.

Additional Information

Although Delaware has enjoyed a low incidence of TB for many years, the Division of Public Health wishes to remind health care providers that TB continues to be a threat.

TB as a differential diagnosis should be considered early if individuals in the following categories present with a compatible clinical picture. (Note: this is not an exhaustive list. For further information visit www.cdc.gov/tb.)

• Close contacts (household members, family) of individuals with active pulmonary or laryngeal TB disease;
• Persons infected with HIV;
• Foreign-born individuals from highly endemic countries (For list of endemic countries, see CDC link under "References");
• US-born individuals who have travelled or lived for one month or longer in highly endemic countries;
• Those who abuse illicit drugs or alcohol;
• Persons residing in congregate living situations, including but not limited to homeless shelters, prisons, and nursing homes;
• Persons with other immune-compromising health conditions, including those with a history of long-term use of medications such as high dose steroids and TNF-alpha Inhibitors; those receiving cancer chemotherapy; and/or those with chronic diseases such as diabetes;
• Chronically underweight individuals (10% of more below recommended weight), or those who have undergone gastric bypass surgery.

Symptoms of Active TB include but are not limited to:

• Chronic, non-remitting cough lasting more than two weeks;
• Fever, night sweats, chills;
• Fatigue or weakness;
• Unintended weight loss;
• Abnormal chest x-ray; especially but not limited to upper-lobe abnormalities. These may include presence of cavities, consolidation, pleural effusion, hilar adenopathy, and nodules.

Whenever pulmonary TB is considered in the differential diagnosis in inpatients, they should be placed in an Airborne Infection Isolation room (AII) as soon as possible, pending definitive diagnosis. Immediately using an AII room will save time and eliminate the need to locate, test, and treat staff and patients that may otherwise have been exposed.

Treatment

Active TB is a reportable illness in Delaware, and the majority of cases are treated by specialists in DPH’s TB Clinics. Patients should be referred to DPH, unless conditions require hospitalization; in which case the TB clinics should be notified of the patient’s diagnosis as soon as possible, and while the patient is still hospitalized.

Treatment of culture-positive TB is based on drug sensitivity, usually with a combination of four medications given by directly observed therapy (DOT) over a period of several months. DOT is legislated in Delaware for all active TB cases.

To report a case of active TB, contact the TB Clinic in your county.

• New Castle: (302) 283-7588
• Kent: (302) 857-5130
• Sussex: (302) 856-5119

For additional information and patient referrals:

Delaware Division of Public Health TB Elimination Program (302) 744-1050.

References:

1. CDC Division of TB Elimination: www.cdc.gov/tb
2. List of TB endemic countries http://www.mass.gov/eohhs/docs/dph/cdc/tb/endemic-country-list.pdf

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