Health Alert
TUBERCULOSIS EXPOSURE AT LONG TERM CARE FACILITY

Summary

In late April 2018, the Division of Public Health (DPH) became aware that residents and staff at Manor Care, a skilled nursing and rehabilitation facility on Foulk Road, Wilmington had been exposed to a case of tuberculosis (TB). The source was an infected individual at the facility and the period of exposure extended from January to September 2017. (The individual is no longer at the facility). DPH is working with Manor Care to ensure current and former residents and employees who may have been exposed are tested for TB infection.

Recommendations

Out of an abundance of caution, DPH is requesting health care facilities and providers ask their patients/residents and staff if they were residents of, or worked at, Manor Care Foulk road at any time during the period from January to September 2017. Should you identify an affected former resident or staff, please call or ask the individual to call DPH at 1-866-408-1899 for information on how to obtain a free TB screening. If your facility can screen for TB, please call the DPH TB elimination Program at 302-744-1050 to report the patient/resident or staff identity and outcome of screening even if it is negative. TB testing and treatment is free of charge at DPH clinics.

Exposed persons who test positive on TB screening either with skin testing (Purified protein Derivative- PPD) or blood testing (QuantiFERON-TB or QFT), or who have a history of prior positive PPD or QFT, must be further evaluated with a Chest X-ray.

Initial drug susceptibility testing (DST) performed on samples from the index case indicates resistance of that TB isolate to isoniazid, ethambutol, and pyrazinamide. As such DPH recommends the use of rifampin for treatment of contacts. The typical dose of rifampin for latent TB treatment is 600 mg daily for 120 doses. For those for whom rifampin is contraindicated, levofloxacin 750 mg daily x 6 months is an acceptable alternative for latent TB treatment. Active TB occurring in contacts associated with this event should be reported to the Division of Public Health immediately as they will need a drug regimen different from the typical regimens used to treat tuberculosis.

Additional Information

Though Delaware is designated a low incidence state for TB by the CDC, DPH reminds health care providers the disease remains a serious threat. TB should be considered in the differential diagnosis for individuals with a compatible clinical picture especially in:

• People who have spent time with someone with TB disease
• People from countries with a high burden of TB disease (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)
• People who live or work in high-risk settings (for example: correctional facilities, long-term care facilities or nursing homes, and homeless shelters)
• Health-care workers who care for patients at increased risk for TB disease
• Infants, children and adolescents exposed to adults with TB disease

Classic clinical features associated with active pulmonary TB are include:

• Cough
• Weight loss/anorexia
• Fever
• Night sweats
• Hemoptysis
• Chest pain
• Fatigue

Hospitalized patients under evaluation for TB should be placed in an Airborne Infection Isolation room (AII) as soon as possible pending definitive diagnosis. This greatly minimizes exposure to staff.

Active TB is a required reportable disease in Delaware and must be reported to DPH.

For additional information or questions, contact the Delaware Division of Public Health TB Elimination Program (302) 744-1050.

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