‘Urgent Situation’: 500 Children Possibly Exposed to Tuberculosis

A doctor examines the X-rays of a patient in a file photo. (Spencer Platt/Getty Images)

One case of tuberculosis disease (TB) and 500 cases of “possible exposures” to the infection among children were identified in Douglas County, Nebraska.

A confirmed case of active tuberculosis TB has been reported at Westview YMCA, according to a Nov. 9 press release by the Douglas County Health Department (DCHD). The agency is “investigating the patient’s activities while they were contagious to learn of potential exposures, helping the patient isolate, and observing them complete their medication until they test negative for TB.” It is also looking into “more than 500 possible exposures that may have happened at the facility’s drop-in daycare and is working to identify individuals who had close contact with the patient. Those possible exposures would have happened from late spring into late October.”

DCHD sent an email to notify parents/guardians of exposed children on Nov. 8. Other individuals who may have been exposed to the patient will receive an email directly.

During a Nov. 10 press conference, Justin Frederick, deputy health director of DCHD, said that “over 500 children that are gonna need to be tested” and insisted that “this is an urgent situation.”

“So, if you develop tuberculosis disease, it does not go away without treatment. So, it’s critical, and it’s especially critical with young children, again, who can develop severe disease fairly quickly. It can be severe. It does often progress to meningitis and potentially even death. So it’s really critical that we move rapidly.”

“It’s not in emergency. We’re not suggesting that folks run off to the emergency room, but utilize the clinic that we have set up. If they have questions, they can call the health department at 402-444-3400. That’s our information line,” he said.

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A clinic was set up at the pediatric hospital Children’s Nebraska on Nov. 11 and 12 to test kids exposed to the patient within the last 10 weeks.

The clinic targeted children under the age of four “that are going to need what we call window prophylaxis or preventative treatment that will keep them from developing TB disease while we test them.”

Three clinics will be set up in DCHD for testing between Nov. 15 and 17, he said. “Those are going to be for any children that are over the age of five or that were exposed more than 10 weeks ago.”

When a reporter asked about the DCHD’s announcement of a potentially forthcoming declaration of a public health emergency (DHM), Mr. Frederick clarified that “this is not a DHM. We are not ordering anything.”

“This is more of an administrative kind of thing. But it also shows the seriousness of the situation. Often, we'll do a declaration of a public health emergency anytime that we may have widespread illness in our community or the potential for it.”

Seriousness of Tuberculosis

According to the DCHD press release, TB cases are “relatively rare,” and the agency is “experienced at managing them.” The county “had 15 confirmed cases in 2022 and had 15 cases through September of this year.” Meanwhile, the U.S. Centers for Disease Control and Prevention (CDC) reported over 8,000 cases this year in the country.

TB is caused by a bacteria called Mycobacterium tuberculosis. Though it usually attacks the lung, the bacteria “can attack any part of the body such as the kidney, spine, and brain,” the CDC states.

“Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease.”

When the bacteria live in a body for years, with the individual not showing any symptoms, the condition is called LTBI. The agency estimates that there are 13 million people in the United States living with latent TB infection.

Symptoms of TB depend on which part of the body the bacteria is growing. In typical TB infections that happen in the lungs, symptoms can include a bad cough lasting for three or more weeks, coughing up blood or phlegm from deep inside the lungs, and pain in the chest.

Other symptoms include weight loss, fever, no appetite, and weakness or fatigue. People with latent TB infection do not show any such symptoms.

“TB bacteria spread through the air from one person to another. When a person with TB disease of the lungs or throat coughs, speaks, or sings, TB bacteria can get into the air. People nearby may breathe in these bacteria and become infected,” the CDC states.

TB does not spread by kissing, sharing food or drinks, sharing toothbrushes, shaking other people’s hands, or touching bed linens and toilet seats, per the agency.

Speaking at the Nov. 10 press conference, Lindsay Huse, health director of the DCHD, said that the United States does not vaccinate its citizens against tuberculosis.

“There was a time when it was in use, [but now] it is not. There are other countries that still do utilize that vaccine. It’s called the BCG vaccine. And so certainly, we do sometimes see foreign-born individuals who’ve had that vaccine, but we don’t use it here in the United States. The efficacy isn’t great, and so it’s just not something that we offer here,” she said.

As to the patient who has been confirmed to have contracted TB, Ms. Huse said that she believes “they are doing just fine.”

When asked about the identity of the individual, she refused to divulge the information “in order to protect the privacy of that patient.”