Airborne TB causing outbreak, warns expert

[ruthbeme]

28 April 2007

Airborne TB causing outbreak, warns expert

By Catherine Shanahan
AN AIRBORNE form of TB is believed to be the reason for the growing number of cases of the disease at two Cork creches, which reached 19 last night.


Yesterday, Dr Philip Monk, a British-based expert in communicable disease control, said there was no other likely explanation for the high level of infection in children at Nurture Childcare in Douglas, Cork city, and Panda Paws Preschool and Childcare facility in Little Island, Co Cork.

Dr Monk is working with public health officials in the Health Service Executive (HSE) South in an effort to control the outbreak, which has generated 17 child cases and two adult cases since March 15. He said TB was most commonly transmitted when an infected person coughed, expelling droplets containing the virus. These normally landed on a surface not more than three feet away, infecting people within this range.
However, Dr Monk said, because TB had been diagnosed in children who were not in the same room as the infected childcare worker, the only explanation was the original case had been able to ?generate an aerosol?.

?This means the bug is attached to a very, very fine particle of moisture, and because it is very fine it is able to float freely about the building, and is therefore not confined to one room.

?This is abnormal. It is extraordinarily rare. Only by very careful detective work have we been able to discover that the index (original) case is likely to have the capacity to generate an aerosol,? Dr Monk said.

He said it was believed this TB strain was very virulent, but laboratory tests were ongoing to determine exactly how infectious.

?The point we are at now is of a cycle of screening where we will find more cases, I think, but the point is we will identify them before they reach the infectious stage.?

Dr Monk said it would be ?utterly wrong? to close the Cork facilities and ?there is no danger of the bug infecting the general public because it would dilute to the extent where it would disappear in the open air?.

Dr Monk is among seven high-level experts on the HSE?s outbreak control team and advisory group who will attend a meeting on Monday night to brief parents of children at both creches on how they are handling the outbreak.

Parents of children at Nurture Childcare will meet with Enterprise Minister Miche?l Martin in Cork on Monday. Nurture Childcare is in his constituency.
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[ruthbeme]

Re: Airborne TB causing outbreak, warns expert

01 May 2007

Experts predict more child TB cases in outbreak

By Catherine Shanahan
EXPERTS handling the biggest TB outbreak on recent record have predicted further cases of the disease among children at two Cork cr?ches.


However, they are confident of containing the outbreak within the two facilities through close monitoring of staff for early symptoms. If they can prevent more adults from becoming infectious, they will stop the spread because child cases are not contagious.

Last night, Dr Philip Monk, a consultant in communicable diseases with Britain?s Health Protection Agency, said even though the TB in question was an airborne strain, there was no question of the cr?che buildings being infectious.
?Just like cigarette smoke, it doesn?t stay in the building forever. It is gone in around half an hour,? he said.

It means, however, in the case of one of the cr?ches, the disease spread from the toddler room ? where an infected adult worked ? to children in other parts of the cr?che. However, because the disease was most intense in the toddler room at both cr?ches, screening for TB was extended to parents of children who were in the room regularly.

Dr Monk was part of a seven-strong panel of experts in disease surveillance, respiratory illness, and public health medicine who gathered at a hotel in Cork last night to address the concerns of parents whose children attend Panda Paws Preschool and Childcare facility in Co Cork and Nurture Childcare in Douglas, Cork city.

At the two cr?ches, 19 people have been diagnosed with the disease since March 15, including 17 child cases. Another 18 children and a similar number of adults have latent TB and are on a nine-month course of antibiotics. The remainder ? more than 230 ? are on a two-month preventative course.

The original TB case was a childcare worker who worked at both cr?ches. A second adult was diagnosed with the disease at Nurture Childcare last month.

Dr Margaret O?Sullivan, consultant in public health medicine for the Health Service Executive (HSE) Cork, said children were being excluded from activities because of misconceptions about TB.

?There has been a lot of ostracisation of children. At parties they are left to one side ? it?s extremely distressing for everyone. Even children who are on (preventative) antibiotics in between screening have been affected. People have a lot of notions about TB and it?s hard to convince them otherwise,? she said.

Dr O?Sullivan said they had passed on parents? concerns to occupational health officials that childcare workers should be screened before starting work.
?We?ve passed on parents? concerns to cr?che inspection teams in the HSE South and we?ve asked them to relay it nationally,? she said.

Paediatric consultant, Dr Muireann Ni Chroinin, said relapses in children treated for TB were not expected. She said complications were extremely rare.

Regarding the efficacy of BCG, the vaccine used to inoculate against TB, Dr Darina O?Flanagan of the Health Protection Surveillance Centre said medical opinion was divided.

Dr Patrick Wall, professor of public health at Univers-ity College Dublin, said: ?Would it have stopped some of these (Cork) cases? Of course it would ? but not all of them. There is no vaccine which protects you against everything.?
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