Extended screening for toddlers in TB scare

THE Health Service Executive (HSE) has taken the unusual step of requesting chest X-rays for two groups of toddlers who tested negative for TB at two Cork creches.

The decision to request additional chest X-rays also applies to 12 staff members at Nurture Childcare, in Douglas, Cork city, who also tested negative.

The extended screening follows confirmation last Thursday of a case of TB in a staff member at Nurture Childcare, bringing to 12 the number of confirmed cases in the past month.

In addition, the HSE has reduced the reaction measurement in adults for the TB skin test from 15mm to 6mm, for improved sensitivity readings.

In total, eight children and one adult at Nurture Childcare are confirmed TB cases. At a second creche in Little Island, Co Cork, Panda Paws Preschool and Childcare facility, two children have TB. A staff member, the original TB case, was working in Panda Paws at the time of diagnosis, but had previously worked at Nurture Childcare between February and December of last year.

To date, more than 130 children spread over both creches are on antibiotic treatment to prevent the development of TB with a further 20 children on a nine-month antibiotic course. Five staff members at Nurture Childcare are also on a course of preventative treatment and the 12 who tested negative are on paid leave until they get the all-clear. Another four adults have been referred to a consultant respiratory physician.

The latest adult diagnosis is of concern to public health doctors because of the contagious nature of the disease in an adult. Children with TB are not contagious. It means contact tracing and screening will have to be carried out all over again. To date, more than 300 children and staff at both creches have been screened.

The decision to offer chest X-rays to approximately 60 toddlers (30 in each creche), despite having a negative skin test, is to further rule out infection and to reassure parents whose children were cared for in the rooms where the infected staff members worked.

Repeat screening cannot be carried out for two months because of the incubation period which ranges between two and 12 weeks.

Dr Margaret O’Sullivan, consultant in public health with the HSE, said they would not be closing either creche on public health grounds.

“It was a consensus decision between the outbreak control team and in consultation with national and international experts,” she said.

Public health officials are also anxiously awaiting the results of tests to determine antibiotic sensitivity of this strain of TB. A result is due by the end of the week.

The HSE has offered additional BCG clinics — the vaccination which protects against TB — but only to children attending the two creches. The public faces a six-month wait. The additional clinics will not be set up until the latest outbreak is under control.

For queries about the BCG vaccine, contact the HSE information line in Cork, Lo-call 1850 742 000, Monday to Friday, 9-5pm.