TB school must make up lost days

A PRIMARY school forced to defer re-opening because of a TB outbreak will be expected to make up lost days during the remainder of the school year.

Ballintemple National School at Crab Lane, in the suburbs of Cork city, was scheduled to re-open next Monday, but following confirmation of three child cases of TB in pupils attending the school, start of term was deferred until September 6.

The Department of Education has confirmed the onus was on the school’s board of management to “make all reasonable efforts” to ensure days lost due to TB screening were re-couped. Under an agreement reached in 2007, primary schools are obliged to open 183 days of the year.

Meanwhile screening of the more than 220 pupils and staff at the school is continuing at the chest clinic in St Finbarr’s Hospital, Cork city, where the results of the first set of Mantoux tests (skin tests) should be available today. A positive reading does not necessarily mean a person has TB; it could be the result of having previously received the BCG vaccination.

However, up until 2008, the BCG was not universally available to newborns in Cork and the incidence rate of the disease has been historically higher here than in the rest of the country.

Although there is now no waiting list among newborns for the BCG, 4,400 children are on the waiting list in the Health Service Executive (HSE) South. The vaccine was not universally offered to newborns in Cork for 36 years.

Last year, in a submission to the Vaccine Damages Steering Group, the Faculty of Paediatrics of the Royal College of Surgeons of Ireland, warned the Department of Health may need to consider compensation for children infected with diseases preventable by immunisation, in areas of the country where routine immunisation was not offered by the HSE. The faculty said the starkest example of this was the 2007 outbreak of TB in Cork city when 18 children were infected during an outbreak that affected two creches.

The Faculty of Paediatrics report said children affected by the 2007 outbreak may have lifelong health issues relating to the HSE’s BCG policy in Cork which was at variance with the rest of the country.

A separate study looking at the uptake of the BCG vaccine in newborns at Cork University Maternity Hospital (CUMH) for a six-month period after it was re-introduced, found less than 1% of parents refused in-hospital consent.

There were 4018 deliveries during the study period from October 2008 to March 2009. In-hospital consent was declined in only 16 babies while the in-hospital vaccination uptake was 80% of total live births. The study, carried out by CUMH department of neonatology, paediatrics and child health at University College Cork and community health service members in the HSE South, also said recent studies had shown “unexpected benefits to BCG vaccination apart from decreasing the risk of TB”, including that exposure to the BCG vaccine in early life prevents asthma, “possibly through a modulation of the immune maturation process”.

The authors of the study said the decision to withdraw the vaccine in Cork was taken for a variety of reasons. “This included a relatively low TB rate in the general population and concerns that BCG immunised children may subsequently have a positive mantoux (skin) test, confounding future diagnosis.”