7.3.10.1: Measures for Detection, Control, and Reporting of Tuberculosis

Tuberculosis is designated as a notifiable disease at the national level and local and/or state public health authorities should be notified immediately about suspected or confirmed cases of tuberculosis infection or disease involving children or caregivers/teachers in the child care setting. Facilities should collaborate with local or state health department officials to notify parents/guardians about potential exposures to people with tuberculosis disease. This may include providing the health department officials with identifying information from children in the child care facilities as well as adolescents and adults who may have had contact with child care attendees.

Transmission of tuberculosis infection should be controlled by requiring all adolescents and adults who are present while children are in care to have their tuberculosis status assessed with a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) blood test before caregiving activities are initiated. In people with a reactive TST or positive IGRA, chest radiography without evidence of active pulmonary disease and/or documentation of completion of therapy for latent tuberculosis infection (LTBI) or completion of therapy for active disease should be required. These people should be cleared for employment by their primary care provider or a health department official. Review of the health status of any adolescent or adult with a child care contact with a reactive TST, a positive IGRA or tuberculosis disease in the past should be part of routine annual health appraisal (1,2).

Tuberculosis screening by TST or IGRA of staff members with previously negative skin tests should not be repeated on a regular basis unless a caregiver/teacher is at risk of acquiring a new infection or required by the local or state health department recommendations. Anyone who develops an illness consistent with tuberculosis should be evaluated promptly by a primary care provider. The need for additional testing beyond placement of a TST or IGRA in immunosupressed people and adults over sixty years of age will be at the recommendation of an individual’s primary care provider or the local or state health department. Staff members with previously reactive TSTs or positive IGRA should be under the care of a primary care provider who, annually, will document the risk of contagion related to the person’s tuberculosis status by performing a symptom review including asking about chronic cough, unintentional weight loss, unexplained fever, and other potential risk factors.

RATIONALE

Young children acquire tuberculosis infection usually from adults and rarely from adolescents (1,2). Tuberculosis organisms are spread by inhalation of a small particle aerosol produced by coughing or sneezing by an adult or adolescent with contagious (active) pulmonary tuberculosis. Transmission usually occurs in an indoor environment. Tuberculosis is not spread via contact with objects such as clothes, dishes, floors, and furniture.

COMMENTS

The two stages of tuberculosis are:

1. Latent tuberculosis infection (LTBI), reflected by a reactive TST or IGRA and the absence of symptoms;
2. Active tuberculosis (tuberculosis disease), reflected by a reactive TST or IGRA and the presence of symptoms, including but not limited to cough, fever, and weight loss.

Virtually all tuberculosis is transmitted from adults and adolescents with tuberculosis disease. Infants and young children with active tuberculosis are not likely to transmit the infection to other children or adults because they generally are unable to forcefully cough out organisms into the air.

A TST should be placed and interpreted by an experienced health care professional. IGRA is only recommended for immunocompetent children four years of age and older, adolescents, and adults.

For additional information regarding tuberculosis, consult the current edition of the Red Book from the American Academy of Pediatrics (AAP).

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
7.3.10.2 Attendance of Children with Latent Tuberculosis Infection or Active Tuberculosis Disease

REFERENCES

1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4^th Edition. Elk Grove Village, IL: American Academy of Pediatrics.

2. American Academy of Pediatrics. Tuberculosis In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 829-853