Tuberculosis (child care and schools)

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What is tuberculosis (TB)?

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The bacteria usually attack the lungs but can attack any part of the body, such as the kidney, joints/bones, spine, and brain. If not treated properly, it can be deadly.

Signs and symptoms

There are TB-related conditions.
Latent TB Infection: TB bacteria can live in your body without making you sick. This is called latent TB infection (LTBI) or just TB infection. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop it from growing. People with TB infection do not feel sick, cannot transmit the infection to others, and do not have any symptoms. Untreated TB infection often progresses to active TB disease (see below), so TB infection treatment is usually recommended in those cases.
Active TB Disease: TB bacteria become “active” if the immune system cannot stop it from multiplying. When TB bacteria are active (multiplying in your body), this is called TB disease. TB disease will make you sick. People with TB disease of the lungs or throat may spread the bacteria to people through the air.

A person with latent TB infection	A person with active TB Disease
Has no symptoms	Has symptoms that may include: A cough lasting three weeks or longer. Pain in the chest. Coughing up blood or sputum. Weakness or fatigue. Unexplained weight loss and/or no appetite. Chills and/or fever. Sweating while sleeping.
Does not feel sick	Usually feels sick (see symptoms above)
Cannot spread TB bacteria to others	May spread TB bacteria to others
Usually has a skin test or blood test result indicating TB infection	Usually has a skin test or blood test result indicating TB infection
Has a normal chest X-ray and a negative sputum smear	May have an abnormal chest X-ray, or positive sputum smear or culture
Needs treatment for TB infection to prevent progression to active TB disease	Needs treatment to treat active TB disease

Incubation period

Infection is detectable by skin or blood test two to 10 weeks after initial exposure to someone with active TB disease.
The risk of progression to active TB disease is elevated in the first two years and when the body’s immune system is not able to fight off the disease (i.e., diabetes, HIV, renal disease, TNF inhibitors, etc.). Young children are at a higher risk of progression to active TB disease because their still-developing immune system cannot fight the TB bacteria as well as an adult. However, the infection may be present for many years in its latent phase (with no signs/symptoms of TB) before progression to active disease.

Contagious period and spread

TB is contagious only during active TB disease. Generally, infants and children aged 12 and younger with active TB disease are not contagious because they don’t form cavities in their lungs with enough bacteria to be expelled into the air when they cough.
TB is spread through the air from person to person. When a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings, the bacteria enters the air. People nearby may breathe in the bacteria and become infected. TB is NOT spread by shaking hands, sharing items (like food, drinks, toothbrushes), touching objects, or kissing.
Public health officials will determine when a person is no longer infectious after starting effective treatment.

Public health reporting requirements

Report the name of the child or staff member with active TB to the facility director or school nurse and the local or state health department within one working day of suspected or confirmed TB diagnosis.
Report positive TB skin tests (using millimeters as metric) to the facility director or school nurse and the local or state health department within seven days of diagnosis.
Positive IGRA (TB blood tests) are reported to CDPHE by labs in Colorado.

Control of spread

Tuberculosis risk assessment should be a routine part of health assessments for adults working in early childhood education, child care programs, and schools.
Referral to local or state public health is mandatory for suspected or confirmed cases of TB. Recent skin or blood test converters should have a chest X-ray and medical evaluation to determine if treatment is indicated and to rule out active TB disease.
People with previously positive skin or blood test results, especially those who were not treated for TB infection, should be evaluated by a health care provider if any symptoms of TB disease are noted — fever, night sweats, weight loss, or persistent cough — to assess their disease status and determine the need for treatment.
Skin or blood testing of all exposed children and staff may be necessary in some instances.
No immunization is recommended in the United States.
Consultation with the state or local public health agency is encouraged for situations that may arise in child care or school settings. The CDPHE Tuberculosis Program can be reached at 303-692-2638.

Treatment

Tuberculosis is treated with antibiotics. There are three treatment regimens for TB infection that range in duration from three to nine months. TB disease is treated with multiple antibiotics for a duration of six months to more than a year. TB treatment for active TB disease requires observation. Public health officials or designees will need to directly observe the administration of each dose of treatment.

Exclusion

EXCLUDE children with active TB disease from child care or school until they are cleared by public health.
Children should not transfer to a new school or facility during the exclusion period.
Children/students and staff who do not have symptoms should not be excluded from child care or school solely based on a positive skin or blood test.

Role of teachers, caregivers, and family

Protect the privacy of the student/child and family.
Collaborate with public health to ensure that discreteness is practiced and help ensure that all prescribed medications are taken as indicated. Local public health may wish to interview teachers or caregivers at some point during this process, which is referred to as a contact investigation. It is imperative that staff protect the child's and family’s identity.