Screening following exposure to congenital tuberculosis in a neonatal nursery

Abstract

Background: In January 2008, a positive Ziehl-Neelsen stained smear of an endotracheal aspirate was collected from an infant in the neonatal nursery. Mycobacterium tuberculosis was identified, yet neither parent had active pulmonary tuberculosis. Further investigation revealed the neonate had congenital TB most likely acquired in utero.

Methods: A definition of ‘potentially at risk’ persons included all staff who worked in the bay with the infant during his two periods of ventilation, all staff in the bay with the infant for a cumulative total of greater than 8 hours and other infants and families who shared a bay with the infant during his two periods of ventilation. Screening for ‘potentially at risk’ persons was performed at baseline and at 10 weeks post-exposure for neonates, families and staff. Individuals who had a positive test were sent for a chest X-ray and referred for appropriate management by an infectious diseases physician.

Results: Overall, 163 staff and 20 neonates and families were considered ‘potentially at risk’. Fourteen staff were positive, none had evidence of active disease and all were born in countries of high-risk for TB exposure and reported previous exposure. No positive results were deemed to be related to the index case. Over 40 h of infection control clinical nurse consultant and clerical time were spent coordinating baseline and follow-up tests and X-rays, notifying staff of results, organising repeat tests and attempting to contact staff who did not present. Pathology staff time was spent collecting specimens from staff and patients and direct costs of over $10 000.

Conclusion: This case highlights that neonatal and paediatric staff can be exposed to TB. The workload and costs would have been significantly decreased if staff had recorded a baseline and interferon-gamma release assay (QuantiFeron^®-TB Gold, Cellesitis, Victoria, Australia) (QFN) or Mantoux result on employment. This is especially important in healthcare facilities employing large numbers of staff originating from countries of high TB prevalence.