Tuberculosis (TB)—Child Care and Schools

What is tuberculosis?

Tuberculosis (TB) is a disease caused by an infection with the bacterium Mycobacterium tuberculosis that usually involves the lungs but could affect other parts of the body.

What are the signs or symptoms?

• Most children and adults initially infected with the bacteria do not have signs or symptoms of disease. That is why TB testing is necessary (see How do you control it?).

• If an infected child or adult does develop signs or symptoms of TB, it most often occurs 1 to 6 months after the initial infection and may include

  • ? Chronic cough

  • ? Weight loss

  • ? Fever

  • ? Growth delay

  • ? Night sweats

  • ? Chills

What are the incubation and contagious periods?

• Incubation period: 2 to 10 weeks after the initial infection. The risk of disease is highest in the first 2 years after infection, but the bacteria can be carried in the body for many years before active disease develops. Most infected people never develop active disease. They remain infected, but without symptoms, called TB infection (TBI).

• Contagious period: Infected individuals without symptoms are not contagious. Generally, infants and children younger than 10 years of age with TB disease (meaning they have symptoms) are also not contagious because they do not create enough force when coughing to expel large numbers of TB germs into the air. Adults and some adolescents with active TB can spread the bacteria through coughing, contaminating the environment, which is how infants and young children can become infected. Usually, a person with active disease will remain contagious until treated.

How is it spread?

• Infection in children is nearly always the result of close contact with an adult who has TB.

• Airborne route: Breathing small particles containing these bacteria floating in the air. These particles first come from an infected person's respiratory secretions as droplets after a cough or sneeze. These germ-containing particles dry out quickly in the air or fall onto surfaces and then dry out and attach to dust particles, which become suspended again in the air. These particles travel along air currents and can infect people in another room.

• It is not spread through clothes, dishes, floors, or furniture.

How do you control it?

• All early childhood education (ECE) staff should have a TB risk assessment and symptom screen when they begin employment the education field. A TB test is only needed if the risk assessment shows risk factors (eg, birth, residence, or travel to areas with high rates of TB, or close contact with people who have TB). Further testing is only done if individual risk changes or if required by a local or state regulation, in line with Centers for Disease Control and Prevention and state guidelines.

• TB testing is only indicated for children at risk (eg, exposed to a family member or another individual with TB or positive TB test result, born in or traveled to a high-risk country). The child's health professional should perform the risk assessment.

• Adults and children of any age who need TB testing can have either a TB skin test or a blood test called interferon-gamma release assay (IGRA). Some children and staff members who come from other countries may have received an immunization against TB called the BCG vaccine. For these children and adults, IGRA is a better test.

• All children and adults with a positive TB test result need a chest radiograph (x-ray).

  • ? If the chest radiograph result is negative and the person has no symptoms or signs of disease, the person is said to have TBI. If there are no findings of infection in a child's or staff member's body other than the positive TB test result, the child or staff member usually requires only 1 antibiotic.

  • ? If the chest radiograph result is abnormal, this is called TB disease or active disease. The child or adult may require multiple antibiotics.

• All contacts of adults with active TB disease should be tested for TB.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the ECE program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the Child Care Health Consultant.

• Report the condition to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

• Ensure children and staff members take all prescribed medication. Directly observed treatment, performed by clinical or public health staff members, may be necessary for active disease and is often advised by the local public health department. For TBI, directly supervised medication taking is not usually used.

• Staff members with previously positive TB test results, especially those who were not treated, should be evaluated by their health professionals anytime they develop a disease that involves fever, night sweats, weight loss, or persistent coughing to assess their need for treatment and any risk of contagion related to their TB status.

Exclude from educational setting?

Yes, if there is active (infectious) TB disease. For people with TBI (not contagious), no exclusion is necessary.

Readmit to educational setting?

Yes, when all the following criteria are met:

• For people with TB disease, as soon as effective therapy has been started, adherence to medication is documented, and the person's symptoms are improving

• When the child or staff member is considered noninfectious to others and is approved by local health officials to return

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group