TB cluster at a nursery in Westminster

14 October 2008

The Health Protection Agency has been working with the NHS to respond to a cluster of TB cases at a nursery in Westminster. The Agency was first alerted to this problem in late July when an adult associated with the nursery was diagnosed with TB. The patient is receiving appropriate treatment and is no longer infectious.

As a result of this case of TB parents at the school were notified and screening was carried out of all this patients' close contacts. Results have now been received for most of the children who were screened. Seven children are receiving antibiotic treatment for TB. A further 26 children who came into contact with the patient, but don't have signs of TB; will need a shorter course of antibiotics. Some further tests are still being examined and because TB can be difficult to diagnose in children, it is possible that some children may require further tests to ensure they are properly diagnosed and treated if necessary.

We recognise that this is a time of considerable concern for the parents of these children and we have been working very closely with them to ensure they have all the information, support and advice that they need to help them deal with what is a worrying, but treatable infection.

All adults who currently work at the nursery have been screened and this showed that one further adult required full treatment, and six required the shorter course of treatment. The adult on full treatment has been excluded from work. Although it is thought unlikely that this second adult case will be infectious to others, some of their close contacts are also being followed up and offered screening.

Dr Brian McCloskey, the Agency's Director of the London Region said, "We carry out screening for TB on a regular basis in London, however this incident is very unusual because of the number of children and adults who have been affected. It is too early to say why so many children and adults have been infected and we will be looking into this over the coming weeks. A possible explanation for this may include that the initial case was particularly infectious and had been suffering from symptoms for eight months before doctors had diagnosed TB.

We have also been working very closely with the local NHS who have worked tirelessly to arrange special clinics for all the children concerned at very short notice.

"It is important to remember that TB is an entirely treatable infection and that anyone identified as being infected can be treated. Those children who have come into contact with the patient, but not developed any symptoms or signs in their chest X-rays will also be offered a shorter course of antibiotics to clear the bacteria from their body.

      
Ends.

 

Notes to Editors

What is TB?
Tuberculosis, or TB, is a disease caused by a germ (called the tubercle bacterium or Mycobacterium tuberculosis). TB usually affects the lungs, but can affect other parts of the body, such as the lymph nodes (glands), the bones and (rarely) the brain. Infection with the TB germ does not always develop into TB disease.

What are the symptoms?
TB disease develops slowly in the body, and it usually takes several months for symptoms to appear. Any of the following symptoms may suggest TB: Fever and night sweats, Persistent cough, losing weight, Blood in your sputum (phlegm or spit). If you are concerned that you might have TB because you develop any of these symptoms, visit your family doctor for advice.

How do you catch it?
The TB germ is usually spread in the air. It is caught from another person who has TB of the lungs. The germ gets into the air when that person coughs or sneezes.
But only some people with TB in the lungs are infectious to other people. Such cases are called 'sputum smear positive' (or "open"). Even then, you need close and prolonged contact with them to be at risk of being infected. Sputum smear positive cases stop being infectious after a couple of weeks of treatment.

How do you screen for TB?
The TB screening used in this case consists of two tests. One is a simple blood test called an Interferon Gamma Release Assay (IGRA) test, and this looks for an immune response (known as T-cell responsiveness) to tuberculosis bacteria in the blood and will show if the person being tested has come into contact with TB. The second is a chest x-ray which looks for evidence of the TB bacteria causing an infection in the lungs.

Can anyone get it?
Anyone can get TB - but it is difficult to catch. You are most at risk if someone living in the same house as you catches the disease, or a close friend has the disease.

How is TB treated?
For many years now, we have had good treatment for TB. You have to take the treatment (usually tablets) for around six months - but it is worth it: Without treatment, many people used to die of this disease.

How important is treatment?
Treatment is vital. If you have TB disease, or if you have been infected with the germ but have not yet become unwell, you must take the treatment as directed. It is very important to complete the full course of treatment, as it will stop you being infectious, and it will remove the risk of you developing drug-resistant TB. We must not forget that TB used to kill many people before we had modern treatments.

What should I do if I think I might have TB?
Visit your family doctor for advice. He or she may then refer you to a chest clinic for some simple tests. If you don't have a family doctor, visit your local casualty (A&E) department. They will refer you to a specialist in TB if they think you may have TB. But you should register with a family doctor as soon as possible.

What if I have been in contact with someone with TB?
Discuss this with your family doctor. Only close contacts are at risk of catching TB. You may be asked to make an appointment with your local chest clinic. Sometimes a TB nurse or chest diseases health visitor will contact you first (they will have a list of close contacts). The nurse will arrange a skin test and/or chest x-ray. This does not mean that you have TB, but it is a chance to check for any symptoms, so it is very important that you do attend, if asked.

Can TB be prevented?
Yes it can. Most important is early detection, especially of infectious cases, and complete treatment. Early case detection reduces onward transmission of the disease and a full course of treatment is vital to prevent the disease relapsing, to prevent the development of drug-resistant strains of TB, and to prevent prolonged infectiousness and preventable death. Identifying cases who have been infected through screening contacts and offering preventive treatment to reduce the risk of infected persons developing TB also contributes to preventing TB. In hospitals and institutional settings infection control measures to identify and isolate infectious cases is important. In some high-risk groups and especially among infants and young children at risk of exposure to TB, BCG vaccination can offer some protection against TB but overall, BCG vaccination plays a limited role in TB control.

More information about TB can be found at www.hpa.org.uk

Media enquiries to Emily Collins on 0207 759 2834, Emily.collins@hpa.org.uk

Last reviewed: 14 October 2008