What Are We Importing, Exactly?

Source: village voice

A nurse's cough turns into a public health crisis in the Bronx

For three weeks beginning in January, about 700 workers and patients at St. Barnabas Hospital in the Bronx, including 238 infants, were exposed to tuberculosis by an infected nurse.

During that time, after the unidentified, foreign-born woman had developed a cough, she continued to report for regular shifts in the maternity ward and the nursery at the facility. When she finally reported her cough to a doctor, he noticed that she'd earlier tested positive for latent TB. A chest X-ray showed that the disease had turned infectious.

Following Centers for Disease Control and Prevention guidelines, the nurse was isolated in her home while she began a drug regimen. The hospital also notified the city's Bureau of Tuberculosis Control, which sent a team of epidemiologists into action. They marshaled months of hospital records and tried to track down every person who had crossed paths with the infectious nurse.

On March 15, when almost two months had passed since the investigation began and 271 potential victims still remained at-large, the city's Department of Health reached out to local media in an effort to track those patients down. More than 100 have come forward since then, and seven people in total have tested positive for latent tuberculosis, which they developed after being exposed to the infectious nurse.

The St. Barnabas case is reminiscent of a 2003 incident in which a nurse exposed 1,500 patients and co-workers at Bronx-Lebanon Hospital. She was also a foreign-born health care worker who had previously tested positive for latent TB. Like the nurse from St. Barnabas, she declined treatment, even though she worked with newborns. In that earlier case, the nurse showed symptoms for two months before she sought a diagnosis; only a third of those exposed were ever tracked down, and at least four infants tested positive for latent tuberculosis.

Both nurses fit an emerging profile. According to a recent report by the Bureau of Tuberculosis Control, the majority of health care workers with infectious tuberculosis are foreign- born female nurses between the ages of 35 and 54 who work in a hospital setting and have previously tested positive for latent infection. *snip*

'TB in foreign-born health care workers is increasingly likely to come from reactivation of old infections,' Munsiff says, 'acquired overseas, not in New York City.'

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