Dozens at school to be tested for TB
The student was sickly and slovenly.
But colds and coughs are common in high schools. “And he’s a teenage boy,” stresses Meghan Wood, director of Royal Elite International Academy, a private high school in Niagara-on-the-Lake that caters primarily to foreign students. “Sometimes teenage boys can be dishevelled. That had nothing to do with it anyway.”
This teenage student, however, has been diagnosed with an active case of tuberculosis. He is in quarantine.
The 18-year-old from China, according to sources at the academy, appeared ill as far back as September. He only sought medical attention in February, by which point he was coughing up blood.
Subsequently, the Niagara Region public health department was called in. Forty-nine students and staff are either getting skin tests or — because some have already returned home at end of term — letters urging them to get tested in their home country. (For accuracy purposes, a wait period of at least eight weeks is required between last contact with the active TB patient and administration of the test.)
At least eight students and four teachers have tested positive so far, the Star has been told, although Dr. Mustafa Hirji, associate medical officer for Niagara Region, would not confirm results, maintaining that to do so would violate health privacy rights.
To be clear: A positive tuberculin skin test does not mean a person has contagious (active) or even latent TB. The next step is undergoing chest X-rays, which are being done this week. A PPD (purified protein derivative) test determines only if someone has developed an immune response to the bacterium that causes tuberculosis. “It means the TB bacterium is living inside you,” Hirji explains.
Some 95 per cent of people with latent TB will never develop the disease. They are not infectious and can’t spread it to others.
All of which should be comforting news to those who’ve been in contact with Teenage Boy X — fellow students, teachers, his billeting family — and especially those now undergoing further examination.
This is Canada, where tuberculosis is scarcely a concern anymore and vaccinations — those telltale scar patches many of us grew up with — are no longer administered except in persistently high-risk aboriginal communities.
In 1867, tuberculosis was the leading cause of death in this country.
But globally — China, Africa, developing nations — TB remains a serious health problem, ranking as second leading cause of death from an infectious disease behind only AIDS. It’s estimated that one-third of the world’s population has latent TB infection, with an estimated 8 to 10 million developing active TB disease annually.
Hirji makes it clear there’s no evidence of an epidemic afoot at the academy and no reason to panic, pointing out that the Niagara Region sees an average of seven active TB cases per year.
“There has been exposure from one person. This doesn’t mean other people have contracted TB.”
But the academy, which has a student population of about 120 and moved to Niagara-on-the-Lake only last fall, has a disproportionately large number of foreign students.
That’s the attraction for families from afar who send their kids — at a cost of about $40,000 for a high school education, according to one teacher — “to essentially buy their child’s entrance into Canadian post-secondary institutions.” Most of the foreign students are from China, but some have come from Nigeria, Mexico, Ukraine and other parts of Europe.
Some faculty are dismayed by the school’s failure to take prompt action even after teachers brought the teenager’s chronic sickliness to their attention. “The boy is over 18,” Wood points out. “He’s responsible for his own health. We couldn’t force him to go to a doctor.”
A teacher who attended a staff meeting with school authorities in November — the main topic of discussion was how to reduce stress for students, as many had noticed that kids were in a high state of anxiety about their academic performance — recalls that the health of Teenage Boy X was raised as well.
“We’re teachers, we’re not health and safety people. Our job is to teach the curriculum. But a few teachers mentioned that this student had a bad cough and it wasn’t going away. Nothing was done.”
This particular staffer tested positive this week. A chest X-ray came back clear, but the teacher will still have to take antibiotics for the next nine months.
“I’m just sick about it. I’m beside myself,” she told the Star. “I was in tears at the doctor’s office. I feel like this puts my entire life on hold.”
The Star is not identifying the teachers who spoke for this column because they fear for their jobs.
“It was apparent to all that the kid diagnosed with TB was ill,” another teacher told the Star in an email. “Staff repeatedly expressed their concern about this kid, who was dirty, coughing and very obviously unhealthy.”
Wood insists the school took every appropriate action after the diagnosis.
In an email sent to staff and faculty this week, Wood — just returned from maternity leave, so not at the school when worries about the boy first surfaced — laid out steps the school is taking. These include covering expenses for the testing process and any antibiotics and treatment required not covered by OHIP; distributing surgical masks for those who wish on exam days; making alternative arrangements for high-risk students who have tested positive (they won’t be allowed back until their chest X-ray results are confirmed); even paying mileage for those who have to drive to a clinic for the X-rays.
Perhaps most crucially, and belatedly, the school will screen newly arriving students from overseas “as it apparently isn’t included in their immigration medical exam,” Wood says in the email. “We are also looking at a new rule that all kids who have been sick longer than 1 week must go to the doctor, regardless of whether they think they are seriously sick or not.”
Citizenship and Immigration Canada screens individuals applying for permanent residency and “cer- tain individuals applying for temporary residency” — but only for active cases of tuberculosis or those who’ve been treated for tuberculosis in the past.
A study released in 2015 showed that the majority of active tuberculosis cases was found in people arriving in Canada from six countries — China, Afghanistan, India, Pakistan, the Philippines and Vietnam, with 157 prospective immigrants (between 2002 and 2011) having active TB and screened out.
Over the decade-long study, 22,391 immigrants were referred by immigration officials to provincial health authorities for post-immigration surveillance, but only 13,387 followed the order. Within two years of obtaining their permanent status, 102 of them developed active TB. By comparison, active TB was found in 334 newcomers out of all those who had not been referred for surveillance and 66 cases involved those who were referred but did not report.
The upshot: Only 1 in 40 cases was actually detected through postimmigration surveillance, demonstrating the ineffectiveness of the post-immigration referral process, the study said.
Infectious disease experts called for Ottawa to improve its immigration health screening system.
In attempting to alleviate fears, Wood urged staff to avoid “unnecessary panic/hysteria,” and that admonishing tone didn’t go over well either.
As one of the aforementioned teachers told the Star via email: “The public health nurse who tested me was completely shocked I had a positive result. She said public health didn’t expect any Canadianborn people to test positive.”
Now there are four. Rosie DiManno usually appears Monday, Wednesday, Friday and Saturday.