TB cases hit 24; testing not done

Health officials say outbreak contained, but many still sought

The investigation into tuberculosis at a Fort Bend County high school has identified 10 additional infections, but public health officials said this week the campus outbreak is now contained.

The new infections bring the total number at George Bush High School to 24, but only the first four, confirmed in late May, involved active disease, which is contagious and potentially fatal if not treated. The other 20 are symptom-free, when the infection is not contagious and the treatment is easier.

“This is good news, that all the testing identified no more active cases of TB,” said Dr. Kaye Reynolds, deputy director of the Fort Bend County Health and Human Services Department. “It’s really good that the investigation has identified people who now will be cured and that the clustering won’t start another outbreak.”

Reynolds said the health officials will continue to monitor the situation and work vigorously to track down 66 people, potentially exposed at George Bush but not enrolled at the school this fall, who still need to be tested. Nearly 560 people were screened as part of a requirement to enroll in fall classes; those not tested

graduated, moved to another school or dropped out.

Two Houston doctors of infectious disease — Baylor College of Medicine’s Dr. Daniel Musher and Children’s Memorial Hermann Hospital’s Dr. Michael Chang — said the numbers at George Bush suggested “a significant clustering,” particularly the original four cases of active disease.

2 rounds of testing

They said the 20 infections identified through mass screening were less surprising because it is unclear how many already were carrying the infection and how many caught it from one of the four experiencing symptoms. They acknowledged, however, that it is a safe assumption that many did pick it up at George Bush.

Reynolds acknowledged the numbers seem daunting but characterized the investigation as successful.

The cluster first was revealed in mid-June, when county health officials called for more than 600 people at George Bush — mostly students but also staffers — to get tested to determine if they had contracted the infection after TB was confirmed at the 2,200-student high school. They initially were vague about the extent of the cluster, but said that there were at least two active cases. They later acknowledged there were four.

A first round of testing on June 19 identified 10 infections, and a second round Aug. 3 identified 10 more. The second round was required for continued enrollment because health officials were so disappointed at the turnout for the first — only about a third of those exposed.

TB is one of history’s great scourges. It declined steadily in the U.S. throughout most of the 20th century before increasing slightly in the mid-1980s and again recently, experts say, partly a result of complacency the disease was on the way to eradication. There are roughly 10,000 cases annually in the U.S., including about 1,400 in Texas and 350 to 400 in the Houston area and 20 to 30 in Fort Bend County.

TB primarily attacks the lungs but can affect other organs, as well. Most infections do not cause symptoms — latent tuberculosis — and, thus, are not contagious. About 10 percent progress to active disease, which kills about half of those infected if left untreated.

In those contagious, it usually takes prolonged close contact to pass on the infection, which is not spread as easily as a cold, flu or measles. It may be passed on if droplets coughed or sneezed into the air reach the lungs of another person.

There is no TB vaccine approved for use in the United States. Treatment is by antibiotics.

Treatment takes time

Wednesday’s announcement of the additional cases caused some alarm among parents, who posted concerns on a Facebook page about Fort Bend Independent School District. The postings described one parent as “beyond frustrated” and raised questions about the extent of the testing, such as whether it included bus drivers.

Reynolds noted that no family members of the four people with active disease contracted the disease, an indication the bacteria likely was not that contagious.

Tuberculosis typically is treated effectively, but it takes time. Prophylactic medicine for those infected but without symptoms typically lasts for four months or nine months, depending on the doctor’s choice of regimen. Antibiotics for those with active disease can be taken for as long as two years, though the duration usually is nine to 15 months.

“It’ s not an easy disease to treat, which is why we need to close the loop and finish out the investigation involving those not returning to George Bush,” said Reynolds. “But we’ll get to them. We have to.”

“It’s not an easy disease to treat, which is why we need to close the loop and finish out the investigation.” Dr. Kaye Reynolds, Fort Bend County Health and Human Services Department