TB warning: Nurse’s infection prompts scare in San Jose.
A nurse at Santa Clara Valley Medical Center contracted active tuberculosis, potentially putting 350 infants in the San Jose hospital’s newborn nursery at risk.
The center placed the employee on leave in mid-November before the diagnosis was confirmed, Joy Alexiou, a spokeswoman for the hospital, said Friday. A group of potentially exposed people in the Mother & Infant Care Center between mid-August until the time the woman left have been notified.
Apart from the babies, an additional 368 mothers and 338 employees were also exposed to the infected worker, said Dr. Stephen Harris, chair of pediatrics. Staff are providing chest X-rays to babies along with a daily antibiotic liquid, which can kill the disease and prevent infants from becoming sick.
“We want people to be appropriately concerned so they follow our recommendations,” Harris said. “We also want people to understand that not everybody that was born here from mid-August to mid-November was in contact with this person.”
Although more than 300 babies were put at risk, about three times as many infants were born at the hospital during the exposure period. While risk of infection is very low, Harris said, the bacteria is serious enough that staff decided to go forward with the proactive measures.
Notifying parents
Officials began notifying parents last week, delaying the calls for weeks because of several factors: First, they went through the lengthy process of reviewing the infected employee’s work locations and shift schedule. Next, staff had to put together a list of babies and mothers the infected nurse came into contact with.
Finally, doctors consulted a number of experts in TB as they weighed the benefits of using chest X-rays and antibiotics on such young patients. The oldest affected were a little more than 3 months old, while the youngest could be around 3 to 4 weeks old.
“We didn’t want to scare a lot of people and not have any answers to what we are going to do about it,” Harris said. “We are confident the amount of time we took was justified to make sure we were doing the right thing.”
This case was particularly strange, Harris said, as the woman had active TB but didn’t even know it.
“TB is carried by a lot of people in California in what’s called a latent state,” he said. “It’s incredibly common for any individual to have inactive TB. It’s activated under unusual circumstances.”
In fact, the nurse passed the hospital’s annual TB screening in September, Harris said. Staff found out the employee was infected after she was evaluated by her doctor for a different medical reason.
“The person who is infected is not terribly contagious because the employee doesn’t have a cough and still has no symptoms,” he said.
Tuberculosis, once the leading cause of death in the United States, is caused by a bacterium called Mycobacterium tuberculosis, which tends to target the lungs.
An infected person could potentially spread the disease through talking, laughing or singing, although it would require a great deal of contact.
Evaluating risks
Allison Thrash, a health information officer with the county’s Public Health Department, said Santa Clara County has a large number of active TB cases — the fourthhighest prevalence of TB among jurisdictions in California.
“The rate is higher in this county,” she said. “There’s a number of reasons for that. It has to do with the make up of our population. There are many parts of the world where TB is endemic, particularly some Asian countries and some Latin American countries. We have a very diverse population in Santa Clara County.”
Harris said the staff “had to very carefully evaluate risks and benefits,” when coming up with a treatment for the infants. They decided on isoniazid, a liquid antibiotic that is being specially formulated by the county’s Public Health Department to reduce side effects.
Infants will have to take the medicine daily for six to nine months, Harris said.
It is not known how the nurse developed active tuberculosis.