North Dakota Child
Spread Tuberculosis
To 16 Classmates
By Gene Emery
BOSTON (Reuters) - The conventional wisdom among doctors is that young children rarely spread tuberculosis. A new case reported in Thursday's New England Journal of Medicine said the conventional wisdom is wrong.
Federal and state health investigators identified a 9-year-old North Dakota boy, a native of the Marshall Islands in the Pacific Ocean, who passed TB to 16 classmates, 10 on his school bus, and three out of four people living in his house.
A total of 118 people exposed to the boy, including 56 young children, ultimately needed some type of therapy to either prevent the lung-dissolving infection or to block its spread to others, the Journal reported.
Ironically, the child was given a tuberculin skin test when he arrived in the United States in 1996. But the test was never read, the Journal said.
``Children with tuberculosis ... should be considered potentially infectious, and their cases may merit investigations of contacts as extensive as the one described here,'' according to researchers led by Amy Curtis of the U.S. Centers for Disease Control and Prevention in Atlanta.
Children were not regarded as capable of spreading the disease because youngsters under age 10 usually can't produce a cough powerful enough to propel TB particles into the air. An evaluation of 84 school-based outbreaks in 12 countries, published in 1965, found only four cases where a child younger than 10 was the source of the infection.
In the North Dakota case, investigators identified the child when his female guardian, 36, was found to have tuberculosis in her left hip. TB in unusual cases can attack parts of the body other than the lungs.
The boy and his twin brother, who was not infected, had come from the Republic of the Marshall Islands where TB is common.
In an editorial in the Journal, Dr. Laurie Miller of the Floating Hospital for Children in Boston said the case ''emphasizes the need for careful screening and follow-up of children born outside the United States'' for TB and other diseases.
Youngsters are supposed to receive physical examinations as part of the visa process, she said, but ``the evaluation is usually cursory.''
Overseas vaccinations may be inadequate, so ``questionable immunizations should be repeated'' or the children should be tested for immunity to key diseases, she said.
In particular, she said, ``adopted children from outside the borders of the United States constitute a special population that deserves focused medical attention. Public and personal health considerations demand that these children receive careful evaluations on arrival in the United States and at follow-up.''