Daycare TB case exposes over 500 babies, children; emergency declared

<em>Mycobacterium tuberculosis</em>.
Enlarge / Mycobacterium tuberculosis.

Health officials in Omaha, Nebraska, are wasting no time in testing over 500 infants, toddlers, and children who may have been exposed to an active tuberculosis case at a local daycare. The Douglas County Health Department (DCHD) declared a public health emergency Friday.

In a press release, DCHD said the exposures occurred at a daycare at the Westview YMCA, which provides “drop-in” care, allowing members to drop off their kids as they use the facility. The exposures occurred between May 21, 2023, and October 30, 2023.

Children’s Nebraska pediatric hospital quickly set up a clinic this weekend to test children ages 4 and under who were potentially exposed in the last 10 weeks. Children in this age group need “window prophylaxis” treatment to prevent the development of tuberculosis as testing is underway. Later this week, DCHD will set up a clinic to test children ages 5 and up who were potentially exposed.

In addition to immediate testing, those exposed between August 21, 2023, and October 30, 2023, should undergo additional testing eight to ten weeks after their most recent exposure.

Justin Frederick, deputy health director in Douglas County, called this an “urgent situation” in a briefing with reporters.

“If this was a situation with a lot of adults, we would probably be handling this a little bit differently; we’d have a little bit more time. Knowing that it’s children and that they can progress to very severe disease very quickly, we’re taking [it] very serious[ly], and we’re wanting to get them in, get them seen, evaluated, chest films, and on preventative treatment if they fall within that 10 weeks and they’re under the age of 4,” Frederick said.

Tuberculosis is a bacterial infection that spreads through coughing, sneezing, speaking, or singing during prolonged, direct contact with an active case.

Officials declined to give details about the person with active tuberculosis at the daycare, including whether it was a child or an adult. They only noted that symptoms began in late August, but the person wasn’t tested for tuberculosis until last week.

In an interview with The Washington Post, Douglas County Health Director Lindsay Huse said officials should start getting testing results from the younger children midweek and should have a better picture of transmission and the full scope of testing needed by sometime next week. Huse estimated that there are about 250 children in the 4-and-under group and 300 in the 5-and-up group. Any children infected will further expand the number of people potentially exposed.

“It could certainly grow,” Huse said. “We are cautiously optimistic that it won’t have gotten that far yet.”

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