Malama Ola: TB or not TB?

Contributing Writer Solomon Singer

On the afternoon of April 11, students, faculty, and staff received an email from the Office of the Chancellor about a health and safety priority issue. A person with an active case of tuberculosis (TB) was on the UH Hilo campus. It’s difficult enough to deal with upcoming finals without having to worry that you might get TB while going to class. Should we all be concerned? Concern is good when accompanied with education. Is there a chance that TB is now spreading across the campus? The TB Branch of the Department of Health (DOH) is conducting a thorough investigation and has assured that the campus is safe for all activities. Should we all be avoiding people who cough? TB transmission takes a prolonged close contact with an active TB case.

According to the Center for Disease Control and Prevention, “tuberculosis (TB) is caused by a bacterium called mycobacterium tuberculosis. When the bacteria are active in the lungs, TB can be spread person to person. TB bacteria can also live in other parts of the body such as the kidney, spine, and brain and cannot be transferred person to person. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and active TB disease. If not treated properly, active TB disease can be fatal.”

Fortunately, it’s actually very hard to catch TB from someone who has it. To learn more about the situation, I spoke with Heather Hirata, UH Hilo’s nurse practitioner at Student Medical Services.

How would someone know if they caught TB?

Hirata says,

“To see if you have been infected with TB, you can get a TB skin test. If the skin test is positive, further assessment will be conducted, such as a chest x-ray to make sure the TB is not in your lungs and can be spread person to person. If there is no TB in your lungs then medication is still highly recommended to eradicate the TB bacteria from your body.”

Should people be worried if someone coughs around campus?

“No, you don’t have to be worried. TB transmission requires prolonged close contact to be transmitted person to person.”

Can TB be spread from surfaces like handles or drinking glasses? Can you get it from being in a room in which someone with active TB had been coughing?

“No, TB is NOT spread from surfaces, rooms that have been occupied, sharing a cup with an infected individual, or even kissing. The only way you could get infected is to be in extremely close contact with an actively infected individual for a very long time, for hours, and have them cough on you a lot of times, not just the one time. TB is spread through droplets coughed up, and the bacteria die quickly once out of the body.”

What is being done about this case at UH Hilo?

“The Department of Health TB branch is doing an investigation and an expert team of TB doctors are working on the case. This is their job and they are very well-trained. They are experts at tracking down and managing a case like this. I feel very confident that we have the best experts taking care of the situation. It has been managed and there is no threat to anyone on campus.”

Has anyone been identified as possibly having contact with the person who had active TB?

“Yes, there were 120 people, including some students, staff, and faculty who were identified by the DOH as possibly having contact with that person and they are being monitored and tested.”

What is the testing procedure?

“The people who were at the highest risk of being exposed are tested immediately with a TB test that is read several days later, and they are tested again in 8-12 weeks. If any of those test results are positive, then the individual gets a chest x-ray to see if it is an active or latent case.”

Can latent TB infections still spread TB to others?

“No, TB can only be spread from an active infection, when you are coughing out bacteria. A latent case of TB is not infectious, and cannot spread TB. If your skin test is positive, it just means that at some point in your life you had come into contact with someone who had TB. Then the TB bacteria enter your lungs. The body doesn’t like it, so it encapsulates it, and it usually just sits there. That is what is called latent TB. You may be able to live your whole life that way, and never get active TB, while still testing positive for a skin test. You may never show signs of TB, unless your immune system is severely compromised sometime in your life, and then the TB may become active. That is why it is best to treat the latent TB with medication to eradicate it from your body so it does not cause problems later on.”

If you get a positive skin test for TB, what then?

“If you get a positive skin test, we do a chest x-ray just to make sure you can’t give TB to someone else. So if it is not in your chest, you can’t give it to someone. TB can live in your pelvis, brain, and other parts of your body, but you can’t give it to someone that way.”

Do you recommend people who are testing positive with a latent infection and no overt signs of TB to receive treatment?

“Yes, it is highly recommended you get treated when you test positive for TB because it is easier to treat when it is latent and you can prevent getting active TB in the future. It is a six month antibiotic treatment, which is hard for many people who show no signs of TB to go through, but it is highly recommended.”

Is there an immunization available for TB, and does the TB skin test we get give us immunity from TB?

“There is a vaccine available in other parts of the world for TB, but we do not use it here in the U.S. The skin test is just a test, not a vaccine. It does not give any immunity to TB. It just checks to see if you have been exposed to it.”

How prevalent is TB?

“About one third of the population has latent TB. Out of that group of people, only about 10% in their lifetime will develop active TB. 90% of people who have latent TB live their whole lives without ever developing active TB symptoms. When the 10% of active TB cases come into contact with other people, only one or two percent of those who had contact with a positive TB individual will test positive. It is really hard to get TB.”

To find out more about TB, go to Student Medical Services, which is located at Campus Center(CC), Room 211. Contact them at uhhsms@hawaii.edu or (808) 932-7369

You can also check out the following: https://hilo.hawaii.edu/uhh/ehso/tb-information.php

https://www.cdc.gov/tb/topic/basics/

The opinions expressed in this article are solely those of the author.

About the author: Solomon Singer is a pre-med student at UH Hilo, and is an Outreach Volunteer for Student Medical Services.