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Update: Tuberculosis on Campus

On November 26, 2007, Dr. Leslie Jaffe, college physician, notified the Smith College community that a sophomore student was being treated for probable tuberculosis. The following is an update on the outreach, testing and education that have taken place to date.

What is tuberculosis?
Tuberculosis or TB is a highly curable and preventable bacterial disease, caused by a germ breathed into the lungs. It is important to distinguish between “active tuberculosis” or “tuberculosis disease,” which is characterized by abnormalities in the lungs, and “latent” or “dormant” tuberculosis, in which the patient experiences no symptoms and is not contagious. Tuberculosis is spread through the air, via repeated exposure to an active TB carrier’s coughing and sneezing.

How many Smith College students are confirmed to have active tuberculosis?
One. The college physician learned of her probable case of TB on Nov. 22 and notified the campus community as soon as classes resumed after Thanksgiving break on Nov. 26. The student is undergoing antibiotic treatment and will be able to return to campus once it is determined she is no longer contagious. 

What are the clinical signs of tuberculosis?
The most common symptoms of TB disease are coughing, fever, loss of appetite, weight loss, weakness, night sweats and feeling very tired. No single symptom would be likely to trigger the need for TB-specific testing. Rather, a clinician would take into consideration a constellation of symptoms.

How is tuberculosis diagnosed and treated?
A skin test, known as a PPD test, can detect latent tuberculosis. A chest x-ray is needed to diagnose active TB. Thus, a positive skin test does not necessarily indicate active TB. It can indicate exposure to TB or a previous TB vaccination. Anyone with a positive PPD test needs to have a chest x-ray to exclude the possibility of active tuberculosis. Further, even if a chest x-ray confirms an individual doesn’t have active TB, standard protocol recommends a six-to-nine-month course of antibiotics as treatment for latent TB. The antibiotics used to treat latent and active TB are covered by most medical insurance plans.

Who is being screened for tuberculosis exposure?
Although TB is an infectious disease, the possibility of spreading it through casual contact is low. Smith is following the testing protocols of the Massachusetts Department of Public Health, which has recommended that the college test the student's close contacts, those in her classes, residents of her house, and others with whom she had regular contact.

Of this group of 267, 263 have been screened, either through PPD skin tests or chest x-rays. The remaining 4 individuals are not on campus for unrelated reasons.

What are the test results to date?
A total of 32 individuals had positive PPD skin tests. Of these, many positive results likely reflect previous vaccination with BCG (see below) and/or previous positive PPD tests. Every individual with a positive skin test had a normal chest x-ray. None has active tuberculosis and none is contagious.

As stated above, even if a chest x-ray confirms an individual does not have active TB, standard protocol may recommend a six-to-nine-month course of antibiotics to someone with a positive TB test. Dr. Jaffe accompanied 13 students and one employee to Baystate Medical Center’s tuberculosis clinic, where they had the opportunity to meet with a specialist to discuss antibiotic treatment. Such treatment was recommended for 11 of these 14 individuals.

The Massachusetts Department of Public Health recommends a final PPD screening test be conducted approximately 10 weeks after the last possible exposure to active tuberculosis. On February 12, from 10 a.m. to 2 p.m. at the Campus Center Carroll Room, the 231 contacts with a negative PPD will be retested.

Are Smith students screened for tuberculosis?
In order to matriculate, every Smith student must present proof of tuberculosis screening, using forms and protocols developed by the Massachusetts Department of Public Health.

Why doesn’t Smith require a tuberculosis vaccine? Do other colleges?
While the bacille Calmette-Guérin (BCG) vaccine is used in many countries with a high prevalence of TB, it is not generally recommended for use in the United States except for very select persons who meet specific criteria. People who have had BCG vaccine can still get TB infection, and many still get active TB disease. Some international students who come to college in the United States have been vaccinated but the majority of domestic students have not. More information about the BCG vaccine is available from the Centers for Disease Control.

How can I learn more about tuberculosis in the United States?
The Centers for Disease Control, Division of Tuberculosis Elimination

The Massachusetts Department of Public Health, Tuberculosis Prevention and Control

Smith College Health Services

Last updated: Feb. 1, 2008

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