Highlights
- •The risk of nosocomial tuberculosis transmission to neonates in a neonatal intensive care unit environment remains.
- •All exposed neonates should receive isoniazid treatment after nosocomial tuberculosis exposure.
- •We handled exposed neonates and health care workers safely with appropriate screening and treatment.
Background
Nosocomial transmission of tuberculosis (TB) in a neonatal intensive care unit (NICU)
is a recognized risk. We investigated TB transmission to neonates and health care
workers (HCWs) exposed to a nurse with active TB in a NICU.
Methods
A NICU nurse in a tertiary referral hospital in Seoul, Korea, developed pulmonary
TB. The investigation included 108 infants and 75 HCWs. Tuberculin skin test (TST)
and chest radiograph were performed at baseline. Isoniazid prophylaxis was started
in neonates. After 3 months of prophylaxis, infants underwent repeat TST and chest
radiograph. HCWs underwent a second TST after 3 months.
Results
Baseline chest radiographs were negative in infants and HCWs. Four (3.7%) of 108 infants
screened had a positive TST, including 2 conversions, and received isoniazid for 6-9 months.
Among the 59 HCWs screened, 27 (45.8%) had an initial positive TST result, and 6 (10.2%)
had a positive TST result at 3 months. Four of the 6 HCWs with TST conversions received
isoniazid treatment for 9 months. In the 2-year period after exposure, none of the
exposed infants or HCWs developed active TB.
Conclusion
In this investigation, 4 (3.7%) of 108 infants exposed to a nurse with active TB developed
latent TB infection. They were given isoniazid therapy without any adverse events
and did not progress to TB disease in the 2 years after exposure.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Childhood pulmonary tuberculosis: old wisdom and new challenges.Am J Respir Crit Care Med. 2006; 173: 1078-1090
- The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection.Lancet Infect Dis. 2007; 7: 282-288
- Guidance for national tuberculosis programmes on the management of tuberculosis in children.World Health Organization, Geneva, Switzerland2014
- Brief report: congenital tuberculosis.N Engl J Med. 1994; 330: 1051-1054
- Management of newborns after nursery exposure to tuberculosis.Am Rev Respir Dis. 1974; 109: 415-419
- Nursery exposure of 528 newborns to a nurse with pulmonary tuberculosis.Southampt Med J. 1978; 71: 7-10
- Neonatal exposure to active pulmonary tuberculosis in a health care professional.CMAJ. 2005; 172: 1453-1456
- Exposure to pulmonary tuberculosis in a neonatal intensive care unit: unique aspects of contact investigation and management of hospitalized neonates.Infect Control Hosp Epidemiol. 2007; 28: 661-665
- A contact investigation of the transmission of mycobacterium tuberculosis from a nurse working in a newborn nursery and maternity ward.J Infect Chemother. 2008; 14: 66-71
- Nosocomial pulmonary tuberculosis contact investigation in a neonatal intensive care unit.Infect Control Hosp Epidemiol. 2013; 34: 754-756
- A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery.Clin Infect Dis. 1998; 26: 303-307
- Miliary tuberculosis in two infants after nursery exposure: epidemiologic, clinical, and laboratory findings.Am Rev Respir Dis. 1976; 113: 267-271
- Arch Pediatr. 2012; 19 ([French]): 396-403
- The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era.Int J Tuberc Lung Dis. 2004; 8: 392-402
- Congenital tuberculosis in a neonatal intensive care unit: case report, epidemiological investigation, and management of exposures.Clin Infect Dis. 1998; 27: 474-477
- The tuberculin skin test.Clin Infect Dis. 1993; 17: 968-975
- Clinical features, diagnosis, and treatment of tuberculosis in infants.Pediatrics. 1994; 94: 1-7
- Exposure to open tuberculosis on a neonatal unit.J Paediatr Child Health. 2006; 42: 557-559
- Letter: management of newborns after nursery exposure to tuberculosis.Am Rev Respir Dis. 1974; 110: 522-523
- The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era.Int J Tuberc Lung Dis. 2004; 8: 278-285
- The seventh nationwide tuberculosis prevalence survey in Korea, 1995.Int J Tuberc Lung Dis. 1998; 2: 27-36
- The role of TST in the diagnosis of latent tuberculosis infection among military personnel in South Korea.Int J Tuberc Lung Dis. 2006; 10: 1342-1346
- A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements.Thorax. 2002; 57: 804-809
- Influence of Bacille Calmette Guerin vaccination on size of tuberculin skin test reaction: to what size?.Clin Infect Dis. 2005; 40: 211-217
- Comparison of two commercial interferon-gamma assays for diagnosing mycobacterium tuberculosis infection.Eur Respir J. 2006; 28: 24-30
- Tuberculosis among health care workers.N Engl J Med. 1995; 332: 92-98
- Connatal tuberculosis in an extremely low birth weight infant: case report and management of exposure to tuberculosis in a neonatal intensive care unit.Eur J Pediatr. 2001; 160: 88-90
- Tuberculosis in healthcare workers caring for a congenitally infected infant.Infect Control Hosp Epidemiol. 2004; 25: 1062-1066
Article info
Publication history
Published online: August 23, 2015
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
