I work in a hospital, though not in a patient care area. “Health care providers” in the hospital must adhere to some periodic testing and immunizations, but the rest of us, everybidy from the janitors to the CEO, have a single universal requirement – an annual TB test. I’ve asked why at the office, and I get shrugs and comments about health regulations. And I’m sure it’s true, we wouldn’t go to the enormous effort of doing it if we didn’t have to.
Is the focus on TB an no-longer-needed holdover from some past outbreak? Is it truly so dangerous? The hospital doesn’t care whether I have syphillis, AIDS, or congstive heart disease for that matter, at least enough to test me for it.
And what can they do to me, employment-wise, if I ever test positive?
Well, I’m not a doctor, but…tuberculosis is contagious, fatal if not treated, can be spread by a cough or sneeze, is increasingly resistant to antibiotics, and apparently is making somewhat of a comeback. What’s more, unlike most other diseases that are spread by respiratory infection (like the flu), it’s a long term disease and there may not be obvious symptoms. You can spread it to a lot of people if you’re infected. So, particularly in an environment where you have a lot of immuno-suppressed people, it pays to take precautions.
IIRC, TB has a particularly long incubation period - so any worker in a hospital would be exposing many many vulnerable people to the illness without seeing symptoms themselves.
It is a bad disease. The bacteria is surrounded by a waxy coat which excludes most drugs and make it difficult for the body to recognize and kill. Drug therapy for TB is difficult for these reasons, and because it quickly gets multiple drug resistance quickly. It can wreak havoc in a person with a normal immune system, not to mention the immunosuppressed with HIV or chronic illness. Multi-drug resistant TB comes out of improperly treated people and spreads quickly in places like prison. There is no vaccine and it will kill you if it goes active or becomes disseminated and is not treated.
The standard drug therapy is a 6 month, 4 antibiotic course. After it is proven that the bug is susceptible to a particular antibiotic, the other drugs can be withdrawn after a few months. If you happen to have a history of noncompliance, you can be forced by law to take the drugs in a monitored setting. If you happen to have a 4-drug resistant TB and are noncompliant, I believe you can be forcefully institutionalized for IV drug therapy. There aren’t many diseases like that anymore.
Well, yes.
But then there’s very few cases of tuberculosis in the Western world (and most of them among recently arrived immigrants from risk areas) - not exactly the people who work in hospitals. I’d think annual TBC test are more of a traditional mantra while other disease - let’s say variants of hepatitis - seem to be much more of a problem (they are only transmitted via infected blood - yet the chance of that happening shouldn’t be to out of the way in a hospital out of all places).
One of my students (not an immigrant) had tuberculosis. I don’t think it is as rare as you might think.
All of the students and teachers in his classes were tested – all except me, that is. I was out sick the day that they came to test and the principal forgot to tell me about it. It was later that I learned that I had been exposed.
Hmmm…you guys have just reawakened a long-ago-disappeared paranoia of mine. One of the fun parts of a prior job of mine was interpreting in deportation hearings in prisons. This meant I was exposed to a) prison inmates b) who were mostly from high-risk areas of the world. I had a TB test, but it was years ago. Should I have another one?
Back when I was in school (when dinosaurs roamed the earth) every child in my school system had a TB test every year. I don’t know if it was a law then or just a local thing. Teachers had to have a chest X-ray as well before they could be employed.
As others have said, this is a nasty, insidious disease, often fatal, hard to treat, easy to spread.
Back in those days, the reason they required teachers to have a chest x-ray was that the tine test only showed if you had any antibodies to TB germs; that is, you had been exposed and your immune system had been strong enough to fight it off. The supposition was that many adults had been exposed to it at some point. The disease can lie dormant for a long time. The school nurses told us that if you’re exposed, one of the thing your body does is to sort of “seal off” the TB infection to keep it from becoming active and doing you harm. But if you became run down or seriously ill, it would break loose.
So, yes, the testing requirement is due to “health regulations.” A good thing, too.
Yep, it’s alright to still have the test for TB (I had to have one some years ago prior to a spell of teaching in the UK). Still I think it’s very much a traditional thing, rather unrelated to present-day risk (anybody know about a teacher invecting his/her students with any kind of contagious disease - and I mean in the Western world).
It’s another story for hospitals of course. And there the sole focus on TB is rather startling. I’d think that these days the risk of someone working in a hospital infecting patients with something like Hepatitis is much higher than infecting anybody with TB - not to mention measles or scarlett fever - which can be quite serious in adults.
BTW a recent (and completely unfounded) scare in the UK about the MMR vaccine (measles, mumps and rubella) that was puported to cause autism has led to an alarming increase to the rate of those infections (due to scared parents having there kids no longer vaccinated) seems to me to be much more a sign of the times. Frequently, today, there’s not much relation between real risk and perceived risk. Some vaccinatons / exams are done for traditional reasons (and I’m not suggesting there’s anything wrong with TB tests), others are not being done at all, and others are being abandoned because of unfounded health scares.
If a hospital worker has Hepatitis B or C, s/he is likely to accidentally infect a very small number of patients, given that fluid exchange is the mode of transmission. With TB, all it would take to infect a large number of patients and staff is one worker coughing while traveling around the hospital. Also, unlike TB, diseases like measles have vaccines, and most American adults have either received the vaccinations or had the disease.
The hospital can require you to undergo the necessary drug treatment to insure you’re not infectious. So take isolation precautions seriously, and wear your respirator mask when indicated!
I am actually helping to fight TB, my laboratory (we solve structures of required enzymes in TB which can be used for drug design) is part of the TB Consortium, a worldwide group who takes different angles at fighting the disease and pool their knowledge.
TB infects over two billion people - or 1/3rd of the earth. I found a site that says over a billion people have died from it in the last 2000 years. It still claims millions a year.
TB cases rose during the Industrial Revolution due to the close living quarters but has since declined due to increased living conditions in the civilized world. The people infected are more likely to die of cancer or an accident since our immune systems are able to block off the areas infected in the lungs which help to contain the bacteria.
A professor recently told me that it’s only ~10 to 100 bacteria in the lungs of an infected person and they basically hang around forever - getting gobbled up by a macrophage and released and gobbled up again. Here the bacterium can detect increased nitric oxide which is used by our immune sysem to fight it, and it goes into a dormant state.
But like others said a carrier in a hospital can be a bad thing around all those immunocompromised patients. Oh and evidently some popular Rheumatoid Arthritis drugs can block TNF which allows the cysts which contain the bacteria to dissolve, which is very, very bad.
When my mom was still alive she worked as a charge nurse at a retirement home. Every employee was given the test on a scheduled basis, right down to the cooks. TB is so easily passed, and the elderly are so susceptible to communicable disease, there really isn’t a reason not to do it. I would think if came up hot, they’d limit any contact with patients untill you were no longer contagious.