Tuberculosis? In Berkeley?!
Tuberculosis (TB) is one of the world’s most common infectious diseases: one third of the world’s population is infected with TB, and many do not know it unless they become sick (which only 5-10% do). A total of 9,557 TB cases (a rate of 3.0 cases per 100,000 persons) were reported in the United States in 2015. Despite remarkable progress against TB over the last 100 years, TB is still diagnosed in California every four hours and we have several new cases of active TB per year in Berkeley. It is not at all uncommon to find out that at some point in your life you have been exposed to TB, especially if you have travelled!
Wait, what, I might have been infected and I don’t know it?
Approximately 6% of California’s population has latent (inactive) tuberculosis, higher in foreign-born populations. While it is a good idea to discuss treatment of latent TB with your healthcare provider in order to reduce the risk of it becoming active in the future, your health is NOT currently at risk when you have latent disease and you are not infectious to others.
Is TB treatable?
Yes! Latent (inactive) TB can be treated with a 12 week regimen of antibiotics. Active TB takes longer, but is extremely likely to be successful in the United States, especially if it is not drug-resistant -- which this case is NOT. Public Health works closely with the team caring for active cases to ensure that treatment is appropriate and cure is confirmed.
How does the Public Health Department figure out who has been exposed?
There is an entire field of Public Health dedicated to “Contact Investigation” and a standard protocol that includes interviewing the index case and family, reviewing schedules and staffing/school plans, visiting buildings where the case has spent time to confirm everything from room size, common spaces, and air circulation patterns, and re-evaluating continually to incorporate new data. They do all this while doing everything possible to maintain the confidentiality of the index case and cannot share that information by law.
I haven’t been told I am at risk, but I am worried as some of my coworkers have! What should I do?
It’s important to keep the current situation in context. Public Health officials use a standard algorithm (see above) in deciding who might be at risk based on proximity to the index case, duration spent near them, and air circulation/space. Someone with casual contact in a stairwell or lobby or sharing bathrooms is NOT at risk. However, if you still believe you are at risk, please contact Occupational Health at UHS or your own clinician.
I spend a lot of time in the 4th street building -- why haven’t I been contacted?
Air circulation in the 4th street building is restricted to each floor, and your work period or duties may not overlap significantly with the index case.
I’m worried about my family at home! What if I am positive? I don’t want to risk infecting them.
If you have been exposed, test positive when you are screened, or have tested positive in the past, and do not have any symptoms, you are extremely unlikely to have active TB or to be infectious. OHC/your clinician will order a chest xray and interview you to confirm as soon as the results become available. If you have symptoms, you should be evaluated. Of course, most coughs are not TB, but it is always a good idea to practice good hygiene and cover a cough to prevent spreading illnesses -- like the cold or flu -- to others.
What are the symptoms of active TB?
Symptoms can include persistent night sweats, cough, fevers, weight loss, fatigue, or coughing up blood. Rarely, TB can present in parts of the body outside the lungs/throat, but then you are not infectious.
How can I feel safe being at work with all of this going on?
There is no ongoing risk of exposure as there is to our knowledge no-one with infectious TB currently at work. The Public Health Department monitors all active cases, by law, and uses rigorous testing in accordance with a standard protocol to ensure that people with active TB stay in quarantine until they are no longer infectious. They also work closely with treating providers to ensure that medication is taken properly without gaps and adjustments are made as appropriate.
This sounds like a serious disease! Why isn’t everyone just tested?
The University of California follows CDC and CDPH guidelines in screening students and staff considered to be at risk. Testing everyone, including low-risk individuals, would lead to lots of false positive results, causing anxiety and risking complications of unnecessary testing and treatment.