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No new active cases of TB
2 with disease doing well, official says

By Eric Fleischauer 340-2435

None of the 165 Wayne Farms employees who tested positive for tuberculosis last week show signs of active tuberculosis disease, according to the area administrator for the State Department of Public Health.

"At this time, we have no positives. They tested positive on the skin tests, but all the other tests were negative," said Judy Smith.

Some test results, which take longer to evaluate, are not complete. All the chest X-rays of the employees have been read, however, and none showed signs of active TB disease.

One out of hospital

That means that, of 212 tested employees at the fresh processing plant, only one showed signs of active tuberculosis disease. A former employee with active tuberculosis, whose diagnosis triggered the mass testing, has left the hospital and is in "good condition," Smith said.

Both of those with active tuberculosis are doing well, she said.

Officials expected a high percentage of the employees to be infected by the TB bacteria — which those who test positive on skin tests generally are — because a majority of the fresh-processing-plant employees were born in countries with a higher rate of TB than the United States.

Being infected by the TB bacteria, however, is not that unusual. Eight to 10 percent of Alabama's general population has a latent TB infection.

Latent TB infections have no symptoms and are not contagious, but last for life if not treated. About one in 10 latent infections progress into active TB disease, which often is fatal if not treated. Treatment, however, drops the mortality rate by more than 99 percent.

An antibiotic — which Smith said is being provided to all those who tested positive on the skin tests — eliminates the infection after a treatment regimen lasting six to nine months.

Smith said testing of other close contacts of the two workers with active TB — including members of their households — showed them to be free of active TB disease, too.

"There are no other cases except those two at this point," Smith said.

Smith said that, even with the TB scare at Wayne Farms, the seven-county area encompassed by Area 2 of the state health department has no more active TB disease cases than last year.

"In 2006, we had 31 cases of tuberculosis," Smith said. "To date we have 25 in 2007."

Area 2 includes Lawrence, Limestone and Morgan counties.

In September 2006, officials administered skin tests to 74 Wayne Farms employees after they had contact with an employee suspected of having the disease. Twenty-six tested positive.

Smith said the mass testing of Wayne Farms employees has taken its toll on health department nurses and staff.

"The biggest hit to us has been the mass volume of skin tests," Smith said. "It's been compounded for us because it's also flu vaccine season. We needed to divert some of our attention from flu vaccinations to mass testing for tuberculosis."

Complicating the process, she said, was the fact that many of the tested employees did not speak English.

Wayne Farms officials said they have offered to reimburse the state for the cost of the TB tests.

Scott Jones, interim director of the division of tuberculosis control with the State Department of Public Health, said he would prefer that Wayne Farms invest its money in screening employees for TB when it hires them.

Smith said that while active tuberculosis disease is contagious, it is very rare for an infected individual to have active TB. Their immune system generally will protect them, so they would have the noncontagious and asymptomatic latent TB infection.

"Those people who are at greatest risk tend to be young children, because their immune system is not as well developed, and older folks because they tend to have other health problems going on," Smith said.

Moreover, those who are contagious generally have obvious symptoms.

"People (with active TB disease) generally are sick," she said. "They have a cough. They're producing sputum. They have unexplained weight loss and hoarseness."

Smith said the two workers with active TB disease have responded well to a four-drug treatment regimen. Only one of them, a former Wayne Farms employee, had symptoms from the disease. He was hospitalized.

"He's doing extremely well. He responded to medication without difficulty," Smith said, "and he is no longer hospitalized."

She said preliminary analysis of his sputum indicates he is no longer contagious, but health officials are waiting on cultures to confirm this.

Some forms of TB are resistant to drug therapy and thus pose a risk of triggering an epidemic. Smith said the fact that the two workers responded well to medication means they do not have a drug-resistant form of the disease.

Both employees with active TB disease worked in the first shift at the fresh processing plant.

Smith said initial tests of the other employee indicate that he, too, is no longer contagious.

She said that some of the positive skin tests could have resulted not from TB infection, but from a tuberculosis vaccine that often is administered to children in Mexico and other countries, but not in the United States.

According to Dr. Karen Landers, the BCG vaccine can cause a TB skin test to show a slight reaction long after the vaccine is administered. She said that would not cause a positive skin-test result if, as is usually the case, nurses are labeling as positive only those reactions that affect at least 10 millimeters of skin around the inoculation site.

Smith said the cutoff used for the Wayne Farms employees, however, was 5 millimeters. She said this means that, if they received the BCG vaccine as a child, it could trigger a positive skin test.

Despite this possibility, Smith said, all those who tested positive are being treated as if they have a latent TB infection. The main treatment offered is the antibiotic isoniazid. The health department cannot require those with latent TB infection to take the medication.

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