TB Reported at USF

Steve Huard, Public Information Officer
Florida Department of Health - Hillsborough County
(813) 307-8044

Lara Wade, Media/Public Affairs Manager
University of South Florida
(813) 974-9060


TAMPA, Fla. (July 16, 2013) – A confirmed case of tuberculosis (TB), involving a University of South Florida student on the Tampa campus, has been reported to the Florida Department of Health in Hillsborough County. Currently, the student is undergoing TB drug therapy, recovering in isolation, and is no longer a health risk to others. With assistance from the University, the Florida Department of Health in Hillsborough County Tuberculosis Center has notified approximately 90 students, faculty, staff, and community members who were at risk of exposure and will begin testing this group next week.

“USF and the Department of Health are working together to ensure the health and safety of all students, employees, and members of the student’s community,” said Florida Department of Health - Hillsborough County Tuberculosis Center Manager Jylmarie Lewis.

This is the first case of TB on the campus in 2013 – the last case of TB at the University was in May of 2012 – and the incidents appear to be unrelated.

TB is a disease that usually infects the lungs, but can affect other parts of the body, causing serious illness. It is spread when an infected person coughs, talks, sings, or sneezes untreated TB germs into the air. Persons who breathe in the germs can become infected—typically, only persons who have had very close, day-to-day contact with the infected person run the risk of contracting the disease. TB is less contagious than measles, mumps, chicken pox, and influenza, and, even if a person is infected, the disease may remain dormant and not contagious to others. For more information about TB, visit www.cdc.gov/tb/publications/factsheets/general/tb.htm.

Students and employees of USF with additional questions may call the Student Health Services nurse line at (813) 974-1797, Monday through Friday, from 8:00 a.m. through 5:00 p.m. If a student or employee not identified/notified by the Department of Health wants to be tested for TB, they may schedule an appointment at Student Health Services by calling (813) 974-2331. Student Health Services will charge for services rendered.

All other inquiries can be directed to the Florida Department of Health in Hillsborough County at (813) 307-8047.

Tuberculosis (TB) Frequently Asked Questions
Source: Hillsborough County Health Department

Is this related to the 2012 cases of TB at USF?
Our investigation to date indicates this is an isolated case of TB, as were the last cases of TB associated with the University.

What does skin testing involve?
Placing test material, called tuberculin, under the skin. In 2-3 days it is checked to see if there is a reaction. This is the most common test used for TB testing; however, the Department of Health is recommending a blood test for those who have been exposed.

What does TB blood testing (aka interferon-gamma release assay (IGRA) testing) involve?
TB blood testing or IGRA identifies the presence of TB infection by measuring a person’s immune response. Unlike the skin test, only one visit is required to obtain the blood sample to test for reaction.

How did the Department of Health determine who should be tested?
TB has been around for a long time; so we know how it is spread, who is at-risk, and in what situations it is most likely to pass from one person to another. By speaking with university officials, we were able to determine those students, faculty and staff with the longest and closest contact with the person who has TB.

Why isn’t the whole university being tested?
Testing is used to help us determine if the infection has spread from this one person. An estimated 5-10% of students, faculty and staff at the university already have TB infection, based on Centers for Disease Control and Prevention (CDC) information and United States estimates. If we tested everyone, we would not be able to identify if we have actually had TB spread at the school. By first limiting the number of people tested, to those with the closest contact, we can identify the risk of spread to the rest of the student, faculty and staff population.

Why isn’t the test being done until July 24, 2013?
To allow us time to answer your questions, provide accurate information, and be sure we can appropriately follow-up on the test results all within a short period of time. It also gives us the opportunity to let the university and you know before the end of the semester if we need to take any other actions at this time. We feel it is in the best interest of everyone’s health to make informed decisions. First, know that TB is treatable and curable. It can take up to 8 weeks to find someone with a positive TB reaction after they came into contact with a person with TB. We want to be sure we are able to track and appropriately follow those with the greatest risk. By testing on Wednesday (July 24, 2013), we can answer your questions so you can make an informed decision about being tested. We do not want to miss anyone. By doing the TB testing on Wednesday, July 24, 2013, we can return the following Wednesday, July 31, 2013 to give everyone tested their results and recommendations. We have planned things to take the best care of each of you.

Why isn’t the university being closed?
Being at the university at this time does not pose a health risk for TB infection. The TB germ was first identified in 1882. TB itself has been in existence since ancient Greek times. Thus it has been well studied. We know how TB is spread, we know how contagious TB is, we know what conditions make the spread of TB easier or more difficult, and we know how long it takes from the time of contact (exposure) to the time of infection (up to 8 weeks). Because we know all this information, you can be assured that we can identify who needs testing, and perform that testing without further interrupting the university’s curriculum or extra curricular activities.

What happens if other students, faculty or staff come up positive for TB?
We expect to see positives. About 10% of US born and up to 33% of foreign born persons test positive for TB. A positive TB test means a person has been infected (non-contagious) but it doesn’t mean they have the disease (contagious). An evaluation of their risks outside of the university will be made to see if the infection came from the university or had another possible source. We will also provide examination through the health department for symptoms, and provide chest X-rays as indicated, for those identified as contacts.

What causes TB?
TB is caused by a bacteria or germ.

How is it spread?
Through respiratory droplets carried on the air.

How long does it (TB) stay in the air?
That depends on the air flow and air exchanges in a room. Consultation with university staff has provided information on who may have been in closest proximity to the person with TB. At this time, there are no indications to test the entire university.

What about common areas, like the Marshall Student Center?
TB is transmitted in small, close environments; the Marshall Center is open and airy. Sunlight kills the TB germ. We feel confident that the targeted testing group will be able to answer the question of whether transmission may have occurred at the university. If necessary, we will provide testing to the entire student body, faculty and staff. We do not anticipate that will be necessary.

Is there cleaning that needs to be done at the university?
The TB germ must be breathed in to cause infection. Regular routine cleaning of the university is all that is needed.

Can I take this home to my family?
Remember, only a person who is sick with TB disease can spread it. A person with infection (i.e., no symptoms) cannot spread the germ. By finding out who has infection, we can then see if any of them are sick. Until then, there is no need to be concerned about bringing TB home. Good hygiene, such as covering your nose and mouth when coughing or sneezing, washing hands well, and staying home when you are sick are the best preventive measures for all types of illnesses.

Can TB be cured?
Yes, TB is treatable and can be cured. That is why we are doing the screening and testing. If someone is infected, there is a preventive treatment that can be offered to keep that person from getting sick.

What is the preventive treatment?
Preventive treatment for TB consists of one anti-TB medication and one vitamin, taken daily, for nine months.

What are the symptoms or side effects of TB?
The symptoms of TB include a cough lasting more than 3 weeks, night sweats lasting more than a week, unexplained weight loss, a productive cough, or coughing up blood. The “side effects” of TB may include fatigue or tiredness, shortness of breath, and chest pain or tightness.

Are any other institutions affected by TB at this time?

If my child or I have underlying respiratory illnesses, like bronchitis or asthma, are we at greater risk?
No. Underlying health or medical conditions do not make TB infection more likely. However, if a person with an underlying health condition is infected they may be at higher risk for getting sick. This is another reason why only testing those who are at risk for exposure is important. That way we can find out who has the infection and needs further follow-up.

What if I want myself or others in my family tested and our names are not on the list?
The Florida Department of Health does not recommend TB testing for people who are not at-risk for infection (in other words they have not been exposed). If you want to pursue testing then please call your doctor or visit a walk in clinic for testing. You may also contact Student Health Services at 813-974-2331; there will be a charge for testing anyone who has not been recommended by the Department of Health for testing.

I am taking immune suppressive drugs, how does that affect me?
As with underlying illnesses, taking immune suppressive drugs does not make someone more likely to have been infected. Again, it is important if you are on the list to be tested to get the TB test. If you are infected, we can recommend medical follow-up. You can also consult your doctor who is prescribing those medications.

I am pregnant or a family member is pregnant. Is testing safe for them?
If you are at-risk for exposure and are pregnant (your name is on the list), it is safe for the testing to be done. If the pregnant woman is infected, we work with her obstetrician to make sure she is in good health for her and her baby’s safety. Generally, we wait to give preventive treatment until 3 months after the baby is born. If a pregnant person has not been exposed or in contact with the person who has TB, than no testing is indicated.

What is “close prolonged contact”?
There is a general rule that at least eight hours of close prolonged contact time must have occurred for someone to be in enough contact with a person with TB for spread of the bacteria to happen.

What if I passed the person with TB in the hall or the Marshall Student Center or somewhere else on campus?
Sunlight kills the TB germ, so any outside activities are excluded for exposure consideration. Because of the way air circulates throughout the buildings, we are concentrating our testing only on those people who have been in a closed environment (e.g., classroom) with the person with TB. There is a general rule that at least eight hours of close prolonged contact time must have occurred for someone to be in enough contact with a person with TB for spread of the bacteria to happen.

Is it possible that additional testing may be offered?
We will have additional information to review after the testing in July, to determine if any further testing is needed. That is why we are testing this targeted group of people first. It will allow us to determine how much, if any, spread of the TB germ may have occurred at the university. We fully expect that some people will be infected. That does not mean that infection occurred at the university. 5-10% of our population has TB infection. We will review the results of testing so we can inform you as soon as possible if additional testing is needed. We are fully prepared to offer more testing if necessary.

What if we find more positive TB tests than expected?
This is an ongoing investigation. Each new piece of information provides us the ability to review what we know and if necessary, update our recommendations. We are fully prepared to provide more testing if needed. We use a process called a concentric circle approach. You can think of it as a stone thrown into a pond. You know how the waves come out in circles? Well that is how we do contact investigations with TB. We test the inner circle first. If we see that TB has spread in that circle, we test the middle circle. If we see that TB is spread there, we do the outer circle and so on. Our responsibility is to each of you, the students, faculty and staff at the university, and really, everyone who lives or visits Hillsborough County.

What if I am tested but was not recommended, and the test comes back positive?
Whoever does the test for the TB should be prepared to follow-up with you--whatever the test results. If it is your own doctor, he/she needs to do the follow-up. Follow-up for a positive TB test includes assessment for other TB risks, symptom screening and a chest X-ray. There is a preventive medicine that may be prescribed for a person with a positive TB test. This is one medicine given for 9 months, along with a vitamin. This medicine kills the TB germ/bacteria in the body and prevents a person from developing TB disease or getting sick with TB. If a person is sick with TB, the treatment for TB disease or sickness includes 4 medications, given for at least 2 months, usually followed by 2 medications for at least 6 months. Each case is treated individually.

Is there a vaccine or prevention against TB?
There is no TB vaccine given in the United States. TB is not a common illness here; there is an average of 80 cases reported in Hillsborough County each year. That is 80 in a population of 1.2 million. Since TB is not common in the US, no vaccine is given. In 2003, the CDC recommended against routine testing for TB because it is no longer common. Nowadays we only test those who have a risk for TB, such as contact with a person with TB or moving to the US from a country in which TB is common. As mentioned above, if a person tests positive on the test for TB, then an assessment will be made to determine whether medication, and which medication, is appropriate.

When did the university find out the person had TB?
The Florida Department of Health was notified of a presumptive case of TB on Monday, July 1st, and had contact with university authorities that same week. We took time to find out more information about the person with presumed TB and met with University officials on Tuesday, July 9th. It was important to understand the university environment before contacting students, faculty and staff—we wanted to provide you with the best available information as quickly as possible. Letters were sent to those recommended for testing on Monday, July 15, 2013.