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Tuberculosis (TB) in the Child Care Setting

Tuberculosis (TB)

TB is a disease caused by bacteria called Mycobacterium tuberculosis. These germs can be spread from one person to others. These germs can be spread through the air when a person with TB disease coughs, sneezes, yells, or sings. Children, although they may be infectious, usually are not as likely as adults to transmit TB to others. (TB is not spread by objects such as clothes, toys, dishes, walls, floors, and furniture.) When a person is sick from the TB germ, the person has TB disease. TB can be serious for anyone, but is especially dangerous for children younger than 5 years old and for any persons who have weak immune systems, such as those with HIV infection or AIDS.

You should know the difference between the two stages of TB: (1) TB infection is just having the TB germ in the body without being sick, and (2) active TB or TB disease is having the germ and also being sick from it, with the symptoms of active TB (see description of symptoms below).

When a child has TB infection, it means that the child was infected by an adult with active TB--often a person in the home. Most persons who have TB infection do not know it because it does not make them sick. A person with only TB infection cannot spread TB to others and does not pose an immediate danger to the public. TB infection is diagnosed only by the TB skin test. This safe, simple test is given at most local health departments. A small injection is made under the skin, usually on the forearm. In persons who are infected with the TB germ, the skin test causes a firm swelling in the skin where the test was given. After 1 or 2 days, a health care provider reads the results of the TB skin test.

A TB-infected person can take 6 to 12 months of medicine, usually isoniazid, to get rid of the TB germs and to prevent active TB (the illness with symptoms). This preventive treatment is most important for TB-infected children younger than 5 years old, persons infected with the TB germ within the past 2 years, and TB-infected persons who have a weak immune system (especially HIV infection or AIDS) because these persons are more likely to get active TB after infection.

Active TB (when infection develops into a disease with symptoms) is preventable and curable. Active TB can attack any part of the body, but it usually affects the lungs. Persons with active TB in the lungs may spread TB germs through the air by coughing, sneezing, or yelling. People who share this air have a chance of breathing in the germs and getting the infection in their lungs, too.

Persons with active TB have symptoms such as a cough that “won’t go away,” a cough that brings up blood, a fever lasting longer than 2 weeks, night sweats, feeling very tired, or losing a noticeable amount of weight. The TB skin test cannot show active TB -- active TB must be diagnosed by a physician, based on a physical exam, a chest x-ray, and laboratory tests. The treatment for active TB usually involves taking at least 3 different drugs and lasts for at least 6 months and usually cures the TB. The law states that doctors must report active TB to the local health department.

In child care settings, TB has been spread from adults to children, although the spread of TB in such settings is rare. In family home child care settings, TB infection has been passed from sick adults living in the home to children, even thought the sick adults may not have been taking care of the children directly. As noted before, a person with only TB infection cannot infect another person. Only a person with active TB can infect another person. Also, children younger than 5 years old who have active TB usually cannot infect other persons. The spread of TB from child to child in a child care setting has not been reported. Still, children under 5 years old who have active TB should not attend child care until they have been given permission. Usually, they may return to child care as soon as they are feeling well and on medication, but this should be decided by the local health department. (Well children should not be kept out of child care if they only have a positive skin test result.)

In the United States, TB is more common in some populations, for example immigrants coming from Asia, Africa, and Latin America and medically underserved minority populations. However, overall, TB infection in children younger than 5 years old is rare. Therefore, TB skin testing of all children in child care centers is not useful. However, a local health department may decide to test children who have more risk for infection. Some programs (e.g., Head Start) and some states require children to have a TB skin test before they can attend. A child who has a positive skin test result should be seen by a doctor to check for active TB and to start medicine that will prevent TB disease, if appropriate. A child should not be kept out of child care only because of a positive TB skin test result.

Persons who are beginning work as a child care provider should have a TB skin test to check for infection with TB bacteria. See the section on health history and immunization policy for child care providers for more information on tuberculosis screening for child care providers. Child care providers who comes from a community with high rates of TB may want to take preventive medicine so they will not develop active TB. Local health department TB control programs can help with these activities.

Note: This information is not intended to take the place of your state's or locality's child care regulations and laws. In every case, the laws and regulations of the city, county, and state in which the child care facility is located must be carefully followed even if they differ from these recommendations.

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