Tuberculosis from Abroad

Coughing from Afar

At what price must we constantly relax the standards of our nation to accommodate vacancies in hard to fill jobs? Case in point, disturbing news of a foreign born health worker, perhaps, infected up to 700 people with TB, not to mention over 200 infants. Below is a grisly reminder that we are only as safe as the health standards of countries that we exert little influence over when we relax restrictions on foreign born workers.

• For three weeks beginning in January, about 700 workers and patients at St. Barnabas Hospital in the Bronx , including 238 infants, were exposed to tuberculosis by an infected nurse.
• After the unidentified, foreign-born woman had developed a cough, she continued to report for regular shifts in the maternity ward and the nursery at the facility.
• When she finally reported her cough to a doctor, he noticed that she'd earlier tested positive for latent TB.
• A chest X-ray showed that the disease had turned infectious.
• Following Centers for Disease Control and Prevention guidelines, the nurse was isolated in her home while she began a drug regimen.
• On March 15, when almost two months had passed since the investigation began and 271 potential victims still remained at-large, the city's Department of Health reached out to local media in an effort to track those patients down.
• The St. Barnabas case is reminiscent of a 2003 incident in which a nurse exposed 1,500 patients and co-workers at Bronx-Lebanon Hospital . She was also a foreign-born health care worker.
• And convincing health care workers to do something about it has been one of the most difficult tasks for epidemiologistswho have made tremendous progress on other fronts.
• "It's a huge source of frustration," says Dr. Sonal Munsiff, an assistant health commissioner at the Bureau of Tuberculosis Control. "Especially given that they are working with some of the most vulnerable groups of people."
• A nationwide nursing shortage is responsible for a large influx of foreign-born workers, many of them coming from regions of the world where TB persists in epidemic proportions.
• "TB in foreign-born health care workers is increasingly likely to come from reactivation of old infections,"Munsiff says, "acquired overseas, not in New York City ."
• Not all health care workers get tested for tuberculosis when they are first hired.
• According to the Bureau of Tuberculosis Control, 20 percent of the 300 health care workers who contracted infectious tuberculosis between 1998 and 2002 had unknown results for the tuberculin skin test (TST) at hiring.
• Health care workers, however, know that latent tuberculosis cannot be transmitted, does not cause symptoms, and in the overwhelming majority of cases, never progresses to the infectious state.
• "A lack of symptoms diminishes people's sense of urgency," Munsiff says. "And with health care workers it's worse; because they already know the odds of developing active TB are small."
• And there are other reasons why health care workers may resist treatment.
• "The disease still carries a stigma," says Joseph Lurio, a Bronx-based primary care physician who worked as a TB control officer for several years. "I had a nurse once who lied about her symptoms for fear of losing her job."
• But because they work with those most susceptible to infection—newborns and people with compromised immune systems—health care workers with latent TB present a unique threat.

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The Village Voice

TB or Not TB
By Jeneen Interlandi

Our Take

We need to make sure that our high standards of health worker safety are maintained for all who come to our country, especially to help out in the critical area of health care. If these foreign born workers are not safe, neither are we. We are only as safe as the health standards of the countries whose workers we let come here.