Tuberculosis exposure in a day-care center: recommended management

Abstract

Background: This article describes the contact investigation, clinical evaluation, and prophylactic treatment of the children and staff members in a day-care center after exposure to a teaching assistant with tuberculosis (TB).

Methods: The investigation included baseline and follow-up tuberculin skin testing, history and physical examinations, and chest radiographs. Directly observed prophylactic therapy with isoniazid was recommended for all exposed children with a negative evaluation and all children with positive skin test reactions and normal chest radiographs. Treatment was discontinued in children with negative skin test results at follow-up. Adult staff members were screened with baseline and follow-up skin tests and were referred for chest radiographs if skin test reactions were positive.

Results: In 3 of the 141 exposed children and 3 of the 41 adult staff members, tuberculin skin tests yielded positive results. No active TB disease was found.

Conclusions: Isoniazid prophylaxis, administered by directly observed prophylactic therapy in the children, was effectively administered and tolerated in the day-care setting.