Tuberculosis exposure in a day-care center: recommended management.

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.