A colleague has TB - am I at risk?

[MsFiremanSam]

Wondering if anyone knows the risk factors of catching TB? My colleague has it and is about to start treatment in the next few weeks. I've just found out I'm pregnant. I work in close proximity with her and everyone in the office shares cutlery etc.

I'd say that if you've had your BCG vaccination then you should be safe

Had it when I was 12 - think it only lasts 10 years?

What kind of TB does she have? (You can get TB anywhere except the hair and nails interestingly although it's most common in the lungs.) Has she been coughing? I assume the cutlery is washed between uses? Generally, if you have had the BCG and you're not immunocompromised, you're very unlikely to be affected. The hospital where she's treated would also have considered the risk of infection to others and would have followed up with your work place if they thought there's a risk. TB is actually quite hard to catch. Are you absolutely sure that's what it is? Treatment is usually started straight after diagnosis and it's quite rare relatively speaking although not unusual in certain communities, especially in London or in people with certain other conditions.

Thanks for your reply. It is definitely TB and she's starting treatment in a couple of weeks - she's been told she'll need up to 9 months off. I haven't seen her coughing but the doctor has told her to quaranteen herself if she catches a cold. I'm not sure I trust that she'll tell people if she's feeling really unwell. She looks very poorly.
I work in a school so I would hope the risk has been properly assessed. They don't know I'm pregnant though and I'm her line manager.
Saying that, I've obviously been working with her while being unknowingly pregnant. Wonder if I need to ring the midwife?

She's at work now still or off already? If she's still at work it sounds odd that she'd be told she's fine to be at work now whilst ill yet will be off when she starts the antibiotics. As well as the midwife (who might not have much experience of it) you could try ringing the TB department of your local hospital for specialist advice. About the BCG, there is no repeat dose given for the general population as immunity is thought to last much longer than 10 years so you're probably still covered.

I think it's because of the side effects of the treatment. Thanks for the advice - I'll give them a call. Hopefully as you say this is being managed and there's no risk!

DH had pulmonary TB after a jaunt overseas. He wasn't unwell at all but something came up on the health screening his employer required on his return home.

He had to have a course of six months of antibiotics. DD was a toddler and neutropenic at the time. He stayed in an apartment at work for three weeks, after that time he was deemed not to be contagious.

I wonder why the delay in treatment, DH's was immediate.

Most people who get infected never develop TB anyway.
I'd probably make sure I was monitored, but diagnosis is quite difficult anyway.

My dad was immunocompromised and caught TB from falling over and scratching his leg on his hospital bed, which obviously an infected person had coughed on in the past and it hadn't been sufficiently cleaned. The wound developed weird lumps around it, on biopsy they found he had TB.

I would take your concerns to your manager and state that you are pregnant and that you are not happy being around someone with an infectious disease, even if the risk is low. Get your concerns logged. It isn't fair to put you or your baby at risk.

As someone else has already said, there are only certain types of TB that are infectious and you actually need close and prolonged contact to catch it. Generally I don't think pregnancy is a particular risk factor for catching it although you are slightly immunosuppressed during pregnancy (to stop you from 'rejecting' the baby). When someone is diagnosed with active TB there is active tracing of relevant contacts done by a combination of the TB team/nurses looking after the case and by the health protection team in public health England. Therefore, you will be contacted if it is felt that you are at risk of being infected. What is often standard practice is that a 'warn and inform' letter is sent to work colleagues which will detail signs and symptoms to look out for and if they are going to screen work colleagues or not. If you get such a letter then you could contact the TB team re being pregnant just for your own reassurance (details should be on the letter). Or else it might be worth informing your midwife just so they know. In all though while I completely understand you feeling concerned, I think your risk is low

As you have just found out you are pregnant I'd suggest a GP consultation for you.
We (as a family with a 10 year old) lived for a few months with someone who had the most dreadful cough. She was a maid/housekeeper. Kept encouraging her to go the the docs, where she was diagnosed with TB.
None of us became infected, but in your condition I'd get checked out and get professional advice.

I wasn't planning to tell work yet that in pregnant but I do feel like they are brushing it under the carpet to avoid panic. The majority of the school don't know she has it and I know of at least one other pregnant woman in a different department. There hasn't been a letter or any public acknowledgement of her illness. I feel that they've done it to avoid her leaving before they can get a supply teacher in to take over her classes.

I could be mistaken, but isn't TB a 'communicable disease' ????
Authorities must be advised ???

TB is a communicable disease and the treating hospital would have informed the relevant authorities. If she's been allowed back to work and the staff haven't been informed of anything (especially as she's not coughing) it may be that she has a form that can't be caught by usual social contact. If the school haven't said anything, has the woman herself been telling people? If the school received a formal communication to 'warn and inform' as a pp mentioned, do you really think they'd be so negligent as to ignore it? That sounds awful.

The main issue with TB at the moment isn't how transmissible it is. It is if it's drug resistant or not.
It seems from the schedule that they are not worried and it's a sensitive strain. But I'd want to confirm it, actually.

If she has pulmonary TB then it can be caught by social contact, AFAIK.

It can be Lweji - hence DH didn't come home because DD was neutropenic.

Lweji that is the type one normally thinks of isn;t it? So what other type of TB could she have which allows her to be in contact with children and adults?
I am only considering that some of those she comes into contact with could have a compromised immunity problem. Surely there is a risk there?

Does she have a CXR showing evidence of TB lesions or is she being treated for a positive PPD test? There is a difference.

If she has had the BCG vaccine she wouldn't be getting skin tested for exposure, but maybe she hasn't had it.

TB is spread through pulmonary droplets, which normally have to be coughed out by a person with TB and then inhaled by another person. However, the droplets persist, so the recipient does not need to be in the same room as someone who is coughing to contract it. But the TB sufferer must have a cough to be actively infectious.

We treat folks with positive TB tests to prevent the development of active TB. Perhaps that is her scenario?

People can get TB outside the lungs, in which case it should be much less contagious.
I imagine what people earlier in the thread meant by the type that spreads is between latent and active. As explained above regarding showing symptoms.
If she looks poorly she is likely to be in the active stage.

Try not to worry is the first thing. TB is infectious only if people are coughing up the bugs from their lungs and even then not everyone who is exposed will get ill. And (very worst case scenario) TB is treatable and the drugs are safe in pregnancy.

There are a few gaps in the story; it seems odd that treatment has been delayed as it would be usual to get started asap. There are also bugs from the same family as TB that are not infectious - it could be one of these. Also people aren't normally told to have 9 months of work - standard treatment is only 6 months!

If she has TB then there will be team of nurses whose job it is to track down contacts of the patient. They are really good at working out who is at risk and visit work places etc. They will ask you some questions about your health and may do a blood or skin test or a chest x-ray (which is safe in pregnancy).

I would recommend seeing your GP and asking them to contact the local TB nurses and maybe trying to find out a little more information.

(I work in TB and I'm pregnant too!)

Thanks so much for all the advice. I'll definitely see my GP. The gap in treatment does sound odd - hopefully that means the risk is low.