Contact investigation of a case of active tuberculosis

The Veterans Administration (VA), Marion, Illinois, following Public Health and Veterans Affairs guidance has an excellent tuberculosis (TB) control program with all employees included.

This VA is a low-risk facility for TB, according to the Centers for Disease Control and Prevention guidelines. A patient presented with active TB in January 2002. Follow-up was complicated and enlarged to the community, adjacent state, and notification of Centers for Disease Control and Prevention. The concentric circle approach in identifying highest-risk contacts had to be modified and expanded because of the immunocompromised condition of some of the contacts.

After identification of active TB, contacts were identified. Initially 108 employees and 42 patients were reviewed for follow-up at the VA, with 98 employees and 27 patients actually tested. At 3-month follow-up there were 2 conversions.

Because of excellent participation in the employee tuberculin skin testing program, conversion was readily identified among staff. Contact investigation of a case of TB requires both diligence in the program and prompt, effective communication and action between state and local health departments and hospitals.