Contact investigation of a case of active tuberculosis in the community

Ashtabula County, Ohio, has been a low-risk county for tuberculosis (TB) based on the Centers for Disease Control and Prevention guidelines. The Ashtabula County TB clinic is provided through the Ashtabula County Health Department. Over the past 10 years, there has been an annual average of one to 2 active cases of TB seen and treated at the county TB clinic. CONTACT INVESTIGATION: In 2005, over a period of 3 months there were 6 cases of active TB identified in Ashtabula County. Contact investigation and follow-up were complicated by the fact that the suspected source case likely had active disease for more than 4 years and had some medical procedures performed at health care facilities in another county. This person was unaware of having TB and was identified through contact investigation by the county health department staff and sent for testing. The investigation was complicated further because the index case did not reveal contact with the suspected source case, although this was confirmed later through investigation. Contact investigation involved Ashtabula County and notification of other counties in Ohio. The Ohio Department of Health also was notified.

Following identification of each case of active TB, contacts were identified through interviews with the clients, physicians, and health care facilities where clients were treated. Initially in Ashtabula County, 97 people were reviewed for follow-up, and 87 people were skin tested for TB. There were 7 conversions.

Although the overall incidence of TB has declined in the United States, increased awareness of TB, appropriate diagnostic work-up, treatment, and control measures among health care professionals in low-incidence areas is increasingly important. Contact investigation of a case of TB requires diligence and effective communication.