Tuberculosis exposure in a day-care center: Recommended management

Background. This article describes the contact investigation, clinical eval uation, and prophylactic treatment of the children,and staff members in a d ay-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 expos ed 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 membe rs, tuberculin skin tests yielded positive results. No active TB disease wa s found. Conclusions. Isoniazid prophylaxis, administered by directly observed proph ylactic therapy in the children, was effectively administered and tolerated in the day-care setting.