South Carolina health officials are under fire for a delayed response to a tuberculosis outbreak at a rural elementary school in which hundreds of people were exposed to the contagious airborne disease, including 465 children who weren't tested until nearly three months after local nurses discovered the outbreak.
Some 53 of those children were infected with TB, including 10 who were diagnosed with an active form of the disease, meaning they had symptoms of TB that require lengthy drug treatment to cure. A person who is infected but doesn't have an active form of the disease still requires some treatment, usually just one drug.
All told, 1,526 adults and children have been tested, 106 were infected, and 12 developed active TB, according to state officials.
Several employees of the state Department of Health and Environmental Control were either fired or suspended; those fired include three nurses and the head of the state's TB unit. The nurses have each filed lawsuits against the state seeking lost wages and other damages.
DHEC Director Catherine Templeton said this week in multiple statements that her department had botched the probe, waiting until late May to notify parents after local nurses discovered the possible outbreak at Ninety Six Primary School in rural Greenwood County in early March.
The local DHEC nurses became concerned after a visibly ill school custodian went to the hospital and tested positive for TB. The hospital on March 8 notified the local health department nurses, who began an investigation by visiting the janitor at home and contacting supervisors in Columbia, according to court filings.
The nurses tested some school staff and asked several times for permission from state health department administrators to begin informing parents and administering TB tests to children and other staff, but it wasn't granted, according to their lawyer and correspondence in court filings.
Ms. Templeton, the director, learned of the outbreak during an unrelated site visit to Greenwood County in late May and started an immediate investigation, according to a spokesman. The state later called in the Centers for Disease Control and Prevention, which said it sent two epidemiologists who spent about a week earlier this month assisting with the investigation.
In a statement Thursday, Ms. Templeton laid much of the blame at the feet of the three local nurses, who she says didn't follow procedures and didn't do enough to grab their supervisors' attention in a crisis. "The investigation did not begin in a timely manner, the public-health protocols were ignored, and the conclusions from the investigation were nonsensical," Ms. Templeton said. She added that the nurses "could have obtained the authority they needed to properly conduct the investigation by contacting me."
State officials said the children with active TB weren't infectious. But children infected with TB have to be treated and watched carefully, TB experts say. They may have more subtle symptoms, or become infected in other parts of the body aside from the lungs. Young children are also particularly at risk of developing active TB if infected, TB experts say.