April 19, 2014

Report: TB identified in death of man who knew infected school employee

A report released by federal health officials last week reveals that a Greenwood County school employee infected with tuberculosis may have had the illness for more than a year before he was quarantined in June.

Ninety Six Primary School (Courtesy: Greenwood County School District 52)

Ninety Six Primary School (Courtesy: Greenwood County School District 52)

And, for the first time, it reveals that a man who sang with the employee in a musical group may have become fatally infected with the disease.

A Centers for Disease Control and Prevention (CDC) report notes the custodian at Ninety Six Primary School likely became infectious in May 2012. However, it does not appear the employee knew he had TB until a physician reported a positive test to state health officials on March 8.

Meanwhile, the report also provides more details about another man who died from complications caused by tuberculosis in April— a death that has gotten little attention and that the South Carolina Department of Health Environmental Control (DHEC) had not publicly acknowledged until now.

While the information is not news to those directly involved in the investigation (the report relies heavily on DHEC’s data), it helps paint a better picture of the chain of events that led to an outbreak of tuberculosis at Ninety Six Primary School this spring.

Because TB germs can be spread through the air (usually by coughing, sneezing, or talking), DHEC policies require identified cases to be reported and treated. Most people who get the germs never actually develop the disease and are thus not contagious. However, about 10 percent of those infected do become sick.

According to the CDC, 14 people have developed active cases of TB so far. Meanwhile, DHEC officials say 53 students and 21 faculty members have tested positive for TB germs. An additional 32 people in the surrounding Ninety Six community have also tested positive for the germs.

Investigators believe all of the cases are linked back to the custodian (known as “Patient A”), who they suspect became infectious roughly three months before he began experiencing TB symptoms in August 2012. The employee worked at the school until March 8, when DHEC nurses told him not to return so they could perform more tests.

But the damage was already done. The report says a Ninety Six teacher and 10 students soon developed the disease because of their exposure to the janitor. One of the custodian’s household contacts also developed the disease.

Now, we’re learning more about the disease’s potentially fatal impact on another Greenwood County man who was in a church singing group with “Patient A.” The CDC report notes this 79-year-old man (identified only as “Patient C” in the report) was already in declining health due to kidney disease and diabetes before he began experiencing TB symptoms in December 2012.

Family members told investigators that “Patient C” began experiencing weight loss, extreme fatigue, anorexia, and fevers until he was finally taken to a Georgia hospital in early March. The report notes “Patient A” visited him there (before ”A” began TB treatment).

Following a brief discharge, “Patient C” soon returned to the hospital complaining of back pain on March 26. Doctors in intensive care were unable to prevent his situation from deteriorating further and the patient died two weeks later of Acute Respiratory Distress Syndrome (a fatal reaction to a lung infection). TB bacteria were not isolated in the patient until after his death. The final diagnosis was “fatal ARDS secondary to tuberculosis.”

It’s not clear when DHEC learned about the death (since it occurred in Georgia), or why officials never mentioned it in numerous news interviews and public releases. A DHEC spokesman did not respond to our request for an explanation.

Meanwhile, an attorney representing three former DHEC nurses claims the CDC report exonerates those ex-employees. John Reckenbeil said federal investigators relied on the same data the Greenwood nurses had collected by April and reached the conclusion that students needed to be tested. DHEC responded to Reckenbeil’s lawsuit, saying the three employees did not need state-level approval to begin testing students or request a quarantine order.

Reckenbeil maintains that executives at the agency’s central office in Columbia did not realize the seriousness of the threat until May.

“Do we really need al Qaeda to say they’re going to fly into the Twin Towers?” he told South Carolina Radio Network. “You’ve got to read the tea leaves. You’ve got to look at the evidence. That’s what you do in a position of government: you take the objective evidence and make the best decision in an unprecedented case.”

We’ve previously covered the confusion at DHEC in mid-April, when the Upstate TB program manager Malinda Martin sent an email to superiors saying there was an “active case” of tuberculosis in Greenwood County. But director of the DHEC’s TB division Shea Rabley issued a different email an hour later stating, there were no “counted cases.”

Rabley explained what she meant an op-ed to The State newspaper Wednesday, saying she was awaiting the results of a bacteria culture test at the time before confirming the existence of TB. DHEC says those results came back positive on May 1. However, Rabley did not say why another four weeks elapsed before parents were notified on May 27.