Active case of tuberculosis on Auraria Campus: Could risk assessment and targeted testing help?

By Molly Maher

Just a little more than a week after World TB Day, an active case of tuberculosis has been confirmed at the University of Colorado Denver.

After the student, whose identity is being kept private, was diagnosed, an unconfirmed number of students, staff and faculty who were at risk of contracting tuberculosis were notified and encouraged to get tested, CU Denver spokeswoman Jacque Montgomery confirmed.

This is the second case of active tuberculosis in the past 12 months reported to Health Center at Auraria. This compares to a record high of four active cases in 2000.

Dr. Randall Reves, director of the Denver Metro TB Control Program, said that the student, who did not live on campus, is suffering from a non-drug resistant strain of tuberculosis and would undergo short-course treatment.
The disease, transmitted from person to person through airborne bacteria over long exposure, is more difficult and expensive to treat if it becomes drug-resistant, according to the Centers for Disease Control.

There is usually some delay in a diagnosis, Reves said. He added that tuberculosis has the potential to be infectious for a longer period of time, and those who spend many hours or live with a patient should be tested.

Measures that are being taken now are preventative, said Martha Eaton, assistant director of the Student Health Center at Auraria. We are not overly concerned, but we do take public health and safety very seriously on our campus.

In fact, those contacted for testing may not have even met the clinical criteria for length of exposure to the diagnosed student, Eaton said, making the risk of infection low and the measures that have been implemented highly proactive.

The community members contacted have been very receptive to testing. They will receive blood tests rather than skin tests, which Eaton says research has proven to do a much better job at identifying latent TB in patients.

Latent TB infection occurs when the bacteria is inhaled, but is fought off and does not cause any sickness or symptoms. A person with latent TB cannot spread the disease, but may become sick if the bacteria multiply, the Centers for Disease Control report.

Reves adds that blood testing allows immediate results, rather than several weeks after a skin test. He also mentioned that it will give an accurate result despite some vaccinations that international students, a population with the highest risk for tuberculosis, receive that could interfere with testing.

The international population is not the only high-risk community, Eaton said. Also at risk are frequent travelers, health care employees, justice or correctional facility workers, or those who spend time in close quarters, such as homeless shelters.

TB is one of the worlds deadliest diseases

  • One third of the worlds population are infected with TB.
  • Each year, nearly 9 million people around the world become sick with TB.
  • Each year, there are almost 2 million TB-related deaths worldwide.
  • TB is the leading killer of people who are HIV infected.

Both Reves and Eaton are proponents of risk assessments and mandatory testing of college students, which would help identify this population and get them tested or treated before infecting others.

TB cases in college students are largely preventable and we are not doing a good enough job of making sure that happens, Reves said.

Because students are very mobilewe may see a higher incidence of latent TB on a college campus compared to other areas, Eaton said.

An effort was launched in 2000 to introduce mandatory testing based on risk assessment. It ended up being totally worthless, Reves said. It just got watered down to nothing.

The current system, which requires students to complete a risk form that is reviewed by the immunization staff, recommends that only at-risk students be tested, Eaton said.

If there is fear of an outbreak, the government can step in to require testing, she added.

A mandatory system is currently in place at the University of Colorado at Boulder.

Eaton mentioned several factors that make targeted testing difficult to mandate, including political or philosophical beliefs.

When you mention the word targeted testing, it makes people have goose bumps on the back of their neck, she said.

The proposal in 2000 was considered unconstitutional by some faculty members, and others expressed concern about alienating international students who know too much about the stigma of tuberculosis in their home cultures, Eaton said.

We try to be culturally sensitive to all of our students, staff and faculty and make a policy in the spirit that we want to have the opportunity to talk, she said.

Reves also mentions the economic burden of this process, but does not think this is reason to avoid it.

It really is, I think, the responsibility of the university.

Visit the Division of Tuberculosis Elimination for more information on testing, treatment and trends provided by the Centers for Disease Control and Prevention.

For more information, contact Martha Eaton, assistant director of Student Health Center at Auraria, at (303) 556-3875.