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October 1, 2014

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TB deaths of Las Vegas mother, baby traced to dairy product

Health district trying to contact those who might have been infected at Summerlin Hospital

The Southern Nevada Health District believes it has identified the initial cause of a tuberculosis outbreak that killed a Las Vegas woman in July and led to the infection of at least 26 other people.

More than 200 people who came in contact with the woman or her infected infant have been tested for tuberculosis, and a few hundred more test results are still pending as the investigation widened this week. As of Wednesday afternoon, there were four families that may have been exposed to the infectious disease whom the health district has yet to reach.

Investigators for the district believe the woman, who was pregnant while sick and gave birth to premature twins who did not survive, contracted tuberculosis from bacteria in a dairy product, most likely cheese, from Central or South America.

“We will never be completely certain about the cause, but the type of tuberculosis she had is transmitted from unpasteurized milk products,” said Chief Officer Jon Iser. “She died before anyone knew she had tuberculosis and she died in Southern California, but there is evidence that she did ingest unpasteurized milk products.”

According to a Southern Nevada Health District report published Aug. 22, a pregnant woman was admitted to an unidentified Clark County hospital in May. She was transferred to Summerlin Hospital Medical Center, where she gave birth to premature twins. The woman had been sick before and during the pregnancy, and was admitted into Summerlin Hospital Medical Center before being transferred to a Southern California hospital before she died. Her autopsy revealed she died from tuberculosis.

One of the twins died in June, before tuberculosis was suspected. The cause of death was listed as “respiratory failure due to extreme prematurity.” Meanwhile, the other baby remained in Summerlin Hospital Medical Center’s Neonatal Intensive Care Unit. When the hospital learned of the mother’s diagnosis, the baby was moved to isolation. The baby was subsequently diagnosed with and treated for tuberculosis but died in August.

In its first steps, the health district tested more than 200 people, friends and family of the infected, hospital staff and others, for tuberculosis. Of those tested in the first phase, 26 tested positive for the disease. However, 24 of those people have a latent form of the disease, meaning they are not exhibiting symptoms and are not contagious. The two dozen people with the latent form of the disease are being treated with medication. Two of those tested, one family member and one hospital staff member, have active tuberculosis and are being treated in isolation, Iser said.

“As soon as we thought the hospital worker was infectious we asked him to isolate and quit working,” Iser said. “Then we put him on the appropriate drugs.”

The Summerlin Hospital Medical Center is working with the health district on the investigation, and there is no indication that proper procedures were not followed.

“Our staff is vigilant in creating and maintaining the highest level of safety of patients and visitors,” said Robert Freymuller, CEO and managing director of Summerlin Hospital, in a statement. “People with infectious diseases may visit many places until they are diagnosed and hospitalized. We use multiple precautions to contain, treat, and prevent germs from spreading to patients, visitors and staff, such as hand hygiene processes, protective equipment such as gowns, gloves, and masks, and rigorous cleaning and disinfecting processes.”

Once the 26 positive results came back, including the two infectious cases, the health district expanded the investigation, including issuing a public notice on Monday. The district is calling and mailing letters to the families of 140 infants who were in the Summerlin Hospital Medical Center NICU from May 11 to Aug 8.

“That is from the period of time from when the mother was infectious to other people to the end date when the infant and hospital worker were identified and put into isolation,” Iser said.

Almost all of those families have been reached, but the district has yet to make contact with four of the families. The families were first notified in August, but the district did not urge them to get tested until this week. The test results on the 140 infants and the parents and other family that visited them in NICU will not be available for a week, if not longer, according to Iser. The health district set up a private clinic to provide testing for both the babies and their parents. The district does not believe Summerlin Hospital Medical Center patients who were outside the NICU faced additional risk of infection.

The identities of the infected are being withheld for medical privacy reasons.

According to Clark County Coroner records, Emma White died June 1 of respiratory failure and extreme prematurity at 3 weeks old, and 2-month-old Abigail White died of tuberculosis on Aug. 1.

Tuberculosis can be fatal if not properly treated. The Centers for Disease Control reported 569 deaths from TB nationwide in 2010, the most recent year for which figures are available. The Southern Nevada Health District sees 80 to 100 cases per year.

The disease is spread through the air when an infected person coughs, sneezes or talks. The symptoms include coughing, chest pain, fever and fatigue.

Members of the public who would like additional information about tuberculosis or this investigation may call the health district’s helpline at (702) 759-4636, Monday through Friday, 9 a.m. to 5 p.m.

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