Q: I have a very good nanny who has been with our family for over 10 years. Recently, she developed a persistent cough. Initially, we thought it was related to allergies but when it did not improve, we took her to hospital where they thought she might have a bacterial infection and put her on several courses of antibiotics.
One day she informed me that she had blood in her sputum and when she was reviewed at the hospital, they discovered that she had tuberculosis and started her on treatment. I am now very worried. Is my family likely to contact TB from her?
Currently, there is no one in the family coughing but I am not at peace. TB is also associated with HIV, should I insist that she goes for testing? To be honest, I am thinking of dismissing her as I do not want to expose my family to this disease.
The truth is, all of us have been exposed to pulmonary tuberculosis at one point or another in our lives. In fact, there are a large number of people walking around with the tuberculosis bacteria even though it is not giving them an active infection. (This group of people are known as ‘dormant carriers’ or ‘people with latent TB’ – and even you could be one of them).
Most of these dormant carriers go through their entire lives with no symptoms or complications of TB. This is because the immune system is able to suppress the TB bacteria. However, about 15 per cent of individuals go on to develop active TB.
Has your family been exposed to pulmonary TB?
Considering that you were living in the same household as your nanny, then your family has definitely been exposed to pulmonary TB. However, it does not automatically mean that you will all get TB.
Should you get tested for TB?
Doctors do not perform extensive tests to look for TB if none of you has symptoms. However, if any of you develops a persistent cough or night sweats or unexplained weight loss, it would be advisable to get tested for TB. However, you can discuss any concerns you may have with your doctor.
HIV and TB
First, it is important to understand that the notion that TB occurs only in HIV positive people is a myth. TB can occur in anyone, including people without HIV.
The second thing is that you cannot coerce someone to go for a HIV test. It needs to be done voluntarily. You would not appreciate it if your employer forced you to go for a HIV test because you have fallen sick.
My question to you is, ‘if your nanny is HIV positive, what will you do about it?’ Are you asking her to do this test because you want to support her or do you want to use it as justification for terminating her employment?
HIV and job security
By law, you cannot terminate someone’s employment because they have TB. It is a curable illness which is easily managed with proper treatment. In addition, you cannot sack someone for having HIV. This is discrimination and you can be prosecuted by a court of law.
TB treatment is able to suppress the disease within two weeks of starting treatment. However, cure of the disease usually requires six months of dedicated usage of the anti-TB drugs. You can grant your nanny some paid sick leave to allow her to recuperate. With guidance from her doctor, you can devise a return to work formula.
Differentiating TB from allergies
TB usually causes a dry, persistent cough that does not respond to regular antibiotics or antihistamines. With time, the cough becomes productive of sputum which can sometimes be blood-stained.
Some people report that the cough is worse at night and is accompanied by night sweats and fever. There may also be unplanned weight loss. Allergies often give a dry cough with an itchy feeling in the throat. It may be accompanied by itchy eyes and a runny nose. The cough is not associated with fever and responds well to antihistamines.
Do we get vaccinated against TB?
Yes, we do. If most of us look on our arms, we have a visible vaccine scar— this is usually from receiving the anti-TB vaccine known as BCG. However, it is important to know that you can still get TB even though you have been vaccinated as a child.
Tips around the home
—Keep your home well ventilated.
—Avoid travelling in vehicles with closed windows.
—Regularly wash your hands (this is particularly important for children)
—Ask the nurse or doctor to teach your nanny ‘cough hygiene’ – this includes covering one’s mouth and nose whilst coughing (discard the tissue used and wash hands immediately after that), and coughing into the elbow and not into one’s bare hands if there is no disposable tissue nearby.