On Monday, April 7, Manchester College medical director Dr. Pamela Higgins confirmed the presence of one case of active tuberculosis (TB) to state officials and the campus population. That student was immediately removed from campus once infection was suspected, and was placed in respiratory isolation. Active TB (in which the person would exhibit symptoms like coughing, chills, and night sweats) is the only form of the disease that is contagious; asymptomatic (latent) cases of TB are not yet infectious.

   
Indiana State Department of Health protocol demands the administration of Mantaux skin tests to people who were identified by health investigators as at-risk. “We’ve tested about 218 people,” said Tara Vogel, R.N. and Manchester College’s director of Health Services on Tuesday. Eight students on the at-risk list have not responded to Health Services e-mails and phone calls to schedule a skin test, she said Thursday.

  
Sarah Burkholder, R.N. and TB control director for the Indiana State Department of Health, explained the “normal impact” of an active tuberculosis case. “We can expect 10-20 percent of the students in the initial contact group to have positive skin tests,” Burkholder said.  She continued to clarify that unless this predicted range of positive reactions is exceeded, there will be no need to “extend the circle” of test subjects.

A positive reaction to the Mantaux skin test (being administered by Health Services, free of charge) indicates only the presence of the TB bacteria in the body, and does not necessarily identify an active form of the disease. “The incubation time is two to eight weeks before you get a possible positive skin test,” Vogel said. “The next step [if the result is positive] is a chest x-ray and a physical exam.”

Along with those students who have not yet responded to the emails requesting that they be tested, any people with immune deficiencies or other chronic health conditions (like diabetes or kidney disease) should contact the Health Services office to take a skin test.

The amount of time required before the bacteria become contagious is a little bit harder to define.

“It completely depends on the individual,” Burkholder explained. 

 
Last Friday Burkholder presented information about TB to the MC community. According to Burkholder, TB is spread by “coughing, sneezing, singing or yelling,” as these activities cause the bacteria to become airborne. The bacteria cannot be spread through the sharing of utensils, kissing or touching, only as vapor absorbed through the respiratory system.

During her presentation Burkholder outlined several conditions that lead to an “increased risk” of spreading TB: small room size, poor ventilation, prolonged or frequent exposure, and close physical proximity (all of which are classroom-like qualities, especially in older structures like the Administration building).

  
Zachary VanWinkle, a first-year peace studies/German major, is concerned about what effects a tuberculosis infection could have on his future. “In the worst case scenario, I could have my travels severely restricted as a result of contracting TB,” VanWinkle said. “I don’t know what Germany’s regulations are regarding tuberculosis, but I know some countries have severe restrictions.” While he has not been contacted to receive a skin test, he is concerned about the potential for the infection to spread. 

  
“Only persons with active TB cannot travel,” said Vogel. “Persons with latent TB are not restricted.”

  
Jeri Kornegay, director of media and public relations, notes that there is only one case of active, infectious TB at Manchester College.  “We immediately placed the student into isolation after the chest X-ray – even before we had confirmation of active TB,” she said.  “We have no suspected cases of active TB and do not expect to find any.

The identity of the infected student (as well as any other students who may have been infected) is protected by Indiana Code 16-41-8-1, which demands “confidentiality” and “voluntary disclosure” of information.  The student is, however, “improving and responding to the drug treatment,” Kornegay said.  “Many employees and friends have gone the extra mile to help make the student as comfortable as possible in isolation." 

  
Other students have expressed their concern about the size and communal nature of life at Manchester College. “Given how small the student body is and how closely we work together, I don’t understand why everyone wasn’t immediately asked to come in for skin tests,” said senior Laura McSpadden.

   
“The College is closely following protocol of the National Centers for Disease Control and the Indiana State Department of Health,” Vogel said. “These experts assure us it is not necessary to test every student – only those who have come in close contact with the student or those with chronic health conditions.”

Burkholder did not provide a concrete answer when asked about the amount of time that had elapsed before the student was isolated, stating that it was “patient-specific information.”

  
A second round of testing is important after a negative reaction, to guarantee that the incubation period has passed. Students are advised to schedule another test after June 2.

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