NUH recalls 178 children suspected of TB

The National University Hospital (NUH) has recalled 178 paediatric patients for TB tests which include chest X-rays, blood tests, and skin tests. All of them have been cared for by a nurse who has been confirmed to have contracted TB.

After the SGH hepatitis C saga which affected 23 patients and saw 4 deaths, we would have thought that other public hospitals such as NUH would have taken a leaf out of SGH’s book and learnt how to practise preventive measures.

Well, apparently not…

Out of the 178 patients recalled, 34 have taken immunosuppression drugs after receiving an organ transplant, which puts them at a higher risk of contracting the disease. Further, children have a weaker immune system compared to adults.

Here’s a quick timeline of the case:

July: The nurse was treated for cough. She had an X-ray and was not diagnosed of TB. However, her cough persisted despite temporary improvement from antibiotics.

27 November: Nurse had CT scan and tests and was diagnosed with TB

4 December: 178 children were recalled

9 December: More than 80 children were screened, none found to have active TB. However, one child was diagnosed with latent TB.

Questions for NUH

1. Why weren’t there more tests done to detect the disease?

An X-ray would be insufficient in diagnosing TB — even a CT scan would only register a “possible” case of TB. Therefore, the question is: why were there no further tests done to confirm whether the nurse had gotten the disease?

Furthermore, how can there be a diagnosis with just a simple X-ray?

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2.   Why wait 5 months to do further testings?

Mind you, it was not a cough that lasted for a week, but one that lasted for about 5 months.

Shouldn’t she have done more tests during the 5 months? Symptoms of TB include a persistent cough which lasts for 3 weeks or longer.

Being a medical personnel, she should have known that it was no common cough.

3.   Should nurses and doctors who are sick be allowed to handle patients?

Needless to say, most patients already have slightly weaker immunity than the average human being, much less children.

Therefore, should hospitals allow doctors and nurses who are sick to continue working? They can easily transmit contagious viruses or diseases. There should be more preventive measures in place instead of trying to pick up the mess by saying that the risk of spreading the disease is “very low” as the nurse was wearing a mask.

It sounds like some people are trying to cover their asses.

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4. If it is not the nurse spreading TB, then who?

Yesterday (9 Dec), over 80 children were screened and none were found to have active tuberculosis. However, one child who stayed at the affected ward was diagnosed with latent tuberculosis, but latent TB is not contagious and can be effectively treated before it progresses to active TB. In addition, people with latent TB do not have symptoms of the disease.

Experts say that there is little or no means to ascertain whether the TB contracted by that child was from the nurse.

In an interview with Channel NewsAsia, Dr Leong Hoe Nam, Infectious Diseases Physician from Rophi Clinic at Mount Elizabeth Hospital said:

It is extremely difficult to find the source of this latent tuberculosis, simply because TB is endemic in Singapore. The person whom you had lunch with, the person who looked after you as a child minder or a person who plays every day at the field – any one of them could have passed you tuberculosis. Similarly, if you look at the nurse, she could have picked it up at work or picked it up from anybody else.

However, it also seems plausible that the child might have contracted TB from the nurse, considering that she had TB while taking care of him.

Which brings back the question: if the nurse didn’t spread TB to that one child, who did?

More preventive measures needed

All in all, a more transparent protocol should be set up and followed when it comes to such issues. After all, it is always better to be safe than sorry. It is also not ethical to risk the health of others when sick medical personnel work.

There is no use playing the blame game. This should be a lesson for all to learn, and more preventive measures should be put in place.

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Picture via PRC-Magazine
With reference to The Straits Times, Channel NewsAsia