Interview with pediatric tuberculosis expert Dr. Jeffrey Starke

To provide more insight into the CDC's TB policy for immigrants and how it affects internationally adopted children like Harper Yue Ye Scruggs, the International Adoption Examiner asked Dr. Jeffrey Starke, a pediatric tuberculosis expert, to answer some basic questions about the illness. Please note that Dr. Starke's answers are for information purposes only and are not meant to apply to any patient or policy in particular. Dr. Starke also points out that the information he provides is not new and is based upon evidence from science from over the last 100 years and literature that has been published by sources such as the World Health Organization and the Centers for Disease Control and Prevention.

Dr. Starke corresponded via telephone to answer the following questions:

Q: How is tuberculosis actually spread?  Is it through touch or purely by breathing in contaminated air?

 A: Tuberculosis is exclusively airborne, meaning that when a person with active TB coughs, other people are infected by breathing it in.

Q: How reliable are sputum cultures in diagnosing TB in children under the age of 12?

A: First let me say that TB in children is a fundamentally different disease than the disease in adults, and the same information and diagnostic criteria cannot be applied to both. In adults, the most common way to diagnose TB is to look at mucus coughed up (sputum) and test it for the TB germ through sputum cultures. Most children, however, have a dry cough and do not produce sputum. In the rare instance that the child does produce sputum, only 20-30% of the samples can actually be cultured to check for the germ.

Q: Then how is TB diagnosed in the pediatric population?

A: In the United States, it is standard procedure to diagnose a child based on four criteria – a positive skin test, an abnormal chest x-ray, a physical exam showing whether the TB has spread to other organs, and the child's history of being in contact with an adult infected with TB. Since children do not usually produce sputum, we have to do a lot of medical manipulation to actually find the TB germ. We sometimes take a sample of stomach juices early in the morning, but even that is not ideal for finding the germ. We really have to go out of your way to find it, even under the best of medical circumstances, which tells us that TB in children is not the same as it is in adults and is not contagious. The bottom line is that, in adults, finding the germ drives the diagnosis, whereas in children, the other things (clinical manifestations) drive the diagnosis.

Q: What are the chances of a child under the age of 12 being able to transmit TB?

A: Only a fraction of 1%. It has only ever been reported a handful of times in medical literature.

Q: How common is the adult form of TB in children?

A: This does occur in teens. In children less than 10 years old however, it is extremely rare. In these cases, it is very apparent that these children have the adult form, as they have all of the symptoms that adults have, including a cough that produces sputum.

The reason cases such as these are often cited is simply because they are so rare. Articles have been written and published about them because of their rarity, not because they are the norm.

Q: How long does it take for a patient on anti-TB treatment to become non-contagious?

A: Most adults only require a couple of weeks on medication before they are no longer contagious. As we know, children are not contagious to begin with, so the question does not apply to them. Children take the medication to treat the illness only, not to become less contagious.

Q: Are there any documented cases of another passenger on an airplane contracting TB from a child flying with diagnosed TB?

A: No, again children are not contagious. However, if you apply the question to an adult…

There are 2 steps to contracting TB

1.  becoming infected – This means that you have breathed TB germs.
2. actually developing TB disease -  After being infected with TB germs, there is only a 5-10% chance of persons over the age of 2 developing the disease of tuberculosis within their lifetime.

Dr. Jeffrey Starke is a professor at Baylor College of Medicine, Chief of Pediatrics at Ben Taub General Hospital, and Infection Control Officer at Texas Children's Hospital.

  To take action against the CDC's TB policy for adopted children:

1. Sign the Build Families, Not Barriers Petition
2. contact members of congress to ask them to take action to exempt this population of adoptees from the policy.