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Q.1) Beyond sending certified mail and making phone calls to those considered most likely to have come into contact with the infected patient, what action is Hopkins taking in response to this possible case of TB transmission?

A.1) Johns Hopkins immediately began a thorough, standard investigation to identify both the source of the infection and those who had contact with the patient during the patient’s time in hospital.  Currently, this process has led us to focus our notification efforts on 20 patients who may have been exposed.  Our investigation will continue in accordance with good practices in infection control, and it is possible that more potential exposures will be found.  Our best estimate, based on medical experience, is that there are unlikely to be more than 100 people in total who were potentially exposed during the time frame when the patient was thought to be infectious and when the TB bacterium could have been transmitted.

Q.2) Does Hopkins suspect there are additional cases of TB?

A.2) The risk of transmission from patient to staff, or staff to staff is very, very low.  We will not know for sure until our investigation is completed.  That may take several weeks or more.

Q.3) Is this form of TB easily transmissible to others?

A.3) Not at all.  TB is spread from person to person through the air, when bacteria are breathed in from direct, persistent and close contact with someone who is infected.  Although the airborne tubercle bacterium can survive for up to 20 minutes, our filtration and air exchange systems at the hospital are powerful enough to have lowered the possible exposure time and risk for most of those who might have been in contact with the infected patient.

Q.4) Who is being screened?

A.4) All hospital staff, clinical and nonclinical, who worked in any areas of the hospital where the infected patient was treated, and who have not been screened since March 1 for exposure to the tubercle bacterium, are being tested.  We hope to have this screening completed by the end of August.  Initial screening consists of a skin test that, if positive, does not necessarily indicate infection but would result in further, more conclusive testing, including sputum smears, chest X-rays and laboratory cultures.  Similarly, all former hospital staff at risk of exposure are being contacted and advised to seek testing.

Patients who shared a room with the infected patient, as well as their visitors, will also be offered testing at Johns Hopkins.  Patients are being notified that testing will be offered without charge to them.  Testing is also available at local health departments.

Q.5) How many staff are affected by this news?

A.5)  Hospital staff are still being identified.  Most have already been recently tested through annual screening.  We expect to screen several thousand staff, primarily those who have not yet received their annual TB screening. 

Q.6) How many patients will need to be tested?

A.6) Currently, we are focusing our notification efforts on approximately 20 patients who may have been exposed.  We are notifying them by certified mail and phone call.  It is routine in these investigations to identify additional people who may have been exposed. 

Q.7) Should the public be concerned?

A.7) Public health experts believe the risk of transmission in this situation is very low.  Some health officials, including those with the city, county and state, have been notified and others are being notified as the investigation progresses.  Johns Hopkins will fully cooperate with health officials who may be involved in the investigation. 

Q.8) What type of TB did this patient have? 

A.8) What we know is that the employee who tested positive for TB has the same strain as the infected patient, verified by matching the genetics of the bacterium in both.  Laboratory test results confirmed this match late Friday, July 20.  Though highly treatable, the strain is not commonly seen in Baltimore.  The infected patient from 2006 was the only case at Hopkins with the same strain and within the time frame of possible transmission.

Q.9)  Was it the same strain as in the case of Andrew Speaker, the presumed XDR-TB patient from Atlanta?

A.9) No. The particular strain of the tubercle bacterium involved is readily treatable, and the patient believed to have transmitted TB to our employee is undergoing standard drug treatment for the disease.  The TB strain involved is not the multi-drug resistant form, nor is it the extremely drug-resistant form of the disease recently featured in international news.  

Q.10) Did your screening reveal other, unrelated cases of TB that could also be transmitted?  Should your staff and the public be concerned?

A. 10) Annual employee screening for TB is mandatory at Hopkins, and is designed to catch early cases of infection, such as this, while they are still readily treatable.  Although TB is endemic to Baltimore, the risk of transmission to staff and to the general public is very low.

Q.11) When was the patient at Hopkins? When was the patient discovered to have TB? And what are staff being told about the patient?

A.11) The patient who developed active TB was undergoing treatment for conditions unrelated to TB within the Johns Hopkins Health System between August and December 2006.  What we know is that the patient initially tested negative for TB during the first visit to Hopkins on Aug. 7.  Infection was first suspected on Dec. 2, when the patient was immediately placed in isolation, and TB was confirmed on Dec. 8.  All affected staff have been notified by e-mail and by letter of the possible transmission, of the need to get screened if they have not already done so, and of their low risk of infection.  Our investigation is focused on no more than a half dozen visits and admissions to The Johns Hopkins Hospital, its Outpatient Center and Bayview Medical Center when we believe the patient was potentially infectious.

Q.12) Should the public be concerned about the employee’s infection?

A.12)  No. The employee’s infection was caught in its earliest stages, when routine skin testing proved positive.  The employee has a very treatable form of TB and has been prescribed standard drug therapy.  The employee is expected to make a full recovery and is not now and was never considered highly contagious or a threat to the health of coworkers or other staff and patients at Johns Hopkins.  The employee remains at work.  To protect privacy, no further information is available.

Q.13) Why did it take so long to launch your investigation?

A. 13) Testing at Hopkins confirmed the patient’s infection on Dec. 8.  Both city and county officials were notified immediately of the positive test result, in keeping with regulations and policies.  The employee’s diagnosis was made within days of the employee’s positive test from routine screening in March.  Verifying the strain of TB involved and its connection to a previously infected patient was not completed until July, and Hopkins was informed by the city on July 20.  Hopkins promptly prepared it notification to other health officials and widened its investigation into the connection between the two cases.

Q.14) Who is paying for the screening tests?

A.14) Hopkins will pay for TB screening tests performed on site for employees, former employees and patients who have been identified as having possibly been in contact with the infected patient.  Free screening is also available from local health departments.