A North Dakota tuberculosis outbreak that was traced to a Pacific islands chain underscores the need to screen children adopted from abroad for diseases and ailments, researchers reported this week.
A boy from the Marshall Islands in the Western Pacific spread TB to 56 people, including many of his playmates, after coming to rural North Dakota.The outbreak was discovered in 1998, when one of the boy's guardians was treated for a painful hip that turned out to be a TB infection, researchers reported in the New England Journal of Medicine.
Although the boy's tuberculosis was not drug-resistant, the outbreak points out problems that could occur when children are adopted from countries where drug-resistant TB is becoming epidemic, said Dr. Laurie Miller, an adoption medicine specialist at New England Medical Center's children's hospital in Boston.
"I think we will see much more clinical disease, and the disease will be much more difficult to treat in the future," she said in an interview.
In an editorial in the journal, Miller said children brought into the country for adoption should be tested for conditions such as TB and syphilis.
U.S. families have adopted more than 125,000 children from other countries since 1986. Although children must get checkups before they get a visa to travel to the United States, that is not enough to ensure that the youngsters are healthy, Miller said.
TB is common in the Marshalls, a chain midway between Hawaii and Australia, but is rare in North Dakota. In the preceding five years, there had been only two cases in the rural two-county area around the boy's home.
The medical journal did not identify the community, but news reports from the time said it was Lakota, a town of 900 about 140 miles from Bismarck. The extent of the outbreak and the fact that a student had spread TB were known, but other details -- namely, that the student brought the tuberculosis from the Marshall Islands -- were not released.
The boy was not adopted but was living with unrelated legal guardians; officials would not give details because of privacy laws. He was 9 when he was diagnosed in 1998.
The boy had been given a TB test shortly after he arrived in this country in 1996, but the test was less reliable than the newer Mantoux test.
The 56 people he infected represented one-fifth of all the people who had spent time with him. They included three of the four people he lived with, 16 of his 24 classmates and teachers, 10 of the 32 children who rode his school bus, and nine of the 61 children and adults at a day-care center.
Most people infected by tuberculosis do not get sick and cannot spread TB because the immune system encloses the germs in hard shells. The disease can affect bones, the brain and other organs; it is spread when the germs get out of their shells, collect in the lungs and get coughed into the air.