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Tuberculosis Advisory for Health Care Providers

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Screening Recommendations for TB Exposures at Eastern State Hospital

Posted Aug. 6, 2025. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Situation

The Spokane Regional Health District (SRHD) Tuberculosis (TB) Program has received a report of TB disease in an individual associated with Eastern State Hospital. The exposure has led to a screening plan for employees and patients at Eastern State Hospital.

Background

One fourth of the world’s population is infected with TB. In 2023, 10.8 million people around the world became sick with TB disease. There were 1.25 million TB-related deaths worldwide. A total of 9,633 TB cases (a rate of 2.9 cases per 100,000 persons) were reported in the United States in 2023 (https://www.cdc.gov/tb/statistics/default.htm). Approximately two-thirds of these cases were individuals born abroad in the 22 countries considered to be “high burden” countries. These include countries in Eastern Europe, Africa, Asia, the Caribbean, Latin America, and the Pacific Islands.

Transmission of tuberculosis bacteria occurs through the air from person to person. In the US, an estimated 85% of individuals with TB disease represent reactivation of latent tuberculosis infection (LTBI). Risk factors for TB disease include:

  • Foreign borne from “high burden” nations, especially recent immigration
  • Close contact to individuals with infectious TB disease
  • Children < 5 years
  • Injection drug use
  • Homeless, correctional facilities, institutional residence
  • Immune compromised, especially HIV, TNF-alpha inhibitors, corticosteroids
  • Advanced renal disease, poorly controlled DM

TB Presentation

Individuals with pulmonary tuberculosis may clinically present with symptoms of a cough lasting for 3 weeks or longer, chest pain, hemoptysis, weakness or fatigue, weight loss, decreased appetite, fever, and night sweats. Symptoms of extrapulmonary tuberculosis are dependent on the area affected.

Actions Requested of All Clinicians

  1. Please screen for TB: individuals who present to any Spokane County Health Care Facility (i.e., hospital ED, primary care clinic, urgent care clinic) who report they may have been exposed to TB while receiving care or during employment at Eastern State Hospital. Some individuals may seek screening through their primary care clinic and not with Eastern State Hospital Infection Prevention. We believe that the timeframe of potential exposure is from 4/11/2025 to 7/11/2025.

Screening Protocol

A. TB Test

An Interferon Gamma Release Assay (IGRA), i.e., QuantiFERON Gold or T-Spot

B. Chest Radiograph

A posterior-anterior radiograph (single-view) should be performed on anyone with a positive TB test or anyone reporting symptoms of pulmonary TB disease at initial clinical assessment. Radiographic findings suggestive of TB disease include:

  • Air-space opacity or consolidation, often referred to as air-space disease
  • Interstitial opacity
  • Nodules or masses
  • Apical consolidation
  • Hilar lymphadenopathy
  • Pulmonary cysts or cavitations
  • Pleural space abnormalities
C. Sputum Examination

Individuals with findings suggestive of pulmonary TB disease on imaging, should have three sputum specimens collected 8-24 hours apart with one being a first-morning specimen

All three sputum specimens should have an Acid-Fast Bacilli (AFB) smear and culture. A rapid molecular test (NAA or GeneXpert) should be done on at least one specimen. 

Note: Please ask your laboratory if they perform rapid molecular testing. If not, you can request part of the sample be sent to the Washington State Public Health Laboratory (PHL) or UW Medicine for testing. 

  1. Complete the SRHD TB Reporting Form and attach copies of labs all labs, radiographic, and microbiology reports. Fax to the SRHD TB Program at 509.324.3600. 

If screening results are highly suggestive that pulmonary TB disease is present, please call the SRHD TB Program within 24 hours at 509.324.1613. (Do not wait for sputum specimen results before reporting.)

Please also report negative screening results from individuals who may have been exposed at Eastern State Hospital to SRHD TB at 509.324.1613. (This will help to avoid duplicate screenings.)