 Do you want grapes or an apple with your lunch? Apple. Is Aunt Cammy coming over tonight? Yeah, she's coming over for supper. You don't have to work late this week? No, baby. The agency got that account that we were working on last month, so we go back to regular hours. For a while anyway. Good. I might go into Grandma's with the mother tonight. Oh, I know. Well, we'll have a nice time with Aunt Cammy tonight. Try to be ready when I come pick you up, because I got to get that roast started by 5.30. Oh, hi, hon. How are you doing this morning? Good, Delma. How about you? Oh, I'm fine. I'm pulling the billing on the video gear account. Do you have the November files? Oh, yeah. It should be right here. Hey, did you hear about Dave? No, what about him? Well, you know how we were saying, how he never seemed to get over that cold and how much weight he's lost? Yeah. Well, his roommate called this morning. The hospital with TB. TB? How long is he going to have to stay there? I'm not sure. I hope for a long time. I thought you liked Dave. Of course I liked Dave. Everyone does. I just mean I don't want to get TB. I've heard that someone with TB just has to breathe on you, and bam, you've got it too. Oh, God. I was in and out of his office all the time when we were doing a budget for that presentation. Suppose he gave it to me. Well, I don't think it's that contagious, is it? I mean, you feel all right, don't you? Yeah, I guess so. But how sick do you get with TB? Oh, I can't afford to be out of work for a long time. And who take care of Danielle? And suppose I gave it to her? I don't know. I never knew anyone who got TB before. Well, Personnel's going to have a meeting about it this morning in the conference room. Everyone has to go. Everyone? Even Mr. Brendan and those guys? Yep, everybody. Well, all the big shots are going. We know this is serious. I'm sure you all know why we're here this morning. Dave Smitka in our accounting department is in the hospital with tuberculosis. Now, normally we don't discuss the reasons for people's hospitalizations, but TB can be infectious. And we're all in pretty close quarters here. I know there's a lot of concern about Dave's health and your own health, so we need to take a few minutes to address these issues. Now, we've all heard of tuberculosis. But I think a lot of us, and I include myself in this, don't know an awful lot about it. I called the health department when we got the news about Dave, and they offered to send over one of their people from their TB program to talk with us. So I'd like to introduce Ed Ramirez, who is going to tell us a little bit more about TB and answer any questions you may have. Ed? Hi, everybody. I'm with the Infectious Disease Bureau of the County Health Department, and I understand a fellow co-worker of yours has been diagnosed as having active TB. So naturally, you have a lot of questions as to what happens now. Let me explain a few things about tuberculosis first, and then if you have any questions, as we go along, feel free to ask them. TB is a disease that's spread by bacteria. It can affect any part of the body, but the area that's usually affected first is the lungs. Now, when a person with active TB in the lungs coughs, he or she releases into the air tiny bacteria-filled droplets. Now, these droplets can remain in the air for several hours. If another person breathes in these droplets, the bacteria may travel to the lungs and that person may become infected. Okay, that's the bad news. But there are a couple of things I want you to keep in mind. First is not everyone that's exposed to TB gets it. Next is that there's a difference between having TB infection and actually having TB disease. Many people who look and feel perfectly healthy test positive for TB infection. That means at some point, they've breathed in some droplets containing TB bacteria and the bacteria got into their system. But usually a person with a healthy immune system doesn't get sick from TB infection. And if you're not sick, you can't infect someone else. Is there any way to get rid of a TB infection? If you test positive for TB infection, there are medicines you can take that will kill off the bacteria, although it could take up to a year. People with TB infection cannot infect other people, so they can keep on working and doing their normal activities. So why is Dave in the hospital? Now, for someone like Dave, the situation's a little different. For whatever reason, his immune system wasn't able to fight off the infection and he's developed TB disease or what we call active TB. Now, some of you have said that for the past several weeks, he didn't look very well, he seemed to be coughing, losing weight, and of course there are other illnesses that produce these same symptoms, but these are some of the signs of active TB. How long does it take to get over TB? Because I was thinking back in the 20s, my grandfather had it. He had to go to some place up in the Adirondacks for a long time. That could very well have been. Back then, that's what they did to treat people with TB, put them in a place with a lot of rest and fresh air and basically wait until their immune system could fight it off. But with today's medicines, recovery time is a lot faster. How long does it take to get over it if you do take the medicine? That really varies from one person to another. The medication needs to be taken for at least six to nine months to make sure the bacteria is completely gone. So how long will Dave be out of work? He'll be out until test show he's not infectious anymore and that could be anywhere from a couple of weeks to a few months. But the point is Dave was working here while he was infectious and we probably all breathed in some TB bacteria at some point. A lot of us are worried that now we're going to come down with it too. That's a very natural concern. Now, it's true that TB can be spread by coughing or sneezing. It's also true that it's much harder to catch than the common cold. Getting TB from someone usually takes pretty close contact over a period of several weeks or months. I share a cubicle with Dave. I've been breathing the same air with him eight hours a day. Okay, that kind of contact over a period of time is definitely a risk. What you need to do, in fact, I would say what everyone here needs to do is to arrange for what's called a mantu tuberculin skin test. Now, if you don't have a regular healthcare provider, we could arrange for you to be tested through the health department clinic. What kind of test is that? A small amount of protein from the TB bacillus is injected under your skin on your forearm right about here. Then about two or three days later you go back so your health provider can look at the skin where the injection was given. Depending on the reaction, they'll decide whether you need further evaluation for TB. How accurate is it? The mantu test? Well, like all medical tests, it's not perfect. Some things can throw it off. For example, if you recently had a vaccination or if you had the measles or a fever when you took the test, these things can affect the reaction. But it's absolutely safe and it's the best test we have right now. If they're putting the bacteria right into you, doesn't that make you get TB? No, it's not the whole bacteria. It's protein that's been extracted from the bacteria and then it's purified and sterilized. It's very safe. So who needs to be tested? Okay, now since we know that TB is spread through the air, it stands to reason that those people that have had the most contact with the infected person are most likely to catch it. Let me show you what I mean. It's sort of like the circles they're created when you throw a stone into a pond. If you think of the infected person as being in the middle, then the first circle of contacts or those people who had the most contact with the infected person need to be tested. If no one in that group is infected, testing can stop right there. If someone is infected, then the next circle of contacts or those people who had somewhat less contact need to be tested and so on and so forth until no new cases are found. Now this is a pretty small office and Mr. Brendan has told me that all of you are in and out of the accounting area all the time. So in this situation, I would suggest everyone get tested as soon as possible. If I test positive, will they have to test my daughter too? Not unless you're showing symptoms of TB. Remember, you're not infectious unless you have active disease. Well, I grew up in India and I was vaccinated against TB when I was a kid. I don't need to get tested, do I? Yes, it would still be a good idea. When studies have been done on how well the vaccine protects against TB, its effectiveness has ranged between zero and 76%. Now no one is really sure why there's such a big range. But these studies do seem to indicate that some people who have been vaccinated might not be protected against infection. So you should get tested just to be on the safe side. So once we have the test, we'll know whether or not we got TB from Dave? Well, you may not know right away. After a person has been infected with TB, it takes a while for the immune system to react to it. Now this reaction time can vary from person to person. Now if you test this week and it's negative, all that would tell us is you haven't been infected with TB before. But it would be too soon to say for certain you haven't been infected because of exposure to Dave. So if you test negative the first time, you have to be tested again about three months later, and by then you'll definitely have a reaction if you've been infected. So some people are exposed to TB and get infected, but they never get TB disease? Actually most people who are exposed to TB don't come down with active disease, but the bacteria doesn't go away by itself. So healthcare provider will prescribe medication to kill off the bacteria if they think it's appropriate. These medications are very strong and can produce side effects like liver damage. So sometimes the health provider will say it's better for you to have the bacteria in your system than take the medication. But if you develop TB disease, then without a question you have to be treated for your own sake and to avoid spreading the disease. What if you've had the test before and you tested positive? Do you have to take the test again? No. Not if you can get a record of the original test from your doctor, but if you can't, you should be tested along with everyone else. I just want to add that the company will cover any costs you may have in getting tested. I also want to stress that we're doing this as a precaution. Hopefully we'll all find out we have nothing to worry about. And what if we do have something to worry about? If you have a positive test, your doctor will evaluate you for symptoms of TB disease. If you show no signs of the disease, then the doctor will decide whether you would benefit from preventative treatment. As I said before, there are medicines available which are very effective. However, they're not appropriate in every case. So that's something you and your doctor have to discuss. Any more questions? No? Okay then. I just want to ask you to let me know when you're going for your test, so we're not all out of the office at the same time. I'd also like to remind you that Dave's health status is being discussed here only because it's information that people who've worked with him need to know. There's no need to name him if you discuss the situation outside the office. All right then. I'll see where we're at next week. Mr. Ramirez, can I ask you a question? Sure. Well, this hasn't come up at a very good time for you, has it? Not really. Suppose my TB test is positive. I don't want to take medications right now if I don't have to. Well, that's understandable. How far along are you? Six and a half months. Okay. Well, first of all, you don't have to worry about the test itself. It's safe to have the test when you're pregnant. Now, if the test shows you're infected, you'll still need to be evaluated for symptoms of active TB like anyone else would in that situation. If the test shows you're infected but you have no symptoms of active TB, then it's up to you and your doctor to weigh the benefits and risks of preventative treatment during pregnancy. If you do show signs of active TB, then you'll definitely have to be treated before delivery. So tell your doctor you've been exposed to TB, get tested, and see where you are. Okay. I will. Just a precaution? Tell me another one. Better be just a precaution. I can't afford to get sick. Oh, let's not borrow trouble. Let's see if we've got anything to worry about like Mr. Brendan said. I guess you're right. Boy, it's going to be a long three months. Danielle, watch what you're doing. Why are you so mad at me? You've been yelling at me since we've got home. Oh, baby, I'm sorry. I'm not mad at you. I'm just worried about something that happened at work. What? Did you get fired? No, nothing like that. Somebody at work is sick. So now we all have to be tested to make sure that we don't have it. That's all. Sick with what? Something called TB. It can make you cough a lot and get kind of weak. Like when Grandma had the flu? Kind of. Could I get it? No, I don't think so. Not unless you've been around someone who has it. Suppose you've got it. Could I get it from you? Well, we don't have any reason to think that I have it. So don't worry. That must be Aunt Cammie. This is my girlfriend. Right there. Hi, Aunt Cammie. How you doing, Sugar? How's my baby sister? Brought to you a little springtime. Oh, they're beautiful. Good. And this is for you. This is what I wanted. Thanks, Aunt Cammie. You're welcome. Mm, mm, supper sure smells good. It's almost ready. Danielle, take your Aunt Cammie's coat and hang it up for her. Okay. Right. How's work? Busy. Mm-hmm. We must have seen 50 people at the clinic today. How are things with you? Not so great at the moment. What's the matter? We just found out this morning that there's a guy in the office who's come down with TB. Now we've all got to be tested to see if we've got it too. Well, that's pretty routine. We test people at the clinic all the time. Do a lot of them have it? Well, it depends on what you mean by having it. You can test positive and not have active TB. That's what they said at work, but I don't quite understand that. How can you have TB bacteria in your system and not be sick? Because if you're in good health, your body can fight off the bacteria. It's only when you get run down or if you get something that breaks down your immune system that the infection can turn into TB disease. It's scary to think of that stuff just sitting in your body waiting to make you sick. Well, that's why people get tested. They can give you medicine that kills off the bacteria before it has a chance to make you sick. Oh. What's the matter? This gravy is lumping up. Here, here, let me stir it. I'm the gravy queen, remember? You got a whisk? Yeah. How come I have to take the test twice? I didn't understand that. This guy's just been diagnosed with active TB, so they figure your exposure's probably been sometime in the last few weeks, right? Yeah. Now, if you breathe in any of those TB bacteria, your immune system's going to try to fight them off. You with me so far? Yeah. But it takes a little while for your immune system to realize the bacteria is there. If you have the test before your immune system is geared up, you won't show any reaction, right? So if you have a negative test now, it won't necessarily tell you whether or not you've been infected from this guy at work. So even if I test negative now, I'll have to be tested again in three months? Right, right. By that time, if you've gotten infected from your exposure to this guy, your immune system will be working to fight off the bacteria. So by then, your test would be positive. If you didn't get infected, it'd still be negative. Of course now, if you start to develop TB symptoms before the three months up, you get yourself to the doctor. You don't wait around for the next test. So what does it mean if I test positive the first time around? It could mean a couple of things. It might mean that you've gotten infected from this guy and your immune system has already kicked in to fight off the bacteria, or it could mean that you've been infected with TB before and didn't know it. Is that likely? Do you mean can you have TB infection without any symptoms? Sure. Around five percent of the population in this country is infected and a lot of them don't know it. Do I think it's likely that you've been walking around all this time with TB infection? Probably not, if you've never spent any time around a person with active TB before. Do you have something for the grape? This is so weird. I don't think I've ever thought twice about TB and suddenly it's all I can think about. Tell me more about the test. They put something under your skin? Yeah. It's protein from the TB bacillus. It's just a little bit and it's dead. It can't make you sick. But it's enough to cause a skin reaction if you have the bacteria in your system. What kind of reaction? The skin gets a little red and gets kind of raised and hard, like a mosquito bite. The bigger the reaction area is, the more likely the test is to be positive. There, those lumps are gone now. I can see you're still the gravy queen. How long will it be before I get to know my test results? Just a couple of days. You're really worried about this, aren't you? Yeah, I mean, I'm just making it with my bills now. But what really worries me is Danielle. Suppose I have it and she gets it, or even if she doesn't get it, how can I take care of her if I'm sick? Now, come on, you got yourself all worked up and you haven't even had the test yet. Look, do you work real close to this TB guy? No, he's not near me. He's right down the hall for me. So he hasn't been coughing in your face for weeks? No, but when we were doing that budget for the presentation, I was in and out of his office all the time, and they said at work that the bacteria stays in the air and you breathe it in. That's true, but it has to be a pretty closed area. How's the ventilation in your office? Oh, I don't know. I mean, we can open the windows and stuff, I guess okay. That's good. Moving air can help keep the bacteria from collecting. Honestly, Charlene, from what you're telling me, I don't think you have much to worry about, but it's good that everybody's getting tested just to be sure. Why don't you call the clinic tomorrow and make an appointment? I think I will. I'd like to get this over with. And remember, even if you test positive, it doesn't mean you have active TB. If it turns out that you did get infected, there are medicines your doctor might want to prescribe to clear bacteria out of your system. There's no reason to think that you're going to get sick or that you'll give anything to Danielle. Give what to me? Give you a big hug. That's what... Oh, boy! There's my girl, alright. Hey, what did you do with her hair? I gave her a nice little braid. But she looks lovely. Now, if your mother would just give us some of that good food and that lovely smooth gravy, everybody would be happy. I think your aunt is hungry. Okay, everybody, let's eat! Charlene Johnson. You can't be sister, right? Yes. Nice to meet you, I'm Alex. Hi. Okay, now you're here for the tuberculosis test. Yes. Any recent exposure to someone with TB? A guy on my job just went into the hospital with it. Do you work in the same room with him or closely with him? He works in the same general area I do, but not in the same cubicle. And if we're working on budget stuff, I might have to ask him something several times in one day and then other times I might not work with him for a week. So you wouldn't say there's been close contact over a long period of time? No. Have you ever had TB before? No. Okay, do you have any conditions that will put you at risk for TB? I wouldn't know what those would be. Well, any condition that breaks down your immune system. Infection with HIV, the AIDS virus is one. People with cancer are at risk, especially those with leukemia or lymphoma. So are people who've had to take cold or sun drugs for a long period of time. People who've had organ transplants. People with diabetes or kidney disease or silicosis or intestinal bypass surgery. They're all at higher risk. No, I've never had any of those things. Now, have you ever taken the HIV and TB body test? Yes, I took it last fall when I took out a new life insurance policy. It was negative. Okay, good. And how would you describe your general health? I guess I'd say very good. I'm almost never sick. And were you born in this country? Yes. You know, I asked that because TB is very common in some areas of the world. And people who come from those areas may have been exposed to TB before without knowing it. Okay, well, Charlene, from what you've told me, I would say the only risk factor you have is exposure to your co-worker. Now, I certainly agree you should take a TB test, but don't make yourself crazy worrying about this. Oh, I can't help worrying about it. I have an eight-year-old daughter to take care of, and I can't get something like this. Let's take a worst-case scenario and say that your skin reaction turned out to be positive. Now, if that happened, we'd do a chest x-ray and a sputum test. That's a test of any mucus you may cough up to make sure you don't have active disease. Is that likely? Oh, it's possible, but I'll be very surprised if that were the case. You're a healthy young woman, and you don't have any underlying conditions that would encourage the bacteria to develop into active TB. So if I have a positive skin test, but the other tests are okay, then what happens? Assuming that the chest x-ray and the sputum test don't indicate any signs of disease, we'd assume that you had TB infection. A doctor might give you prescription for a medication that will kill off the TB bacteria in your system, but you have to take it for up to a year to make sure it's effective. But if you take it for the recommended length of time, your chances of ever getting active TB are greatly reduced. You wouldn't be infectious, so you wouldn't miss work or you wouldn't have to worry about your daughter getting it. Do you think you can handle that? I guess so. It doesn't sound quite so scary the way you described it. Why don't you read the consent form, and then I'll take your temperature. Okay. Okay. Thank you. Do I have to do anything special to the area where you did the test? Keep it dry or anything? No, just make an appointment to come back here in two to three days so I can examine it. This is Tuesday, so you should be checked on Thursday or Friday. Oh, I'll have examined it a couple of times myself by then. Don't try to rate it yourself. Some people react to the solution that the TB protein's in. They'll get a little flare up even though they're negative. You need to come back to someone who's been training, reading these tests can examine it. And it's very important you come back between 48 and 72 hours, because the reaction starts to fade after that and you can't tell what's happening. Oh, I'll come back. My sister would be on my case like you wouldn't believe if I didn't. I wish more people had sisters like that. So your follow-up test was negative too? Yep. It was a little red right around where they did the test, but the nurse said it was negative, and I felt fine right along. See, I told you not to borrow trouble. Oh, I know, but look at poor Don. He told me his second test was positive. Well, they expected that might happen after all. He does sit right next to Dave. He's being pretty calm about it. I guess his doctor told him if he takes the medications like he's supposed to, he'll be fine. I was surprised that he had to take him for such a long time. I know. Six months to a year, he said. Won't that get expensive? Well, I guess his insurance will cover most of it. Good. Hey, has anybody heard from Sherry how she may not with her test? I haven't seen her since she went on maternity leave. Oh, Amanda went to see her on Monday, and she said Sherry told her her test was negative both times. And Amanda said the baby is adorable. Bet she was relieved. It's tough enough having a new baby without having to worry about TB, too. You know it. I sure hope we don't have to go through anything like this again. Well, you never know. But at least we'd have some idea of what we're dealing with. Yeah, that's true. I don't think I'd ever be so freaked out another time. But it sure makes you stop and think what it would be like to get something like TB. Speaking of which, how does Dave seem? He seems pretty good. We've been spending a lot of time on the associated account, and he's been able to keep up with no problem. How do you feel about working with him? What do you mean? Well, you were the one who wanted him to be out for a long time so he wouldn't breathe on you. Oh, well, I didn't know much about TB then. I mean, now I know he's not infectious anymore, so I'm not worried. Actually, I'm glad he's back. I've been doing most of his work while he's been out. You know, I should be glad to see anybody take some of these files off my desk. You think that's a hint? Oh, I don't know. She's pretty subtle. I guess since we're healthy, it's time to get back to work. I guess so. You know, normal life is going to seem a little dull after all this excitement. Oh, I'll take dull and normal any day.