Tuberculosis threat returns - includes related article

HR Magazine, June, 1994 by Todd Lassa

A resurgence of TB calls for awareness by practitioners, particularly in the five types of facilities covered by a new OSHA rule.

A contagious disease that health-care experts thought had been conquered by the mid-1980s is on the rise again and could threaten your workplace.

There were 26,673 reported cases of tuberculosis nationwide in 1992, compared to 22,201 cases in 1985, the year of the lowest recorded level of infections, according to the Centers for Disease Control and Prevention (CDC) in Atlanta.

Between 1953 and 1984, the number of active TB cases declined 74 percent annually, said a U.S. Office of Technology Assessment report released earlier this year. Since then, strains resistant to anti-TB drugs have complicated public health efforts to end the disease.

Each year tuberculosis kills about 3 million people, and 8 million new cases are reported worldwide, according to the U.S. Department of Health and Human Services. The CDC reports that up to a third of the world's population is infected with the TB germ, including an estimated 10 million people in the United States.

The problem with TB, health-care experts agree, is one of proper diagnosis and treatment. TB is easily cured in most cases, but those with the disease must be identified and must be isolated until their treatment is complete. They must take antibiotics for six months until they are cured, said Dr. Lee Reichman, immediate past president of the American Lung Association and the executive director of the New Jersey Medical School National Tuberculosis Coalition in Newark.

The disease has a 50 percent fatality rate worldwide among patients who are untreated, he said.

TB is caused by Mycobacterium tuberculosis, a bacterium that produces lesions. Infectious droplets with a diameter of 1 to 5 microns are spread by coughing, sneezing, singing or speaking and can float in the air for hours.

NO REGULATIONS FOR MOST EMPLOYERS

So what is a human resource manager to do if an employee is found to have TB? There is virtually no guidance for employers who are not in one of the five types of "highly hazardous" facilities: health care, correctional institutions, homeless shelters, long-term care facilities for the elderly and drug treatment centers. These five types of employers are subject to Occupational Safety and Health Administration (OSHA) enforcement standards issued in October 1993.

Jim Johnston, regional hygienist for OSHA's Region III office in Philadelphia, said the agency has no requirements for businesses or employers outside the five facilities listed above. Essentially, the typical human resource manager has no legal obligation to do anything.

"The other side of the coin is," Johnston said, "if your employee had TB, you should offer TB skin testing to other fellow employees."

Although the CDC's description of the bacterium that causes TB indicates it is highly contagious, Harvey Shapiro, assistant regulatory administrator for technical support for OSHA's Region II in New York, said TB is highly contagious only in settings where there is prolonged exposure to someone with the disease.

Those who share the same air space with persons with infectious TB disease are at greatest risk of infection, according to the CDC. As for typical contacts among co-workers and customers, Shapiro said, "it would be highly unlikely [to contract TB] in those settings, based on what we know about how the disease is spread."

Reichman agreed. "The first thing is, concern needs to be raised that it is a problem," he said. "The second is that in most workplaces, it is not a problem."

DISCRIMINATION CONCERNS

However, Reichman's advice for workplaces raises other human resource management concerns. In places such as New York City or Miami, where many foreign-born people are finding jobs, he said, employers should test new employees for TB before they start work. If an employee is found to have TB, he said, the employer should repeat the testing process in the workplace.

In cities with a less diverse population, employers need not bother, he said.

While that may be potentially discriminatory, CDC figures do show the disease is growing faster among foreign-born persons. The number of foreign-born persons with TB rose by 47.6 percent, to 7,270 cases in 1992. In 1985, foreign-born persons accounted for 22 percent of all TB cases in the nation, but in 1992, they accounted for 27 percent. And of foreign-born persons with TB whose year of arrival was known, 58 percent had been in the United States for five years or less. The CDC figures did not distinguish legal aliens from naturalized Americans.

Employers in the five "highly hazardous" types of work sites will not have to worry about discrimination. But existing federal rules and regulations on TB were not written with discrimination concerns in mind and thus are catching up with the disease's resurgence. The federal OSHA rule issued October 8, 1993, was a memorandum by the director of the directorate of compliance programs. This ruling essentially adopted at the federal level the compliance regulations that OSHA's New York City office established for Region II in May 1992.