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Testing a Prospective Nanny or Housekeeper for Tuberculosis

In 1989, Center for Disease Control and Prevention announced the goal of eliminating Tuberculosis (TB) from the United States by year 2010.

However, today TB and drug-resistant TB cases are continuously reported in every state. An estimated 10 to 15 million persons in the United States are infected. More than 14,000 cases were reported in 2003 in the U.S. TB killed 1.7 million people in 2003. It remains the leading killer of adults in the world.

The increase in TB worldwide is due, in part, to the expansion of the HIV/AIDS pandemic (at least one-third of the people with HIV die of TB. Social forces such as racism, sexism, other social inequalities and political violence and poverty contribute to the spread of HIV/AIDS and TB.

Drugs that could stop or slow down these epidemics, such as first hand anti-tuberculosis medications and anti-retrovirals are not available in impoverished countries where they are needed most.

In the United States, and especially in California, Tuberculosis is largely an immigrants' affliction. In a recent report by the state's Department of Health Services, California led the nation in the number of new TB cases reported last year - 2,989. Three-quarters of those were among people born outside of the United States and nearly a fifth were younger than 16.

Experts say that many immigrants bring the bacterium from countries, including Mexico (24%), the Philippines (14%), Viet Nam (9%) and other foreign born (29%) where TB is endemic and health systems are relatively weak.

Many immigrants come infected but undetected due to inadequate screening of new immigrants who are foreign students, workers and visitors. Only refugees are screened, and that system is not flawless. The concern is how entrenched TB remains in some immigrant enclaves and how 1% to 2% (8 to 10 cases) in California is resistant to standard antibiotics. This, of course, has given fuel to the fire over illegal immigration.

Many people from immigrant families live in the poorest and most crowded neighborhoods in the Los Angeles area. With its large immigrant population and dense neighborhoods, Los Angeles County is a TB stronghold. It had 930 tuberculosis cases in 2004, more than most states, according to Health Department figures. They live in the most likely places to find tuberculosis.

Due to financial constraints, they may think it is merely a cold and not seek medical help until they are really sick. Understanding TB and how it is carried and contracted should be of interest to you if you have an immigrant working on a daily basis with you and your family members.

Tuberculosis (TB) is a disease caused by bacteria that usually attacks the lungs. It travels through the blood and can also attack other parts of the body such as the kidney, spine and brain. If not treated properly, it can be fatal. TB is spread through the air from one person to another when a person with the active TB disease of the lungs or throat coughs or sneezes.

People may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria actually becomes sick. In most cases, the people who breathe in the bacteria can fight it so that it does not grow. The bacteria become inactive, but remain alive in the body and can become active later. This is what is called "latent TB infection." People who have latent TB infection have a positive skin test reaction but do not feel sick, have any symptoms nor can they spread TB and they have a normal chest x-ray and sputum (phlegm) test; however, some who have weak immune systems do go on to develop TB disease.

Babies and young children have weak immune systems. People with active TB can get treated with medicine and get cured and those with latent TB can take medicine so that they will not develop the active TB disease. The TB disease attacks the tissue and can actually create a hole in the lung.

The following are symptoms of active TB disease:

A bad cough that lasts longer than 2 weeks;
Pain in the chest;
Coughing up blood r phlegm from deep inside the lungs
Weakness or fatigue
Weight loss
No appetite
Chills and fever

An important question when hiring a nanny or housekeeper would be how do you confront your prospective employee with the concept of getting TB tested prior to coming to your home to work with your newborn child. If you are working with an agency, you should ask them to have their applicant tested for TB. Your decision to hire this employee would be subject to the test results.

This can get sticky, if you are dealing with a prospective nanny or housekeeper directly. You may not want to inform this applicant that you will only hire her/him based on the test results. This could get messy. The way to approach the offer would be to say that you would like to have the following medical tests performed and that you will be concurrently checking references along with criminal and DMV records to determine a job offer. If the TB skin reaction test comes back positive, you would need a chest x-ray to see if the TB is in effect latent and inactive. As mentioned earlier, with medication, this condition can be controlled and never develop into active TB.

You may or may not feel comfortable about not knowing whether or not the employee would take the necessary medication. What is most important, however, is that you know the test results so that you can incorporate this information into your decision making when hiring household help, housekeeper or nanny.

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Marta Perrone, author of How to Find, Hire, Train and Maintain Household Help. Free report: Top 10 Mistakes Household Employers Make When Recruiting Help. www.domesticpublications.com, domestic-connections.com, martaperrone.com

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