METHODS: We defined contacts as HCP, infants, and visitors who spent time in the same NICU room while the patient was present. HCP were screened using TSTs. Infants were screened for tuberculosis infection with clinical assessments, TSTs, and interferon-gamma release assays (IGRAs). Because screening tests are unreliable in infants, we recommended preemptive latent tuberculosis treatment (9 months of isoniazid) and monitoring for all exposed infants. Family members were offered IGRA testing.
RESULTS: Among 134 HCP identified as contacts, 130 (97%) were evaluated. In total, 7 HCP (5%) had a new positive TST. All had performed procedures that are high-risk for exposure (e.g., stabilization, intubation, suctioning); none had prolonged exposure to the infant’s mother. Of 26 infant contacts, 22 were screened; none had a positive screening test. Eighteen infants began isoniazid therapy; four additional infants are under monitoring only. Of 23 visitors tested, one had a positive IGRA; this individual had no other risk factors for tuberculosis infection and reported spending >20 hours with her infant immediately adjacent to the index patient. All adults with a positive screening test began latent tuberculosis treatment.
CONCLUSIONS: Evidence suggests that transmission of tuberculosis, likely from a congenitally-infected infant, to HCP and one visitor occurred in a NICU. While thought to be rare, M. tuberculosis transmission from congenitally-infected infants to HCP has been reported. Respiratory support of the infected infant, including aerosol-generating procedures and HFOV, might have contributed to this unusual transmission event. These findings reinforce the importance of following current tuberculosis contact investigation guidance to evaluate all persons, including visitors, who share airspace with an infectious tuberculosis patient for a prolonged period or during aerosol-generating procedures.