The winning battle against tuberculosis in the United States may, ironically, be part of the reason why the disease wasn't detected in a young Las Vegas mother and her baby until it was too late, experts said.
A leading cause of death in the early 20th century, the airborne illness most associated with a bad cough has declined in the U.S. to the lowest levels since record-keeping began 60 years ago. Tuberculosis claimed 569 lives in the U.S. in 2010, meaning fewer and fewer doctors have experience treating or recognizing it, especially in otherwise healthy young patients.
"This idea that young people don't get it is wrong," said Dr. Ihsan Azzam, Nevada's state epidemiologist. "It's now on the radar again. We thought this was eliminated in our country, but there's now a resurgence of the disease."
Health officials first learned of a potential outbreak when California officials informed them that a 25-year-old Nevada woman had died in a hospital there in July. She had been sick before and after giving birth to extremely premature twins, according to a Southern Nevada Health District report, but it wasn't until the autopsy that doctors diagnosed her with tuberculosis.
By that time, one of her baby girls was already dead due to respiratory failure and extreme prematurity, the Clark County coroner said. She was never tested for TB. The second twin, who was being housed in Summerlin Hospital's Neonatal Intensive Care Unit, was treated for tuberculosis but ultimately succumbed to the disease Aug. 1.
A first round of testing over the summer screened more than 200 hospital workers and friends and family of the woman. So far, 26 people have tested positive for tuberculosis, although only two of them have the contagious form.
This week, the Southern Nevada Health District expanded the investigation to some 140 babies who were in the NICU when the sick baby was, as well as their family members. Dr. Joe Iser, chief medical officer at the health district, said it's unlikely other babies are affected, but the measure is out of an "abundance of caution."
Handling such a wide exposure amid a group as sensitive as babies in a NICU was so delicate, state officials sought out expert assistance from the federal Centers for Disease Control and Prevention. The health district also issued a "technical bulletin" to doctors on Monday that explains symptoms of TB in children and describes treatment options.
"We have to keep our skills and personnel on the ball, or we'll once again see TB begin to spread," said Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine.
Meanwhile, a grieving family is seeking answers.
Attorney Ryan Dennett, who represents the woman's family, said he plans to investigate which tests were and weren't administered to the young mother during her time in the hospital and is exploring the possibility of filing a lawsuit.
Laboratory testing is still ongoing, Azzam said, but investigators believe the woman contracted TB after eating an unpasteurized dairy product from somewhere in Latin America. The strain she had, mycobacterium bovis, is found in dairy cattle, although it accounts for only about 2.5 percent of total human tuberculosis cases, he said.
That finding has added fuel to state health officials' crusade against unpasteurized dairy products. An existing state law preventing the distribution or transportation of unpasteurized milk helps to mitigate the problem, but word about the infection risks may not be getting to minority communities where foreign-made, raw dairy products are more commonplace.
Azzam said state officials plan to work with the CDC and other agencies to improve outreach and awareness — but after the current threat is under control. He said it appears the worst has passed.
"The expectation was that we may have a wildfire," Azzam said. "Thank heaven for human immunity and our resistance. ... The transmission is less than what we thought it would have been."