Disease outbreak rocks small Greenwood County town

Parents express outrage over tuberculosis contamination at primary school

sfretwell@thestate.comJune 8, 2013 

  • What is tuberculosis?

    Tuberculosis has become relatively rare in most North American and European nations. Symptoms typically including coughing, night sweats, chest pain when breathing and coughing up blood, according to the World Health Organization and the Mayo Clinic. People with TB often lose their appetites and lose weight. Most TB cases can be cured when medicines are taken properly, the World Health Organization reports. But if not treated, the disease can be fatal.

  • A timeline

    Early March: Ninety Six Primary School employee suspected of exposing students and staff to tuberculosis stops working at the school; some teachers tested for disease

    March 28: DHEC officials walk through the school with school officials but discuss only the possibility of an infectious disease problem, district officials say

    April 8: School superintendent says he began calling DHEC, looking for information to relay to parents.

    May 27: DHEC tells superintendent it has identified a person with contagious tuberculosis

    May 28: Schools and DHEC send home notes to parents explaining threat; testing offered later in week

    June 3: Test results show more than 50 students at Ninety Six Primary School are positive for TB germ

— From the shade of her front porch, Barbara Lyons watched quietly as laughing children whizzed down the street on bicycles or wrestled with their friends in grassy front yards.

Her 6-year-old boy, Zy, was out there among them, running through the neighborhood, his smile seemingly brighter than last week’s June sun.

But on such a carefree day for Zy and his friends, Lyons’ mind filled with questions about the disease that threatens the children of Ninety Six.

Since June 3, more than 50 kids – including Zy – have tested positive in exams for tuberculosis, a relatively rare disease that can cause coughing, wheezing, chest pain, and in extreme cases, death.

State health officials say that with proper treatment, the children’s health will be protected, but parents remain skeptical and are full of questions.

How, they ask, could this happen in quiet Ninety Six? Why was an infected custodian not kept from spreading tuberculosis germs at Ninety Six Primary School?

And why did the local school district and the S.C. Department of Health and Environmental Control wait so long to tell people about the threat to their children?

“I was immediately angry,” Lyons said, remembering her reaction at hearing Zy had tested positive. The boy must now take medication under close supervision for months as treatment to prevent the disease.

“I’d like for them to be accountable – for everything,” she said. “DHEC should have notified the school system, and the school system should have notified us” sooner.

DHEC and the Ninety Six school district sent notices home with the children May 28 and began testing them for TB later in the week – fully two months after the agency launched a contagious disease probe at Ninety Six Primary School. A DHEC spokesman declined to discuss the probe in mid-April when questioned by the media.

In an interview Saturday with The State newspaper, health agency director Catherine Templeton said the children were infected well before a private doctor informed DHEC in early March that a school employee might have contagious tuberculosis. Consequently, failing to tell parents before May 28 didn’t compromise the children’s health, she said.

But Templeton agreed parents needed to know what was going on long before notes went home May 28.

“I wish they had known sooner,” she said Saturday.

The health agency and the school district blame each other for not speaking up to address rumors about the infectious disease.

District superintendent Mark Petersen said DHEC didn’t share much information about its disease investigation in March, so he had little to tell the public. Templeton said DHEC tested numerous Ninety Six Primary School employees in March and gave the district plenty of information to provide parents.

Talk of the town

The Ninety Six tuberculosis outbreak is the worst in Greenwood County and one of the worst in South Carolina since at least 2003.

DHEC records show that Greenwood County has had only 17 cases of tuberculosis reported since 2003. Statewide, no other county has had more than 30 cases of TB reported in a single year during the past decade, records show.

After DHEC began testing in late May, 63 people – including 53 children – have had positive tuberculosis skin tests. Of those, 10 kids have developed full-blown cases of the disease, the agency says. The kids are not considered contagious, but two adults are.

The outbreak has stunned historic Ninety Six, a community of 2,000 near Greenwood that reportedly received its unusual name from a Colonial-era surveyor.

Best known for an early Revolutionary War battle and for a big league baseball pitcher who wore the number 96 on his uniform, the nearly 300-year-old community has seldom experienced anything like the recent tuberculosis scare. From lunch counters to convenience stores, the disease is the talk of the town 70 miles northwest of Columbia.

“This is the topic anywhere you go,” said Al Armstrong, a 46-year-old grandfather who moved to Ninety Six while in grammar school.

After pumping gas at a local convenience store on the edge of town, Armstrong said he couldn’t believe the lack of information about the tuberculosis threat.

“People just don’t feel like they were told enough,” he said as his 7-year-old grandson, Hunter Simmons, picked flowers from a field next to the gas station. “They felt like they were kept in the dark on this. We don’t know if this happened in November, in March, or when.”

Armstrong said Hunter showed no signs of the tuberculosis germ after the boy was tested for the disease in late May, but two of his grandson’s baseball teammates have tested positive. Armstrong said a good friend of his also has a child who has tested positive.

Greenwood attorney Billy Garrett said the community is upset for a simple reason: It affects children.

“That’s the flashpoint,” he said. “The first reaction from all these folks is ‘Our children were not protected.’ Their next question is, ‘How is this possible in the 21st century when you send your kids off to school?’”

Garrett filed a lawsuit last week against DHEC and the Ninety Six school district, alleging the government agencies were negligent in quickly identifying the health dangers and notifying those at risk. DHEC spokesman Mark Plowden denied that, calling the lawsuit a “distraction” to agency efforts in the TB outbreak.

DHEC says the source of the tuberculosis germ is a Ninety Six Primary School worker, believed to be a janitor who had worked there for years. Infections result from breathing tuberculosis germs.

According to DHEC, the children at Ninety Six Primary could have been infected directly from close contact with the contagious school employee or by breathing in microbes that flowed through a ventilation system and settled in classrooms. The confined rooms allowed for the “sustained suspension” of germs, the department says.

So far, DHEC says the man and a second school worker have a contagious form of tuberculosis and could be dangerous to the community if they come in contact with other people.

The man, who DHEC says has been uncooperative, is being held in a Columbia detention facility so he cannot expose other people to the disease. He is being treated and will remain there until he is well, records show. The other infectious person is cooperating, is being quarantined at home and also is being treated, Templeton said. The more than 60 people who have tested positive for TB aren’t infectious but are getting the preventative treatment, she said.

“I really think it is vitally important for people to know they can trust DHEC,” Templeton said.

TB can kill

Tuberculosis, which has declined dramatically in the U.S. in the past century, is now rare and few people are vaccinated for it.

The TB rate fell more than 6 percent from 2011 to 2012 nationally, with only 3.2 people out of every 100,000 people affected by the disease, according to the U.S. Centers for Disease Control and Prevention.

Nationally, the rate of TB disease hit an all-time low in 2012 with fewer than 10,000 total cases, the CDC said in an email to The State last week. DHEC statistics show only 122 reported cases of tuberculosis in South Carolina in 2012, with Charleston County’s 22 cases leading the state.

Tuberculosis, however, remains a threat in many other countries and foreign-born people who come to the U.S. are particularly at risk, the agency reported. Nearly 9 million people were sickened and more than 1 million died from TB around the world in 2011, the CDC said.

DHEC and the CDC emphasize that just because someone tests positive for tuberculosis, it does not mean the person will contract the full-scale infectious form of the disease. They also note that children are far less likely to be infectious and spread tuberculosis than adults. DHEC says the children it has checked so far are not contagious.

Despite DHEC’s assurances, Lyons and others remain uneasy. Some said they had been hearing talk about disease at Ninety Six Primary School long before government officials confirmed anything in late May.

“Evidently my son had to come in direct contact with” a contagious school employee, Lyons said. “Who is this person who got him infected? I had heard rumors about somebody having something at the school.”

DHEC officials have declined to name the infectious workers, citing federal medical privacy laws.

On a drive down a country lane outside Ninety Six, Fred Turner pulled his golf cart to a stop and showed his 2-year-old grandson a pasture filled with cattle. The youngster, talkative and full of questions, pointed at the different cows as his grandfather explained his family’s concerns about tuberculosis.

The boy’s health means everything to the Turner family – and that’s why the youngster was tested last week for tuberculosis, he said. The youngster attends a daytime nursery not far Ninety Six Primary School.

“We just wanted to be sure,” Turner said. “He got sick not too long ago. So we just want to have him checked for this. This has been going on for a while. They should have notified us.”

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