A secret with consequences: a school nurse from Zelenograd who suffered from tuberculosis hid her illness until her death. Sick child in a children's group

The school nurse in Zelenograd school 1151 continues to develop from tuberculosis. They involved about 1,200 children, primary school and kindergarten students - a nurse worked in both of these buildings - as well as their families. The school held several parent meetings with the participation of doctors, school administration and representatives of Rospotrebnadzor, which monitors the epidemiological situation in the city.

Doctors and the school talk first of all about what to do and what has already been done - about diagnosing tuberculosis and disinfecting premises. Parents want to hear something else - how it could happen that a school nurse with an open form of tuberculosis continued to work with children, who is to blame, and who will be punished.

The parents contacted the prosecutor's office and wrote a petition to the Russian Ministry of Health and Education. The investigation is being conducted by Rospotrebnadzor of Moscow and the Tver region - so far its results have not been announced. Allegedly, the school health worker knew about her real diagnosis and hid it.

According to the latest data, all children who have a medical test for Mantoux and Diaskintest will receive a free alternative T-Spot test, and the school will be re-disinfected.

What happened: they didn’t know about tuberculosis at school for more than a month

Tuberculosis became the cause of death of a nurse who worked at school 1151 for two years - until the last days of December 2017. Then she was hospitalized in the Zelenograd city hospital, but she did not name her place of work: she said that she had not worked anywhere for about two months, and she did not need a sick leave. The disease was fatal in January, but for a long time no one knew about the risk of infection among schoolchildren.

“Indeed, it was established that we are talking about tuberculosis, and precisely its open form. We receive information from the city system, which records all cases of infectious diseases in the city,” Vera Tikhonova, deputy head of the Zelenograd branch of Rospotrebnadzor, told her parents. - Information about a woman’s tuberculosis was received without indicating her place of work. Later, the phthisiology service, collecting information about contacts, found out that the woman was related to school 1151. As soon as we received this data - in early February - we, without waiting for confirmation of the diagnosis, launched all the measures prescribed by law and Sanitary Regulations.”

The nurse worked in two buildings of the educational complex - in an elementary school (building 1464) and in a kindergarten (building 1463), in total there are about 1,200 schoolchildren and pupils. The work schedule was daily, half a day in one building and half a day in another building. However, the nurse was not a school employee. For several years now, all school health workers have been subordinated to clinics, and schools only provide them with a room for work - a medical office. This partly explains why the disappearance of the school doctor did not concern the school administration.

Mass testing of children for tuberculosis and referrals to a tuberculosis clinic marked “TB contact,” which children were given in March, caused panic among parents. When conducting diagnostics, doctors avoided talking about the reasons - this was later explained by the mystery of the medical diagnosis. Clinic 105, where the sick nurse worked, also refused to answer all the site’s questions, citing medical confidentiality and a ban on the transfer of personal data - although the questions related to the official activities of the clinic employee.

What has already been done: disinfection and first diagnostics

On February 15, the school received an order from Rospotrebnadzor that it was necessary to disinfect two buildings within a week. From February 19 to February 22, it was carried out by a disinfection station, as the director informed the parents - these were school holidays, and the kindergarten was treated in the afternoon, disinfection was total in all premises, including catering units. However, the parents demanded to see the reports and still doubt the quality of the processing: “The school management refuses to show documents about this,” they wrote in the petition.

Doctors began examining children and adults. At the end of 2017, teachers already underwent a mandatory examination, including fluorography - using these lists, the phthisiology service selected which teachers to examine first, and who a little later. In addition, school and clinic staff were examined using a mobile fluorograph. “All school employees will definitely be examined and TB specialists will decide on the need for further treatment,” Tikhonova confirmed.

Information was also prepared for all children: who is vaccinated, who has the Mantoux test (it is done routinely once a year), who has a medical outlet. The children's clinic was ordered to administer the Mantoux and Diaskintest tests to all children, except those who had already had them done recently. Based on the test results, phthisiatricians decide who will be given Diaskintest again after some time, who needs a phthisiatrician’s consultation and examination, and who needs treatment, at least preventative.

“We have come to you now to tell you that all the measures that are required in such a situation are being carried out. We are now trying to help with all our might so that the children do not get sick, we offer you an examination plan and ask that you take it seriously,” the doctors admonished at the parent meeting.

Getting sick with tuberculosis is not so easy, according to specialists at the tuberculosis dispensary: “The contact would not be family or close. This happens very rarely, even in close contact with the patient - children from families in which someone had tuberculosis rarely become ill. The BCG vaccination protects the body's immunity and other factors. There is a serious risk of getting sick among people with HIV, those receiving genetically engineered drugs, hormones, etc. Those who are not vaccinated against tuberculosis are also at risk.”

There is an algorithm for which Mantoux and Diaskintest results a child should definitely visit a phthisiatrician. If the reactions to the tests are negative - there is no trace - the diagnosis will simply be repeated six months later. If the reactions are positive, they are compared with last year's samples and see if there is a so-called turn - a sharp increase. The Mantoux test can give a positive reaction, but within reason. If the growth is 6 mm or more, with a positive reaction to both tests, Mantoux and Diaskintest, you definitely need to see a phthisiatrician. This suggests that the tuberculosis bacillus is in the body, and the disease is developing.

At the tuberculosis dispensary, doctors work by appointment, but everyone who has been given referrals at school 1151 will be accepted without an appointment - parents were urged to “just have patience.” “Last year, schools and kindergartens were also examined in this way - by contact. What to do, this is life,” stated the representative of the dispensary.

When making medical appointments due to a recent illness or allergy, it is recommended to postpone the tests, go to the pediatrician and ask for an alternative examination (lung x-ray) in order to rule out tuberculosis and not worry. Parents and family members of schoolchildren do not need to be examined, doctors say.

At the same time, parents report that they were forced to sign consent for Mantoux and Diaskintest tests, despite the recent illnesses of their children and medical withdrawals. “Many are ready to simply take their children out of school,” they write in the petition, “However, the management warned us that in this case we are violating the children’s rights to education, and this will be reported to the guardianship.”

By mid-March, about half of all children who needed it had been diagnosed: the resources of doctors and clinics are limited, and supplies of tuberculin tests are also limited. “We were told that one student has been diagnosed with tuberculosis, and another is suspected, and two school employees are also infected.” , - the Federal News Agency reported from the words of the parents.

“At the moment, no tuberculosis patients have been identified among children or school staff. I would like to emphasize that during 2016-2017, not a single case of tuberculosis was detected among children and adolescents - permanent residents of the Zelenograd district,” said the director of the Moscow City Scientific and Practical Center for the Fight against Tuberculosis, the chief phthisiatrician of the Moscow Health Department, on March 21 Elena Bogorodskaya.

Children exposed to tuberculosis will be monitored for two years - this is the maximum incubation period for this disease.

How could this happen

“We have done all our work, but we are already analyzing the consequences,” the local doctor at the tuberculosis dispensary answered the indignant parents. - All questions to the person who carried out the medical examination of this health worker. No, all regular checkups were followed, but apparently she was hiding her illness. Tests can be taken anywhere. We cannot verify this."

The investigation is being carried out by divisions of Rospotrebnadzor in Zelenograd, Moscow and the Tver region. In the nurse’s medical book, issued in August 2017, there was a note about undergoing fluorography in one of the hospitals in the Tver region, the chief TB specialist in Moscow reported: “The management of the clinic had no reasons for removal from work due to illness. Currently, a request has been sent to the specified medical organization regarding the revision of fluorography. A copy of the medical record has been sent to the hospital for an internal investigation.”

As a source in medical circles told the site, presumably the woman had been treated for cancer for a long time, that is, the diagnosis was made incorrectly. Modern forms of tuberculosis are well disguised as other diseases, and diagnosis can take two or more months.

There is another version: according to parents who tried to undertake their own investigation, the school nurse was registered at the anti-tuberculosis dispensary in Tver, however, she also hid her place of work there. The woman is left with two teenage children - a daughter and a son. They are now in quarantine, it is not yet clear whether they are sick or not.

“We have the right to demand that representatives of the Ministry of Education and the Ministry of Health visit us. We need guarantees that our children will be okay. The investigation should be under special control in several departments at once, so that this is not allowed in children's institutions throughout the country,” the parents of school 1151 appeal in the petition.

The petition has already been responded to - officials from the capital's education and health departments, as well as the chief phthisiatrician of Moscow, came to the school on March 21 for a parent meeting. Results of the meeting: all children who have a medical withdrawal from the Mantoux and Diaskintest tests will receive a free alternative T-Spot analysis; TB consultations will take place directly at school; After preliminary general cleaning, the school will undergo repeated disinfection treatment until April 7, which will be monitored by a committee of parents.

A scandal broke out at school number 1151 in Zelenograd - as it turned out, a nurse had worked at the school for two years and suffered from an open form of tuberculosis. They learned about the health worker’s illness only two months after her death, writes "Moscow's comsomolets" .

As the mother of one of the students said, the new director of the school announced the woman’s illness at a parent meeting. He stated that the nurse was on the staff of the clinic and “was just sitting on the territory of our educational institution.” However, the parents found out that the nurse was in close contact with the junior high school students, gave them vaccinations and ate with them in the same cafeteria. The woman came from the Tver region and was registered at the tuberculosis dispensary there. At the same time, the woman alone tested students for the Mantoux reaction and worked at the school until the end of December. And in early January she died.

“And in mid-February, shortly before the holiday, our students were sent home for four days for some unknown reason. It seems that at this time the school was being urgently sanitized. We were told to take absolutely all the children’s belongings with us, but they did not give a reason , so some thought that this disinfection was due to viral pneumonia, which many people are now also suffering from,” continues the student’s mother. At the same time, the school, which is attended by about 1,000 people, was not quarantined until all the circumstances were clarified, and the director said that he himself learned about the emergency only in February and allegedly immediately took action. When asked to show the reports of the sanitation carried out at the school, he refused, saying that this was a purely internal and closed document.

Employees of Rospotrebnadzor stated that they knew about the woman’s illness, but in all documents she was listed as unemployed, hiding the information that she worked in a children’s institution. According to another version, the deceased also did not know that she had open tuberculosis, and was being treated for cancer. However, this does not justify the negligent attitude of the school and clinic management. Now the students of this school are required to regularly check for the presence of Koch bacilli: two children have already tested positive, and the English teacher has not returned from sick leave for a month. The capital's Department of Education and Department of Health do not comment on the situation.

Parents of Zelenograd schoolchildren intend to contact the prosecutor's office and demand that the Ministry of Education and Health take control of the situation. “Since this happened here, it could happen in any school and in any kindergarten, so no one is immune from the fact that their child will be taught or treated by a terminally ill patient,” they say.

This is not the first case in the capital region recently: at the beginning of last year, it turned out that a teacher with tuberculosis taught at one of the schools in the north-west of Moscow, and even after the teacher was hospitalized, classes at the school did not stop for a single day - the management decided not to declare quarantine and wait for the conclusion of epidemiologists. At the same time, many employees of the institution believe that this was the director’s mistake, since children who were not vaccinated were allowed to attend classes. The director himself said that he knew nothing about this.

Parents of students at Moscow school No. 2005 are seriously concerned about the health of their children due to the fact that the teacher was diagnosed with tuberculosis. More than 130 elementary school students were registered at the tuberculosis clinic, although even more students are at risk. Parents claim that the school administration kept silent about the fact that the teacher was ill, so they contacted the prosecutor's office with a request to conduct an investigation. A RIAMO correspondent spoke with parents of schoolchildren to understand the situation.

Alarming Rumors

School No. 2005 on Rodionovskaya Street in the North-Western District of Moscow continues to operate as usual. Entrance to the educational institution is prohibited for outsiders, so it was not possible to get inside. Several parents who were near the school could not really explain the situation, and some were barely familiar with the story about the teacher suffering from tuberculosis.

As the mother of a third-grade student told RIAMO, back in late October - early November 2016, a rumor began to spread among parents that during a medical examination at school, two teachers were diagnosed with serious health problems.

“We didn’t know exactly what problems had been identified, but according to rumors it turned out that a fluorograph machine arrived at the school yard, teachers took routine pictures of the lungs, and two teachers were diagnosed with darkening. This means organic damage to the lung tissue, which happens with serious illnesses,” the agency’s interlocutor said.

According to her, parents became seriously worried after one of the elementary school English teachers was ill for a long time and did not go to work. After the New Year holidays, on January 11, parents received papers from which it followed that on January 17, the children would undergo a mantu test and undergo a diaskintest - a study that detects latent forms of tuberculosis. If parents refuse to conduct these tests, their child will not be allowed to attend classes and will be required to undergo a consultation with a phthisiatrician at a tuberculosis clinic, the document noted.

“This paper raised a lot of questions in us, and we started asking these questions. There was no one to answer because the school doctor was silent,” said the schoolgirl’s mother.

137 children at risk

Later, according to her, the class teacher told one of the mothers over the phone that a case of tuberculosis had been recorded at school. By this time, some parents had already refused to carry out tests, since their children already undergo such tests on a regular basis. When information about tuberculosis at school was confirmed, concerned adults began to actively sign consent for children to be examined.

“That’s how we found out, literally pulling out information in pincers, that it turns out that there is a contact group of children who had direct contact with a teacher whose diagnosis of tuberculosis was confirmed. These are 137 children from second to fourth grades,” said the agency’s interlocutor.

According to her, all these children are now subject to registration for observation at the dispensary for a year as contacts of a tuberculosis patient.

Secret meeting

Parents demanded that the school management hold a meeting with the participation of doctors to clarify the situation, but the school administration urged not to panic and “continue to study calmly,” noting that this problem concerns only employees of the educational institution, students and their parents.

“We did not agree with this formulation of the issue and insisted that the meeting be held. They brought phthisiatricians from the local clinic to talk to the parents. On Monday, January 16, the meeting was held in the strictest secrecy,” said the schoolgirl’s mother.

When the parents asked about the diagnosis of the additional education teacher, who was also diagnosed with lung problems, school representatives replied that in this case tuberculosis was not confirmed.

Parents went to the authorities

A group of parents of schoolchildren filed an application with the prosecutor's office of the North-Western Administrative District, and also sent appeals to Rospotrebnadzor and the Moscow Department of Education. They demand to check whether the necessary medical checks were carried out when hiring teachers. Moreover, the teachers who were diagnosed with serious health problems have only recently been working at school No. 2005: the English teacher came about 11 months ago, and the additional education teacher came in September 2016.

“Currently, according to our information, an investigation has been launched at the school by the prosecutor’s office. It seems that the sanitary inspectorate inspected the school and the fire inspectorate. But this is inaccurate information,” the agency’s interlocutor clarified.

According to her, an order was issued against the school by Rospotrebnadzor on December 21 or 25, 2016, indicating a set of measures that the school must take. However, according to the student’s mother, the school administration refused to present this order to parents, citing the fact that it was an official document and intended only for internal use.

According to the parents, the order concerned the actions of the school management and the tuberculosis clinic. In particular, the document defined actions in relation to the contact group of schoolchildren, as well as in relation to 199 students who were not vaccinated against tuberculosis. These children, according to the regulations, should not be allowed to attend school until their tuberculosis status is clarified.

“As far as I know, this order was not implemented. These children still attend classes at school,” the woman noted.

The agency's interlocutor also said that the teacher is currently suspended from working at the school. But there is still no information about how much time passed between medical examination and suspension.

All necessary measures are taken with regard to the contact group of students. They were registered at the tuberculosis clinic, they were given a mantu test and a diaskintest, and in the near future the children will undergo blood and urine tests. These schoolchildren were also sent for x-rays of their lungs, the agency’s interlocutor said.

In addition, according to her, a teacher who fell ill with tuberculosis taught another group of preschoolers aged about 6 years. Nobody informed their parents about the current situation, there was no order from Rospotrebnadzor regarding them, they were not included in the contact group and they were not registered at the tuberculosis dispensary.

“We wish this man only goodness and health. Our questions are not for this person and not for the second teacher, whose diagnosis, as they say, has not been confirmed. We have questions in general regarding the system for hiring employees,” the student’s mother emphasized.

The authorities will intervene in the situation

The words of the mother of the third-grader RIAMO were confirmed by several other parents of students from school No. 2005. In addition to the prosecutor's office, Rospotrebnadzor and the capital's department of education, some of them turned to State Duma deputy Gennady Onishchenko. In the near future, activist parents also plan to meet with the head of the Moscow Department of Education, Isaac Kalina.

In turn, one of the teachers at school No. 2005 told RIAMO that neither the students nor the high school teachers were prescribed any additional examinations.

The editors of RIAMO also sent requests to Rospotrebnadzor and the Moscow Department of Education, but have not yet received a response.

As explained to RIAMO by a general practitioner, director of the Medical Center for Immunocorrection named after. R. N. Khodanova Lyudmila Lapa, tuberculosis spreads quite quickly, and its causative agent is tenacious. The disease is transmitted both by airborne droplets and through household contact, therefore, in the same room with the patient, certain rules must be followed to avoid infection. So, the patient should have his own household items. In the case of tuberculosis, timely diagnosis and therapeutic treatment are important to defeat the disease.

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Tuberculosis is a serious infectious disease caused by Mycobacterium tuberculosis. The disease belongs to the group of socially dangerous pathologies. Children are especially susceptible to it, since their immunity is not yet fully developed, and they are more often in crowded places. It is necessary to figure out whether the child can become infected and attend school, and whether he poses a danger to others.

The disease is caused by Koch's bacillus; the condition is a weakened immune system in the infected person. There are 5 main routes of infection with tuberculosis:

Airborne. Mycobacteria enter the environment through droplets of saliva when sneezing, coughing and talking. This can happen in any public place, and even at school. The microorganism enters the respiratory tract and then into the blood. About 80% of all people are infected by airborne droplets.

Airborne dust. When released into the air, the stick settles into dust. When this dust stirs, the microorganism rises approximately 1-1.5 m above the ground. This height is equivalent to the height of a child, which increases the risk of infection when inhaling dust particles.
Nutritional. Involves the entry of bacteria into the body through the digestive tract. For example, if a baby plays in a sandbox, in which the sand contains a Koch stick, and then puts dirty hands in his mouth. If we are talking about school-age children, infection can occur by eating meat and milk from sick animals. Bacteria are not destroyed by improper or insufficient heat treatment of products. When feeding a child in the canteens of a kindergarten or school, the relevant authorities must carefully check the products supplied.
Transplacental. Occurs when a pregnant woman has tuberculosis and has not received appropriate treatment. Babies become infected while in the womb and are born with a congenital disease.
Mixed. It involves the penetration of bacteria into the body in several ways simultaneously.

With children, you need to be especially careful when in public places, and try to avoid it if possible.

Conditions for tuberculosis infection

A child can become infected with tuberculosis only when several factors favorable for the development of the disease combine. These include the following:

A form of tuberculosis. It must be remembered that only the open pulmonary form of the disease is contagious. In this case, the focus of caseous necrosis is localized in the lungs, then it disintegrates. As a result, a cavity is formed - a cavity filled with cheesy masses containing a large number of mycobacteria. It communicates with the environment through the draining bronchus. Microorganisms enter the air during coughing attacks, that is, by airborne droplets. Extrapulmonary forms of tuberculosis are not dangerous.
Time of contact with the patient. In order to become infected, it is necessary to communicate with the bacteria-transmitting agent for a long time. According to the results of scientific research, you need to be in contact for at least 8 hours every day for six months or around the clock for about 2 months.
The child's health status. Children with reduced immunity are much more susceptible to tuberculosis. This can be facilitated by factors such as immunodeficiency conditions (congenital and acquired), oncology, and diabetes mellitus. Children who receive constant treatment with glucocorticoids (for bronchial asthma, autoimmune diseases) can also get sick.

With short contacts with patients with closed form of tuberculosis, a healthy child will not get sick.

Sick child in a children's group

What to do if there is a child in kindergarten or school who has tuberculosis? Is it possible to get infected from it?

It is important to understand the difference between infection with mycobacteria and the presence of the disease. An infected child has a positive Mantoux test, but has no signs of disease and is not considered sick after testing. Often these are children who have not had the BCG vaccination.

Nowadays, almost every person is infected, but he can only get tuberculosis if his immunity is significantly reduced.

If the child is still sick, then it is necessary to find out the form of tuberculosis. In the open form, a person is a bacteria excretor, or MBT+. This means that bacilli were found in the sputum.

Patients with the open form are extremely contagious. In the closed form, there are diagnostic signs of pathology, but there are no mycobacteria in the sputum. In this case, the infection will not be transmitted from this person. All patients with open tuberculosis are treated in tuberculosis clinics, and a child with tuberculosis cannot be at school.

Prevention methods

First of all, it is necessary to observe prevention in the event that the mother is sick. A very common question from mothers is: “I got tuberculosis. Can a child get infected from me? Everything again depends on the form of the disease.

In case of any of them, the mother is prohibited from feeding the baby with breast milk, since it carries bacteria and drugs that treat the disease.

A child can become infected with tuberculosis either through infection through the mother's milk, or if she has an open form of the pathology. If a closed form is diagnosed, the woman is not dangerous.

To ensure that your child has no chance of contracting tuberculosis, general preventive measures must be followed:

Complete calorie nutrition.
Organization of the daily routine.
BCG vaccination according to the vaccination calendar - in the maternity hospital and at 7 years of age.
Regular hardening and exercise.
Avoid stress and overwork.
Health improvement in sanatoriums.
Minimum presence in public places.

In all groups where there are large gatherings of people, it is necessary to carry out public prevention of tuberculosis:

Social. Sanitary educational work, informing the population about the disease. Every doctor should do it.
Infection control. Includes measures aimed at stopping any routes of spread of infection. For this purpose, tuberculosis dispensaries are located in separate buildings outside the city. If a disease is detected, everyone around you must wear masks. The premises must be regularly ventilated and disinfected using quartz lamps.

Sanitary. Implies timely detection of all types and foci of tuberculosis. The patient must be isolated, the room disinfected and all persons who were in contact with him examined.
Secondary. Includes preventive prescription of a course of treatment with one drug, improvement of healthy children and adults who have been in contact with a person with an open form of the disease.
Primary specific. Timely vaccination of children against tuberculosis at birth and at 7 years of age is carried out with the BCG vaccine. This type of prevention also includes the annual Mantoux test.

When raising a child in a loving family and in good living conditions, the risk of getting tuberculosis is reduced to a minimum. The emotional background is very important, because children worry about everything much more than adults. With constant scandals at home, the child is in a state of chronic stress. This seriously affects his immunity, essentially opening the gates for infection. That is why positive emotions are the key to health.