Active tuberculosis case identified at Lane Middle School
Multnomah County public health officials have confirmed one case of active pulmonary tuberculosis (TB) at Lane Middle School in Southeast Portland. A case investigation is underway, and may impact area clinicians.
We request that area clinicians:
- Test your primary care patients who have known exposure and who request testing in your setting. Testing guidelines
- Notify Multnomah County Public Health of any positive results related to this investigation.
- Treat latent tuberculosis infection (LTBI) per current TB guidelines.
- Contact Public Health with any questions about this alert or if you are concerned a patient has active TB.
- Review current U.S. Preventive Services Task Force recommendations for LTBI screening in your patients at increased risk (Grade B recommendation). Review the difference between LTBI and active TB disease and be ready to discuss with your patients.
Preferred testing for those exposed to tuberculosis
- Screen exposed individuals with an IGRA. If you are testing children under age 2 then use both an IGRA and TST.
- If the exposed individual has a documented past positive TST or IGRA, repeat testing is not needed. In this situation, a CXR may be needed if the TB exposure was extensive or the contact is immunocompromised. A CXR is also indicated for individuals with symptoms consistent with TB.
- If the exposed individual has a history of BCG vaccination, QFT is the preferred test due to chance of false positive with TST.
- Exposed individuals who have an initial negative test should be tested again 8-10 weeks after their last exposure (retest early August).
- Exposed individuals who are HIV+ and others who are immunocompromised require different follow-up. CXR and window prophylaxis may be needed regardless of screening results. Contact your LPHA to consult on assessment and management for these individuals
- If the exposed individual is symptomatic for TB and/or has an abnormal CXR indicative of TB, TB disease must be ruled out by obtaining sputum or other appropriate respiratory, tissue or fluid specimens for lab testing. Do not start LTBI treatment until culture results are known to be negative. Advise the individual to isolate, and report the suspect case to the county health department of their residence.
Local Public Health agency permission is not required for LTBI or TB disease testing in Oregon, and IGRA labs may be ordered through your contracted lab service provider.
Case reporting
LTBI is not reportable in Oregon, but reports of infections related to this exposure are requested.
Local public health authorities may be reached 24 hours a day to report positive results and/or suspect TB cases (LPHA notification is required within 24 hours for suspect or confirmed TB disease):
- Clackamas County Public Health: 503-655-8411
- Multnomah County Public Health: 503-988-3406
- Washington County Public Health: 503-846-3594
Background
An individual at Lane Middle School was recently diagnosed with TB and may have been contagious between September 2024 and May 2025. They are being treated and are no longer contagious.
Potentially exposed individuals at Lane Middle School will be contacted by the Health Department via an emailed letter or phone call recommending Interferon Gamma Release Assay (IGRA, Quantiferon or T spot) testing.
The Health Department has also created an TB questions page and has been working closely with Lane Middle School administrators and Portland Public Schools on this contact investigation, and in support of the school community.
Families or staff with questions have been advised call the Multnomah County Health Department's Tuberculosis Clinic at 503-988-3406, but area clinics and healthcare providers may also receive questions and/or requests for testing. The Health Department is working to coordinate testing at the school. Families and staff have been asked to inform the health department if they plan to seek testing independently.
While additional individuals with infection may be identified, community spread is unlikely to occur from this case and there is little risk to the general public at this time.
About tuberculosis
TB is caused by Mycobacterium tuberculosis. People with infection but without active pulmonary or laryngeal disease are not infectious.
TB disease can develop very soon after infection or many years later. In the United States, unless treated, about 5% of recently infected people will develop TB disease in the first year or two after infection. Another 5% will develop TB disease later in their lives. The remaining 90% will remain disease free for the rest of their lives. Treating LTBI when identified substantially reduces the risk that latent TB infection will progress to TB disease
Some conditions increase the risk that LTBI will progress to disease. The risk may be about 3 times higher (as with diabetes) to more than 100 times higher (as with HIV infection) for people who have these conditions than for those who do not.
Although most patients with TB have pulmonary disease, TB disease can develop anywhere in the body, including bone, meninges, organs and skin. TB disease outside of the lungs is called “extrapulmonary.” The symptoms of pulmonary TB typically include cough, chest pain, and hemoptysis. The symptoms of extrapulmonary TB depend on the site of disease. Systemic symptoms consistent with TB include fever, chills, night sweats, appetite loss, weight loss, and fatigue.
TB is spread from person to person through the air. When a person with active pulmonary or laryngeal TB coughs, sneezes, speaks, or sings, droplet nuclei containing M. tuberculosis can become airborne. Depending on the environment, these tiny particles (1–5 microns in diameter) can remain suspended for hours. If another person inhales air containing droplet nuclei, transmission may occur.
The probability TB will be transmitted depends on multiple factors including the infectiousness of the person with TB disease (the number of organisms expelled into the air), the immune competency of the person exposed, the environment in which exposure occurred, the duration of exposure, and the virulence of the organism.
Persons at highest risk for becoming infected with M. tuberculosis are those who had prolonged, frequent or intense contact. These close contacts may be family members, roommates, friends, coworkers, etc.
Every year the Health Department performs contact investigation and supports treatment for 25-30 individuals with active tuberculosis.
Resources
Oregon Health Authority Tuberculosis Investigative Guidelines
USPSTF LTBI Screening recommendations (Grade B recommendation)
Thank you for your partnership,
Richard Bruno, MD, MPH | Multnomah County Health Officer
Teresa Everson, MD, MPH, CPH | Multnomah County Deputy Health Officer
Paul Lewis, MD, MPH | Multnomah County On-Call Deputy Health Officer
Sarah Present, MD, MPH | Clackamas County Health Officer