An unusually high number of students and teachers at a school in southwestern Germany have been infected with tuberculosis. Health officials are scouring the school for clues about why the disease spread.
Image: picture-alliance/dpa/G. Fischer
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Health officials on Thursday examined a school in the southwestern German town of Bad Schönborn where a tuberculosis outbreak has infected dozens of children and adults.
A total of 109 students, teachers and other school employees have been infected, the district administration of Karlsruhe said.
Four people, including at least two students, have active cases of tuberculosis. That means they are presenting symptoms and could be contagious.
The actively sick students have been removed from the school and are receiving medical treatment, the district administration said.
"We cannot rule out the possibility that there will be new cases of active illness," Ulrich Wagner from the Karlsruhe health department told the Badische Neueste Nachrichten newspaper.
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Unusual number of cases
At the beginning of July, two children at two different schools in Bad Schörnborn were found to have active tuberculosis.
Since then, the number of infected people has continued to rise, particularly at the Michael Ende Gemeinschaftsschule, where a student in the eighth grade was initially infected.
Officials said that some 56 students in the eighth grade — 88% of the entire class — are currently infected.
The case is concerning because several children from different grades as well as teachers who would not have been greatly exposed to to the eighth grade students have also tested positive for the infection.
Health officials are now examining the school's classrooms to determine how the bacteria were able to spread to so many people, local public broadcaster SWR reported.
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Treatable and curable
Local officials emphasized that tuberculosis is a treatable and curable illness, adding that not everyone who is infected with the disease will become sick.
Tuberculosis is caused by bacteria that spread from person to person through tiny droplets released into the air by coughing and sneezing.
When active, tuberculosis most often affects the lungs — resulting in chest pain, fever, weight loss, and coughing that lasts for weeks. Sometimes blood is coughed up.
The World Health Organization (WHO) estimates that around a quarter of the world's population is infected with latent tuberculosis — meaning they are not actively ill and cannot transmit the disease.
The WHO says that those who are infected with tuberculosis bacteria have a 5 to 15% chance of becoming sick.
Together with HIV, tuberculosis remains one of the world's most dangerous diseases, with poor populations in Africa and Asia especially badly affected. The NGO Apopo is using sniffer rats to help tackle the problem.
Image: Jeroen van Loon
Meet a 'hero rat'
The Belgian organization Apopo is breeding rats to help medical professionals detect tuberculosis (TB), one of Africa's most deadly diseases. Gilbert, an African Giant Pouched rat, is smelling at human sputum samples hidden in a rectangular cage in a research centre in Morogoro, Tanzania. He's one of the forty so-called 'hero rats' that Apopo has on its books.
Image: Jeroen van Loon
Training techniques
Every time Gilbert scratches both of his front paws at a sample that has already been tested positive for tuberculosis at the hospital, he gets a reward of a mix of bananas and peanuts, motivating him to continue working.
Image: Jeroen van Loon
Not just for TB
Apopo has been using rats already for many years to locate landmines in countries like Mozambique, Angola and Cambodia. In Mozambique alone the project has found and destroyed 2,587 landmines, over 1000 explosive devices and some 13,000 small arms and ammunitions.
Image: Jeroen van Loon
A worthwhile investment
The African Giant Pouched rat has a very sensitive sense of smell and is relatively calm. Training each rat takes up to nine months and costs some 6000 euros but the animals live up to eight years, are easy to keep and don’t bond to one trainer like dogs do.
Image: Jeroen van Loon
The dirty work
Apopo breeds most of the rats themselves on site. This allows the organization to start training the rats just after they have opened their eyes. Once in a while the organization accepts wild rats to help with the breeding program.
Image: Jeroen van Loon
The testing begins
A patient gives a sputum sample at the Mbagala Kuu Hospital in Dar es Salaam, Tanzania's biggest city. Tuberculosis, an infectious disease affecting the lungs, killed more than 1.3 million people worldwide in 2012 according to the World Health Organization.
Image: Jeroen van Loon
Double checking
The samples from sick patients that test negative for TB, also get sent to the Apopo facilities. Because many public clinics have outdated technology, more than half of the tuberculosis sufferers in Africa go undetected. This has dramatic results, as one untreated person with active TB can infect 10 to 15 other people per year.
Image: Jeroen van Loon
A deadly disease
Patient Savera Komba (left) was coughing, lost a lot of weight and complained of tiredness. She was tested negative for TB at the hospital. Her sputum sample, however, was sent to the Apopo research centre in Morogoro, where the rats flagged it as positive.
Image: Jeroen van Loon
Making sure
Apopo lab technicians retest samples that were tested negative at the hospital but got flagged as positive by the rats. After confirmation, the patient is informed and needs to return to the hospital to start treatment.
Image: Jeroen van Loon
Starting treatment
Savera Komba still weighs only 39 kilograms, but since she started to take the medication, she has begun to feel better and is happy again, she says. "Without the rats, maybe I would be dead now," she told DW.
Image: Jeroen van Loon
Unconfirmed technique
Using rats to detect tuberculosis isn’t yet approved by the World Health Organization. Still, 1700 undetected patients were identified by Gilbert and the other trained rats last year in Tanzania. These encouraging results have prompted Apopo to open another TB lab in Mozambique and there are plans to expand to South Africa soon too.
Image: Jeroen van Loon
Speed machine
The main advantage of Apopo's tuberculosis rats? They're fast. A rat can process as many samples in seven minutes as a lab technician can in one day. Because of this, this method could also be suitable in the future for quickly screening large samples from communities at risk of contracting tuberculosis, for instance in refugee camps or in prisons.
