As her story gained media attention, authorities took action to address community concerns. The Vermont Department of Health conducted TB screenings for about 500 people who might have been exposed, with 21 testing positive for LTBI using the QuantiFERON®-TB Gold blood test, a method more precise than traditional skin tests.
Born in Peru, Hall was vaccinated against TB in childhood with the BCG vaccine and underwent regular tuberculin skin tests throughout her career, which failed to detect her latent TB.
This issue has been recognized globally, leading to changes in screening practices. In early 2018, the WHO revised its guidelines for latent TB screenings, and the CDC now requires blood-based TB tests for immigration screenings, acknowledging the limitations of older skin tests.
Addressing TB in its latent stage is key to halting its spread, and effective screening is vital. The adoption of the CDC's new guidelines for latent TB screening could prevent situations like Hall's. Dr. Michael Lauzardo, a lung disease expert at the University of Florida Health system, supports this approach. “With the increased precision of this blood test, you take the whole issue of vaccination out of the equation.”
Lauzardo notes that requiring blood tests for immigration screenings is an “exceptionally effective strategy.” He points out the skin test's drawbacks, especially for those from high TB-prevalence countries: “This can lead to people being put unnecessarily on medications, which consume public health resources and can cause side effects." He also mentions that false positives in BCG-vaccinated individuals can lead to complacency: “As a result, they don’t seek treatment.”
Hall, having experienced TB firsthand, now views infectious diseases differently. “Anybody can get TB, so when that cough won’t go away, think about getting tested,” she advises. She returned to teaching after three months but confesses the experience took a psychological toll. “I felt ashamed and worried for my students,” she says, expressing gratitude for their welcoming attitude post-recovery. “I am so grateful that they all made me feel welcome again after my ordeal.”