Access in Action: How UCSF is Expanding Care to Support San Francisco’s Pediatric TB Response

When a tuberculosis (TB) outbreak emerged at a San Francisco high school at the end of 2025, the scale was immediately clear. More than 1,200 students required evaluation, with high rates of infection and several confirmed active cases. Classes temporarily moved online while public health officials mobilized a rapid response.

Given the magnitude of the outbreak, the San Francisco Department of Public Health (SF DPH) requested additional support from pediatric providers across the city.

At the UCSF Department of Pediatrics, teams responded immediately — and continue to support families, frontline providers, and public health partners as guidance evolves.

“We knew students and families needed clear guidance and rapid outpatient access to care,” Devan Jaganath, MD, MPH, associate professor in the UCSF Division of Pediatric Infectious Diseases and Global Health. “That required coordinated action across primary care, infectious diseases, laboratories, and hospital teams.”

What Parents Should Know: Signs of TB in Children

UCSF pediatricians have prioritized equipping families with clear, practical guidance about when to seek care and what symptoms to watch for.

While most children exposed to TB do not develop active disease, timely outpatient evaluation is essential. Antibiotic treatment is highly effective when initiated promptly.

In children and adolescents, symptoms of TB may include:

• Persistent cough lasting more than two to three weeks.
• Fever.
• Night sweats.
• Unexplained weight loss or poor weight gain.
• Fatigue.

Many children may have no symptoms at all but still require evaluation after exposure. Ensuring families can access appropriate outpatient screening — without unnecessary emergency department visits — has been central to UCSF’s response.

Expanding Ambulatory Access in Real Time

As news of the outbreak spread and calls from families surged, UCSF rapidly expanded outpatient clinic capacity and partnered closely with SF DPH to ensure children were evaluated in the appropriate ambulatory setting. Key actions have included:

Rapid Clinic Capacity Expansion

Primary care and infectious disease teams implemented new workflows to address high call volumes, expand appointment availability, and deliver safe, coordinated care. Primary care nursing teams supported early symptom screening and facilitated necessary laboratory testing and imaging.

In collaboration with SF DPH, ambulatory leadership and hospital epidemiology and infection prevention (HEIP) developed a UCSF TB Exposure Assessment algorithm to guide testing decisions and determine when referral to pediatric infectious disease specialists is indicated. The algorithm prioritizes early symptom screening to support infection control and reduce exposure risk for patients, visitors, and staff.

Supporting Providers and Advancing Pediatric TB Expertise

“TB in children can present differently than in adults, and it is critical that providers feel equipped to complete a comprehensive pediatric evaluation,” said Jaganath, who leads the UCSF Maternal and Childhood TB Initiative.

During the outbreak, specialists in the UCSF Division of Pediatric Infectious Diseases and Global Health worked closely with SF DPH and the California Department of Public Health to share updated guidance and pediatric-focused training resources, including materials from the UCSF Curry International TB Center.

The Curry Center serves as the CDC Western Regional Center of Excellence and has provided clinical consultation and TB training throughout the Western United States and Pacific Island territories for decades.

Beyond the immediate response, more than 45 UCSF faculty advance global research for TB through the UCSF Center of Tuberculosis, strengthening diagnostics, treatment strategies, and implementation science worldwide. This depth of expertise has positioned the Department of Pediatrics to respond quickly and effectively to the current outbreak.

Operational Alignment Across Clinics, Labs, and Hospital

“HEIP has been working with ambulatory leadership, laboratory services and radiology to facilitate timely screening for students and staff while protecting healthcare workers and other patients from potential exposures,” said Nahid Hiermandi, DO, MA, associate medical director of HEIP at UCSF Benioff Children’s Hospital San Francisco. “It is crucial to provide concise guidance for such a large scale outbreak.”

To safely manage increased testing volume, clinical and laboratory teams refined workflows, prepared for higher demand, and reinforced infection prevention protocols across clinics, laboratories, and hospital settings.

Strengthening coordination across these systems ensures children are being screened, tested, and treated efficiently while maintaining rigorous infection control standards.

Expanding Pediatric Access as a Priority

This mobilization reflects the Department of Pediatrics’ broader commitment to strengthening outpatient infrastructure and regional partnerships.

By investing in ambulatory capacity, specialty access, and coordinated systems of care, the Department is building a resilient framework designed to respond rapidly to public health emergencies while keeping children in the appropriate outpatient setting whenever possible.

As the situation continues to evolve, UCSF remains committed to ensuring children across San Francisco receive timely, high-quality care — and that families and providers have the guidance and access they need.