County to Begin Child TB Tests : All Kindergarten Pupils, Transfers to Be Screened

All incoming kindergarten students and older pupils transferring to Los Angeles County schools will be required to undergo tuberculosis skin testing beginning this fall, county health officials announced Wednesday.

About 200,000 students will be affected by the new policy, meant to help eradicate Los Angeles’ persistently high tuberculosis rate. Los Angeles area residents suffer from tuberculosis at nearly twice the national rate, due in part to the large immigrant communities in the county, Dr. Paul T. Davidson, the county’s director of tuberculosis control, said.

Mandatory testing for tuberculosis--a contagious bacterial infection that usually attacks the lungs--follows earlier requirements that children be thoroughly immunized against such diseases as polio, measles, mumps and diphtheria before being allowed to enroll in school.

A state law enacted four years ago allows county health directors to add tuberculosis tests to the required list. Davidson said the continued presence of high levels of the disease prompted the new policy.

“Tuberculosis has remained a rather persistent problem in Los Angeles County,” he said. “We haven’t experienced the usual decrease seen (elsewhere) in the United States.”

Nationally, tuberculosis rates have declined over the years and now rest at less than 10 cases per 100,000 people, Davidson said. But the Los Angeles County rate in 1983, the last year for which there are complete statistics, was more than 18 cases per 100,000, he said.

In some county areas, such as the downtown Civic Center region, tuberculosis may strike as many as 80 people per 100,000, county studies have shown.

Much of the Los Angeles increase is due to the presence of immigrants from Southeast Asia, Mexico and South America, where tuberculosis is more common, Davidson said. The results of the new testing will allow health officials to determine where the largest concentrations of tuberculosis carriers live, he said.

Greater Problem

“We think it probably is going to be a much greater problem in areas with a lot of foreign-born individuals,” the official said. “Presumably they are the ones transmitting. Individuals like this are scattered in wide areas of the county.”

County health officials decided against testing all students in grades kindergarten through 12 because of the huge numbers of pupils involved. Some students in higher grades are already tested in random voluntary programs, Davidson said.

Under the policy, incoming kindergarten and transfer students in grades 1 through 12 will have to undergo tests within one year of the beginning of school each September. Davidson said health officials hope the long advance period will prevent long lines immediately before the school year begins.

In the test, which can be received at no cost at county health centers, a small amount of material made from the tuberculosis germ is injected just under the skin. Three days later, health workers read the test area for a reaction--a raised welt can indicate a positive reaction.

Further Examination

Children who show a positive reaction will be further examined to determine whether they have an active case of tuberculosis. Only a small percentage of those with positive reactions actually suffer from an active case, Davidson said.

Parents and siblings of those with positive indications can also be checked, in an effort to locate the individual who is spreading the disease, he said.

“We don’t have a monitor of how much infection is being transmitted,” Davidson said. “This will actually tell us what we need to work on in the future. If they (young children) have it, we know it occurred recently. They then act as sort of a marker for us.”