TB : Number of Cases Growing as Schools Cut Back on Testing Programs

Kenny was worried. The nurse at the Van Nuys public health clinic had just told the wide-eyed 12-year-old that his tuberculosis skin test was positive.

“What’s going to happen to me?” the boy asked softly.

Kenny is one of a growing number of children in the San Fernando Valley infected with tuberculosis. A chest X-ray will determine if he has an active case of TB or if he is merely at risk of contracting it.

In either case, with proper treatment, he’ll be fine.

Once the nation’s leading cause of death, tuberculosis is preventable, curable--and on the rise in urban areas nationwide.

Los Angeles County saw more than 2,100 active cases in 1991--up 79% since 1988--according to the county Health Services Department. The state Department of Health Services reports that California had more than 5,000 active TB cases last year--more than any other state.

According to the Centers for Disease Control, 25,701 active cases of TB were reported in the United States in 1990, compared to 22,255 cases in 1984.

The worldwide TB problem impacts heavily on the United States, the CDC explains. Of active TB cases in Los Angeles County, 60% occur in immigrants, especially those from Mexico, Central and South America, the Philippines and Asia. Latinos account for almost half of all TB cases in Los Angeles County.

“Central L.A. has always been heavily infected,” said Brenda Ashkar, county TB control specialist. “But as the demographics change, we see more TB in the Valley, where it had not been a big problem. The Valley is less psychologically equipped to deal with it.”

Until this year, the Los Angeles Unified School District had its own TB control program. Nurses and physicians employed by the district traveled to schools, offering free TB exams and X-rays to students, teachers and employees. But the TB program became a victim of the school district’s massive budget deficit.

“The TB program was certainly a needed service,” said Karen Maiorca, communicable disease nurse for high schools in the district. “It’s too bad the program was dismantled. Now kids must go to the county health department for TB tests.”

Los Angeles County requires that children entering kindergarten and students enrolling for the first time in a California school be tested for TB. As many as 10% of kindergartners in the Valley test positive. At most Valley high schools, a third or more of students tested have positive reactions.

Among foreign-born students, the numbers are even more startling: Students who test positive often outnumber those who test negative, according to the county Health Services Department.

A positive TB reading does not mean a student has the disease; it means that the student has been exposed to TB. If X-rays show the lungs are normal, the student is not contagious and is not sick but is advised to take medications for six to 12 months to prevent the disease.

Now that the school district no longer routinely tests for TB, many students who become infected are not identified, said Stephanie Yellin Mednick, school nurse at William Mulholland Junior High School in Van Nuys.

“These kids spend three months here, go to Mexico when school is not in session, are exposed to disease, and then they come back here,” she said. “Those are the kids that we were able to identify when the schools offered annual TB tests.”

Unlike other Valley schools, San Fernando High School has its own campus-based clinic. Susan Mitchell, nurse practitioner in charge, estimates that she gives as many as 15 TB tests a day.

“At least half of the students at San Fernando High School are recent immigrants, so there is a high number of positives,” Mitchell said.

“I have also seen an increase in recent converters,” she said, referring to students who previously tested negative but now test positive, indicating recent exposure to TB.

Almost 70% of San Fernando High School students who had a TB test during the fall semester had positive reactions, according to the county Health Services Department.

Despite the high number of students testing positive for TB, health professionals say the risk of a child catching TB from a classmate is small.

“People get paranoid and don’t want their kid sitting next to a kid who is coughing,” said Janet Mahoney, a nurse at the Mid-Valley Comprehensive Health Center, the county public health clinic in Van Nuys. “But very few children have an active case of TB.”

Last year, 136 active TB cases were reported in children ages 5 to 18 in all of Los Angeles County. County health districts in Canoga Park, North Hollywood, San Fernando and Van Nuys saw 18 school-age children with TB in 1991. No TB cases in children were reported in Tujunga and Valencia.

But even when young children develop TB, they cannot spread the disease to others.

“Children under 12 rarely have communicable TB because they do not cough sputum into the air,” Ashkar said. “It’s not until they reach junior high or high school that they may become contagious.”

However, Ashkar said she does know of instances when older students passed TB to their classmates.

“Kids who are contagious are taken out of school until they are no longer contagious, but there is a risk, definitely,” she said.

“Unfortunately,” Mitchell added, “you can be in the elevator, and if someone coughs on you, you can get it, especially if you are run-down or debilitated.”

Even active cases of tuberculosis are curable if patients take medications as prescribed for as long as a year. After a few weeks of treatment, the disease is no longer communicable, and students with TB may return to school.

“Parents should not be panic-stricken, but they should be concerned,” Mednick said. “If parents are worried, they should see that their child has a skin test every year. Think of the test as a first-line defense mechanism.”