New TB Cases in O.C. Schools Force Skin Tests

Following the discovery of a student with active tuberculosis at Orange Coast College and another with symptoms at Santa Ana’s Sierra Intermediate School, county health officials announced plans Wednesday to test more than 300 students and faculty members likely exposed to the disease.

Dr. Jody Meador, the county’s interim TB controller, said that beginning Tuesday all students and staff members who have come in contact with the two potential carriers will be offered skin tests next Tuesday and Wednesday that should quickly reveal whether they have been exposed, and whether follow-up testing is needed.

The two students who are potential carriers of the disease are no longer attending classes, and are receiving treatment from the public health officials.

County officials said that contrary to what happened in last year’s TB outbreak at of La Quinta High School in Westminster, they were promptly alerted to the two newest cases by private physicians. This quick response, they said, greatly diminishes the likelihood of another large outbreak of the disease.

At La Quinta, an infected student’s condition was not properly diagnosed or treated, and her case not promptly reported to health authorities, so her classmates were exposed to the disease for more than two years.

Earlier this week the federal Centers for Disease Control in Atlanta released a report of its investigation of last year’s outbreak at La Quinta, where 12 students were infected with a drug-resistant form of the disease linked to a single carrier.

Investigators concluded that spread of the disease could have been prevented by earlier diagnosis, reporting, and monitoring of the original case.

Commenting on the cases at Orange Coast College and Sierra Intermediate, Meador said, “Two private physicians . . . did an appropriate and expeditious work-up and referred them immediately (to the county Health Care Agency) for definitive diagnosis and treatment.”

One of the physicians transferred to the county the care of a 12-year-old girl who attends Sierra Intermediate. Meador said the girl was hospitalized several days last week with lung problems that, according to X-rays and other diagnostic tests, seemed to be caused by active tuberculosis. She said the county is doing a sputum culture to confirm the diagnosis.

County health officials learned from another physician last month that a 21-year-old female student at Orange Coast College had a preliminary diagnosis of TB. Her infection was later confirmed by laboratory tests, Meador said.

Jim Carnett, the college’s director of community relations, said the school was notified last Thursday about the infected student and instructed her not to return to classes.

Penny Weismuller, the county’s director for disease control, said the Orange Coast student was born in Southeast Asia, and had a positive TB skin test when she entered the United States. This indicates that the young woman was exposed to the TB bacteria outside the United States, most likely in Southeast Asia, where tuberculosis is prevalent, Weismuller said. She noted that tuberculosis can be latent for years before developing into active disease.

The recent resurgence of tuberculosis in Orange County and nationally, Weismuller said, has been traced in part to immigrants who were originally exposed to the disease in poorer countries.

The student who spread the disease at La Quinta High was also a native of Southeast Asia, she said.

This is the fourth time county health officials have called for precautionary TB screening at schools since the La Quinta tuberculosis outbreak was publicized last fall.

In October, 150 students at Golden West College were tested after they were exposed to an infected student from La Quinta who had attended summer school. In January, 225 La Habra High School students were tested, followed in February with the testing of 60 preschoolers at Cuddle Care Center in Fullerton and in March by the testing of 146 students at La Quinta when an infected student there suffered a relapse.

During all this testing, only two active cases of tuberculosis were discovered, Weismuller said, and both were preschoolers who had contracted the disease from a teaching assistant.

“Children under the age of 5 who are exposed to TB very rapidly develop active disease but are not communicable,” Weismuller said. “Older children who are infected don’t as often progress to active disease immediately, so we have an opportunity to give them preventive medication.”

Meador said the two latest students thought to be infected with the disease “are getting good clinical results to medication. They will be kept out (of school) until it is determined by bacteriological studies that they are no longer communicable.”

Meanwhile, steps have been taken to notify students in both schools, as well as the parents of the intermediate school students, about the possible exposure and to arrange large-scale testing.

Diane Thomas, spokeswoman for the Santa Ana Unified School District, said parents of all 1,200 students at Sierra Intermediate will receive explanatory letters in the mail today. Parents of the 170 students targeted for testing, she said, will also be asked to sign a consent form.

The tests will be administered on campus Tuesday and Wednesday, Thomas said, with the results to be determined by week’s end. In addition to the 170 students, she said, about 10 faculty members will be tested.

Thomas said all parents have been invited to the school today at 7 p.m. to meet with school and county health officials who can answer questions. She said the school principal also met Wednesday with the affected students in hope of putting them at ease.

Catherine McDonough, director of student health services at Orange Coast College, said there are plans to test 146 Orange Coast students in four classes attended by the student with contagious tuberculosis. Also, three faculty members and two course assistants who may have been exposed will be tested, she said.

McDonough said she has met with the students to encourage them to show up for the tests.