State Sends Specialists to Help With TB Outbreak : Health: Experts on communicable diseases arrive after renewed threat from drug-resistant strain that has plagued La Quinta High.

State experts on communicable disease arrived in Orange County Wednesday to help county health officials sharpen plans for handling the tuberculosis outbreak at La Quinta High School.

The stepped-up role for the state is due in part to officials’ belief that 20 people have been exposed to a student who suffered a recent relapse of a highly drug-resistant strain of TB. Almost 200 students and staff members were already being treated before the new cases started appearing in February.

In response to the renewed threat, the county next week will retest most of the Westminster school’s 1,300 students and staff, in an undertaking similar to the massive skin testing completed there last September.

Dr. Richard Jackson, chief of state’s division of communicable disease control, said he sent a physician with expertise in epidemiology and a public health adviser to carefully review the case of Debi French, a senior who in February suffered a relapse of contagious TB although she insists that she was taking her daily medication. French had a strain of TB that is multi-drug resistant.

“There is a lot to learn when these medications fail,” Jackson said. “And we need to figure out where we go from here. . . . We are interested in looking at the extent of this problem and stopping this outbreak.”

Jackson said the state will be acting in an advisory capacity to the County Health Care Agency, which has primary responsibility for countering the outbreak of tuberculosis discovered last year at La Quinta. Seventeen La Quinta students are being treated for active TB and 175 others, who tested positive for exposure to the bacteria, are receiving medication to prevent their developing the disease.

More recently, 18 more students and two staff members at the school who were in contact with French between December and February, when she relapsed, have tested positive for TB bacteria. There is concern that this makes them vulnerable to the same multi-drug-resistant TB strain that forced French to have part of a lung removed last month in Denver.

Dr. Hugh Stallworth, the county’s chief public health officer, said that at Jackson’s request he already had decided to devote a physician full time to coordinate the TB control effort at La Quinta.

Stallworth said Dr. Jodi Meador, the county’s TB controller, will head a medical team charged with carrying out the TB screening and devising a plan for tracking students who are found to have latent or active TB. The county wants to be certain all receive proper medication and follow-up testing to catch any relapses.

Since most of the TB cases and positive exposures have been in the senior class, where the first multi-drug-resistant case was identified, Stallworth said Meador’s team must devise ways to track graduates who move out of the area to enter the work force or attend college. Health officials want to be certain that all cases are monitored by local health agencies and school health organizations to ensure that the patients follow their treatment regimen.

Though the Health Care Agency recently was authorized to fill 29 new positions to cope with the recent countywide increase in tuberculosis, Stallworth said the agency will be understaffed during the hiring process. He has asked the state Department of Health Services to assist him in finding physicians with experience in treating tuberculosis who can fill in temporarily.

The state is ready to help. “I want the La Quinta episode to be very closely watched by the local health department,” said Jackson, who has been conferring with Stallworth on almost a daily basis from his Sacramento office.

“I want to have both a physician and epidemiologist focused very closely on this. If they do not have an adequate staff of physicians, I want to help them find the physicians,” Jackson said.

Jackson said he also has instructed his staff to investigate the records of the La Quinta outbreak “to see if there are episodes where cases had been medically mismanaged.”

One of his concerns, he said, is about a report by the federal Centers for Disease Control that the outbreak at the school might have been prevented if the first case of drug-resistant tuberculosis had been more promptly diagnosed and reported to the county and the patient’s treatment had been more closely monitored.

The state agency will determine whether any physicians should be referred to the state medical board for discipline, he said.

“Given the seriousness of this illness, physicians need to adhere to their public health responsibilities,” he said. “You can offer all the continuing medical education courses you want, but sometimes it is time to be more forceful.”