TB: It’s Back, It’s Virulent, It’s Trouble : Time to return to option of mandatory annual school tests?
As recently as two decades ago, children attending public school in California were required to line up and receive a tuberculin skin test from the school nurse or other public-health official every year. The purpose of the dull, and at times slightly painful, exercise was simple: to control and ultimately eliminate tuberculosis, a centuries-old global scourge that slowly, corrosively and painfully snuffs out human life by ravaging the lungs.
ONCE UNDER CONTROL: For a time, those and other efforts to control TB--through frequent screenings and, when necessary, immediate, aggressive and sustained treatment--resulted in a dramatic reduction in the disease--not only in the state of California, but across the nation. Health statistics bore that out. By 1985, TB fell to a historic low of 22,210 U.S. cases from a high of 84,000 in the early 1950s.
With the TB threat perceived to be receding, public-health officials understandably turned their attention and resources to other health problems, most notably the emerging AIDS epidemic. Most schools, too, began to loosen standards, dropping school-based testing requirements and opting instead for proof of a TB test from a child’s personal physician upon his or her initial enrollment.
Meanwhile, while most everyone was looking the other way, TB flared anew in urban areas among addicts, the homeless, AIDS patients and immigrant populations. But in marked contrast to TB cases of yore, traditionally treated with a combination of medicines, a growing number of these new patients were afflicted with TB strains that resist all the usual drugs. Yet, despite these alarming new strains and the fact that these days 3 million people around the world die annually of the disease, the United States has been slow to recognize the return of this villain.
ON THE UPSURGE: Nowhere is that truer than in California, which leads the nation in TB with one out every five cases. It’s particularly evident here in Southern California, where state officials have now officially confirmed the largest-ever reported outbreak of drug-resistant tuberculosis at a U.S. high school. The affected students attend La Quinta High in Westminster, where, since September, 1993, nearly 300 students have tested positive for TB, with more than 80 exposed to the drug-resistant strains. Seventeen have developed active TB cases.
The U.S. Centers for Disease Control concluded that the outbreak began with the failure of a private physician to recognize, properly treat and immediately report a La Quinta student who developed a drug-resistant strain of TB and was contagious for more than a year. For their part, and to their credit, Orange County health officials responded to contain the outbreak at La Quinta High once they understood its magnitude.
But this case raises disturbing questions about how prepared California school districts are to react to--or better yet preempt--TB. A TB-mitigation plan for California schools is conspicuously absent from the state’s Strategic Plan for Tuberculosis Control and Elimination.
REGAINING CONTROL: Sending county, state or federal health officials out to a school after an outbreak is too late. And merely asking kids to take one TB test--when they can be so easily exposed any time after that--is too little. State officials need to conduct an urgent cost/benefit analysis on a program that would return to the days of yearly TB tests in schools. That approach worked then; it can work now.
