TB Screening

Your July 25 editorial suggesting the need for annual tuberculosis screening in schools omitted several pertinent facts.

First, because the TB skin test is imperfect, universal screening would incorrectly identify a substantial number of children as infected and, therefore, could result in the needless administration of medication to uninfected kids. For these reasons, the Centers for Disease Control and Prevention and American Academy of Pediatrics recommend annually screening only those children at high risk for TB by virtue of increased exposure to people with the disease.

Second, state law allows counties to decide whether to require annual TB skin tests for first-time schoolchildren. While Los Angeles is among the counties that require TB skin testing of kindergarteners, no county requires annual TB testing.

Finally, as part of its Strategic Plan for Tuberculosis Control and Elimination, the state will be conducting a cost/benefit analysis of TB screening in schools. In the meantime, the Wilson Administration is working with local officials and health care providers in communities with increased incidence of TB to implement the plan’s strategies for ensuring prompt diagnosis and reporting of cases, completion of appropriate therapy, thorough contact investigations and improved education--all of which are essential to halting the spread of TB in California.

S. KIMBERLY BELSHE

Director, Department of Health Services

Sacramento