ORANGE COUNTY VOICES : COMMENTARY ON PUBLIC HEALTH : Working to Increase the Level of Awareness of TB and Its Effects : A recent outbreak in a high school illustrates need for rapid diagnosis, appropriate treatment and prompt reporting.

The recent accounts of tuberculosis in the news have brought considerable visibility to the increase in reported cases of tuberculosis in Orange County. Some of these reports undoubtedly have led to considerable concern and a number of questions on the part of county residents. As your county health officer, I want to be sure that you have the most accurate information regarding this disease.

The resurgence of tuberculosis is not only an Orange County problem but also a statewide and national problem. Tuberculosis in California has increased 54% from 1985 to 1992. California accounts for more tuberculosis cases than any other state (5,382 in 1992), and its rate of 17.2 cases of tuberculosis per 100,000 population is the third highest in the United States. Santa Ana, San Francisco, Oakland and Los Angeles are among the 10 cities in the United States with the highest tuberculosis case rates.

What is tuberculosis?

Tuberculosis (TB) is a bacterial disease that most commonly affects the lungs. Someone with active TB can spread the disease to other persons through coughing, sneezing or singing. While tuberculosis is not easy to spread, it tends to be spread between people sharing a common air space for a prolonged period of time (e.g., home, dormitory rooms, classrooms, enclosed work space.)

The myth that someone testing positive with TB can spread the disease is false. The disease must be active within the lungs before it can be spread by an infected person.

TB is a very treatable disease. Therefore, it is important to recognize the symptoms and seek medical help. The symptoms include: prolonged cough (greater than two to three weeks,) night sweats, weight loss, fatigue, chest pain and coughing of blood.

A recent outbreak of tuberculosis in an Orange County high school illustrates the need for rapid diagnosis, appropriate treatment and prompt reporting.

In 1991, an Orange County high school student with tuberculosis was misdiagnosed. As a result, the student went untreated and unreported and consequently exposed classmates at the student’s school. In 1992, a second physician diagnosed the student as having TB but did not treat it appropriately or report the case. When the patient’s care was transferred to the county’s Health Care Agency in 1993, we found a total of 17 active cases of TB in the school and 177 skin-test positive students.

The following factors contributed to this large outbreak:

* The original outbreak case had been symptomatic with an illness consistent with tuberculosis since January, 1991, but was not diagnosed with tuberculosis until February, 1992. This failure to diagnose tuberculosis resulted in prolonged exposure of contacts in the household, in the school and elsewhere in the community;

* Failure to promptly report the original outbreak case to the local health department resulted in inadequate isolation and delayed the contact investigation, further contributing to the spread of tuberculosis; and

* Inadequate treatments resulted in prolonged infectiousness.

As public health officials, we have the goal of maintaining and protecting the health of Orange County residents by organizing and coordinating both the public and private sector to prevent the occurrence and spread of disease, like tuberculosis. Specifically, public health officials apply preventive and treatment strategies to reduce disease and mortality rates. One way to address this goal is through the dissemination and sharing of information with the private health community.

In an effort to increase the level of awareness of tuberculosis and its effects, a tuberculosis communication plan has been designed to specifically identify target populations and audiences, messages to be conveyed to these groups, barriers to reaching the populations and specific plans to reach each group. The plan has been developed and its elements will soon be implemented by our public health staff.

In response to the resurgence of tuberculosis, recent changes in legal reporting requirements concerning suspected and confirmed cases of tuberculosis by physicians have been enacted. The law requires physicians and other health care providers to report promptly to the local health officer when there is a reasonable suspicion of active tuberculosis, before discharge from a hospital or penal institution and when a person ceases treatment for tuberculosis.

Further, effective last Thursday, students entering Orange County’s schools are required to present evidence of having been screened for tuberculosis. This includes all children entering first grade and those entering a school in the county for the first time. This policy applies to all public and private school students.

My hope is to strengthen our tuberculosis program as well as to enhance the flow of information between the public and private sector. Responsive, open lines of communication and increased community awareness are necessary to ensure an effective plan and a healthier community.