Tuberculosis, a serious respiratory infection considered largely wiped out from developed countries, has surfaced in four Sacramento-area schools in the past two years, infecting at least eight students and raising concern among parents. The most recent cases were identified at two Elk Grove schools this week.
The active form of the disease, marked by persistent coughing and fever, is caused by a bacteria that is transmitted through microscopic droplets in the air, and can spread more quickly in close quarters with limited ventilation. California has a tuberculosis rate of 5.7 cases per 100,000 people – nearly twice that of the national rate. Sacramento County ranked 13th in the state for TB in 2013.
Before the advent of antibiotics, TB was one of the most deadly diseases in the United States, but today it is treatable.
Officials at Franklin High School informed parents Monday that a confirmed case of tuberculosis had been identified in the school by Sacramento County Public Health officials. On Tuesday, the county announced another confirmed case at Franklin Elementary School. The two infected students are related and contracted the disease from a family member in their household, said Dr. Olivia Kasirye, public health officer. They were removed from school and are receiving treatment.
At the end of January, public health officials identified one active case of tuberculosis at Florin High School, which they also attributed to an infected adult in the household. The county did skin tests on 155 Florin students in early February, finding 16 students infected with the bacteria. Chest X-rays performed on those students showed that they were carrying the latent, non-contagious form of the disease, which many people live with for months or years without knowing it, Kasirye said. Those students were given antibiotics to prevent them from developing active tuberculosis.
Next week, the county will perform tuberculosis skin tests on about 300 students between the two Franklin schools, namely those who had prolonged exposure to the infected students in the classroom. One of the first steps for the county upon identification of a confirmed case is an on-site evaluation of a school’s classroom layout and ventilation system. Initial reports showed no issues of concern at the Franklin schools, Kasirye said.
“These were adults in the family who had the disease and passed it on to the students – it has not spread in these schools,” she said. “With the two cases next week, the students were caught very early, as part of our contact investigation that we were doing for the adult. Our expectation is that we will not have any exposures at the schools.”
The number of Sacramento County tuberculosis cases, school-age or otherwise, was 84 in 2013, down from 157 cases in 2004.
Though case numbers are declining, they’re still disproportionately high among immigrants from countries where TB is rampant. About 75 percent of California’s TB cases each year occur in people born outside the U.S., mostly in Mexico and the Philippines, said Dr. Jennifer Flood, chief of the California Department of Public Health’s Tuberculosis Control Branch.
Nationally, the Asian population has the highest TB rate at 18.7 per 100,000 people, followed by the black population and then the Hispanic population. The case rate for Caucasians in 2013 was 0.7per 100,000.
Health departments statewide remain vigilant about identifying residents at high risk for TB, and working with health providers in ethnic communities to get people in for testing, said Flood. If latent tuberculosis is caught early, before symptoms show, the bacteria can be eliminated by a 12-week medication regimen before the active form develops.
“It’s going to take a very concerted action, not just from health departments but from providers across the U.S., to have TB on their radar,” she said. “It’s a preventable, curable disease. With our current tools, we can do a much better job at reaching those who have infection, to test them and make sure they don’t go on to be our TB patients.”
The vaccine for tuberculosis, though used in countries where the disease is more prevalent, is not commonly administered in the United States. Students in the Elk Grove Unified School District are not required to provide a negative tuberculosis test result before enrolling, said communications director Xanthi Pinkerton.
Luis Solares, a Franklin Elementary School parent, said he was surprised there was not more stringent testing for the disease, and that he is concerned about his kindergarten son, Isaiah. He said he is waiting to find out whether his child was exposed to the infected student. Parents whose children require a skin test will get an additional letter in the mail this week.
“I’m worried he might get it too,” he said. “I don’t want him to come down with that kind of thing. I guess I’ll have to take him to the doctor and see.”
Franklin Elementary School’s student body is 36 percent Hispanic. Asians make up the third-largest group at 14 percent. Franklin High School’s student population is 27 percent Asian and 20 percent Hispanic. Florin High School, where the active case appeared last month, has an Asian population of 40 percent. The ethnicities of the students with active TB cases have not been released.
The biggest way to keep TB out of schools is to make sure those who are at risk get tested by their health care providers, Kasirye said. She expects that as more people become insured under the Affordable Care Act, early detection of latent TB infections will increase.
One of the biggest problems is that physicians in the U.S. don’t think to look for TB, said Dr. Ronald Jan, medical director of the Paul Hom Asian Clinic – a free, multilingual clinic run by UC Davis students each Saturday. Additionally, many adults in the Asian community distrust physicians or become confused in medical situations because of a language barrier. If they don’t feel sick, they aren’t likely to seek help.
“There’s a fundamental factor of denial,” Jan said. “These treatments might not be pleasant. Then their whole family has to be tested and there’s more expense and more inconvenience. ... It’s an enormous problem.”
Most of the county’s TB cases are in adults, making the recent school cases a bit unique, Kasirye said. Before the Grant High School outbreak last year, the county had not done TB testing in schools since 2008. Results from the skin tests at the Franklin schools will be returned March 19 and 20, after which chest X-rays will be taken if needed.
“It is an important disease that we need to know is still in the community,” she said. “But we should let people know that we have a very good system in place, and remember that TB is treatable, both the active disease and the latent infection.”
Call The Bee’s Sammy Caiola, (916) 321-1636.
▪ An airborne bacteria enters the body, most commonly affecting the lungs.
▪ The latent form of the disease does not cause symptoms, but can later progress into an active infection.
▪ Persistent coughing
▪ Coughing blood
▪ Chest pain
▪ Loss of appetite
▪ Weakened immune system
▪ Exposure to high prevalence areas including Asia and Africa
▪ Poverty and substance abuse
▪ Health care work
▪ Living in a residential care facility