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Student with TB Prompts Skin Testing

Beginning Dec. 12, the Fairfax County Health Department will administer skin tests to teachers, students and others considered close contacts of a Centreville High student recently diagnosed with TB.

But Principal Pam Latt and Dr. Ronald Karpick, a TB expert with the Health Department, say people shouldn't be unduly alarmed. The student's pulmonary tuberculosis (TB) was confirmed Nov. 21, but Latt took it in stride.

"I wasn't upset because I've been in schools with active TB before," she said. "I knew what was involved in informing people about their own health risks, and I also knew the chances were slim that someone else would contract it."

AND ALTHOUGH it's not common knowledge, Karpick said TB in Fairfax County actually isn't all that unusual. In fact, the county hired him in February specifically because of his expertise in dealing with it — because the incidence of TB here is nearly twice the national average.

"Fairfax County has a high prevalence of TB — 9.8 people per 100,000 with active TB — which is one-third of the [total] number of cases in Virginia," he said. "The U.S. average is 5.2 people per 100,000."

Karpick said it's because this county has such a large number of immigrants who've generally come from places that don't have health-care systems set up to deal with TB once people get it. As a result, he said, "They don't contain and treat it as well as they should."

In addition, he said, many immigrants living here "don't have health insurance, so it delays them getting diagnosed and then getting good medical care." So it's not too surprising, he said, that Fairfax County has had 66 active cases of TB in 2003.

As for Centreville High's TB student, Karpick said, "This individual was born in a foreign country." Neither he nor Latt can reveal the name, age, grade or gender of this person because of county patient-privacy and confidentiality laws.

But, said Latt, even though the school has a current enrollment of 2,008 students, this particular student had "very limited contact with the general school population." And, she said, he/she was out of school, anyway, "for weeks, before we notified the community."

The student is a patient of Kaiser and, on Nov. 21, it gave confirmation of the student's TB to the Health Department. Latt said the Health Department called her 24-48 hours after all the tests were done, a firm diagnosis was made and the patient was notified.

"I realize it's a scary thing," she said. "But the Health Department and Kaiser did a fantastic job of quarantining him/her and taking him/her out of the general population before it was diagnosed. And because Kaiser, the Health Department and the school acted so well together, we were able to minimize the risk."

ON NOV. 25, Latt sent home a letter to all the households of people with whom this student had been in close contact. By then, the Health Department had already contacted students with whom the person had been in close contact and recommended their getting skin tests. Latt's letter provided the Health Department's phone number, told parents that a Centreville student had been diagnosed with TB and explained what it is.

"Tuberculosis is a bacterial disease that is usually spread from person to person by airborne droplets (such as coughing or sneezing)," she wrote. "Some of the symptoms of tuberculosis include weight loss, night sweats and cough. Prolonged exposure to someone with tuberculosis may lead to an infection. The incubation period is from four to 12 weeks."

Karpick said the exposure to these infected droplets is usually prolonged. And in this, particular case, he said, "The negative TB skin tests of the student's closest and highest-risk contacts suggest that the student has not spread the infection. None of his/her family have any symptoms, but we're following them."

Latt's letter also contained health-history forms on which respondents were urged to report any previous positive TB skin tests and previous TB vaccines. (Foreign countries often administer such vaccines, and they can result in a positive skin-test reading).

After confirmation of Centreville High's TB case, county health investigators immediately worked with Fairfax County Public Schools to identify the student's household members, fellow bus riders and students and teachers in his/her classrooms. Approximately 150 people were identified as close contacts.

County Health Director, Dr. Gloria Addo-Ayensu, said those individuals "are considered to have a slightly increased risk for TB infection" and will be tested at the school. Skin testing to check for this infection will be done next Friday, Dec. 12, with follow-up evaluations Monday, Dec. 15.

TIMING FOR TB skin testing is determined on the basis of TB incubation periods. It can take up to 12 weeks for the body to react to a TB skin test after becoming newly infected. The test involves injecting a small amount of testing fluid (tuberculin) under the skin of the forearm.

Then on Dec. 15, Health Department clinicians will examine the test recipients' arms and measure any resulting skin reactions to determine the presence of TB bacteria in the body. Those with negative readings that day will be re-tested 12 weeks later. Any people testing positive will be referred for a chest x-ray to confirm or rule out active TB disease of the lungs. If the x-ray is negative, the patient would take one daily antibiotic for nine months.

Anyone not considered a close contact of Centreville's TB student, but still concerned, may receive a TB skin test at a county Health Department clinic (one's at 1850 Cameron Glen Drive, Suite 100, in Reston) or request one from their doctor. Those with further questions may call the Health Department at 703-481-4242; ask for the nurse of the day.

"TB is a slow-growing bacteria so, even if a person acquires the infection, 90 percent of these individuals never develop the disease," said Karpick. "And only 25-30 percent of those exposed become infected."

He said the Centreville student "had a positive TB skin test, years ago, but a negative chest x-ray, so [the infection] was not treated. [He/she] at one time lived where people with TB coughed and [he/she] inhaled it. And for reasons which we don't wholly know, it again became active."

Besides weight loss and night sweats, he said, TB symptoms usually include a productive cough — bringing up sputum — for longer than three weeks, unexplained fever for several weeks, and chest pain or pleurisy — inflammation of the lung's outer surface.

Karpick said Centreville's student — whose cough started around Halloween — is receiving four antibiotics a day for at least eight weeks and will remain isolated until he/she is no longer coughing up TB germs on a sputum smear examined by a lab technician. "This has to happen three times over three days," he added.

He said TB usually has no long-lasting results and the student has an "excellent prognosis" and should recover completely. "About 5 percent of individuals get it again within two years, but 95 percent have no reoccurrence."

Meanwhile, Latt said Centreville's atmosphere is relaxed and parents have called to see if the student's family needs any help. The student is doing schoolwork at home and is eager to return when cleared by a doctor. "It's a very nice family and a very nice kid," she said. Added Karpick: "It's something we should be aware of, but not alarmed by, because [TB] can be easily handled."